The Bobath concept - a model to illustrate clinical practice.

PubMed

Michielsen, Marc; Vaughan-Graham, Julie; Holland, Ann; Magri, Alba; Suzuki, Mitsuo

2017-12-17

The model of Bobath clinical practice provides a framework identifying the unique aspects of the Bobath concept in terms of contemporary neurological rehabilitation. The utilisation of a framework to illustrate the clinical application of the Bobath concept provides the basis for a common understanding with respect to Bobath clinical practice, education, and research. The development process culminating in the model of Bobath clinical practice is described. The use of the model in clinical practice is illustrated using two cases: a client with a chronic incomplete spinal cord injury and a client with a stroke. This article describes the clinical application of the Bobath concept in terms of the integration of posture and movement with respect to the quality of task performance, applying the Model of Bobath Clinical Practice. Facilitation, a key aspect of Bobath clinical practice, was utilised to positively affect motor control and perception in two clients with impairment-related movement problems due to neurological pathology and associated activity limitations and participation restrictions - the outcome measures used to reflect the individual clinical presentation. Implications for Rehabilitation The model of Bobath clinical practice provides a framework identifying the unique aspects of the Bobath-concept. The model of Bobath clinical practice provides the basis for a common understanding with respect to Bobath clinical practice, education, and research. The clinical application of the Bobath-concept highlights the integration of posture and movement with respect to the quality of task performance. Facilitation, a key aspect of Bobath clinical practice, positively affects motor control, and perception.

The Use and Abuse of Diagnostic/Classification Criteria

PubMed Central

June, Rayford R.; Aggarwal, Rohit

2015-01-01

In rheumatic diseases, classification criteria have been developed to identify well-defined homogenous cohorts for clinical research. Although, they are commonly used in clinical practice, their use may not be appropriate for routine diagnostic clinical care. Classification criteria are being revised with improved methodology and further understanding of disease pathophysiology, but still may not encompass all unique clinical situations to be applied for diagnosis of heterogeneous, rare, evolving rheumatic diseases. Diagnostic criteria development is challenging primarily due to difficulty for universal application given significant differences in prevalence of rheumatic diseases based on geographical area and clinic settings. Despite these shortcomings, the clinician can still use classification criteria for understanding the disease as well as a guide for diagnosis with a few caveats. We present the limits of current classification criteria, describe their use and abuse in clinical practice, and how they should be used with caution when applied in clinics. PMID:26096094

Need assessment of enhancing the weightage of applied biochemistry in the undergraduate curriculum at MGIMS, sevagram.

PubMed

Kumar, Satish; Jena, Lingaraja; Vagha, Jayant

2016-05-06

In order to review the need assessment of enhancing the weightage of Applied Biochemistry in the undergraduate curriculum at Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, a validated questionnaire was sent to 453 participants which include 387 undergraduate students, 11 interns, 23 postgraduate students, and 32 faculty members. A web-based data collection and analysis tool was designed for online questionnaire distribution, data collection, and analysis. Response rate was 100%. Most of the respondents agreed that the subject Biochemistry has relevance in clinical practice (81.24%) and applied based learning of Biochemistry by medical undergraduates would help in overall improvement in the health standards/patients care (83.44%). According to 65.12% respondents, most of the medical undergraduates read Biochemistry just for examination purpose only. Nearly half of the respondents agreed that minute details of biochemical reactions were not much useful in clinical practice (53.86%) and the vast majority of diagrammatic cycles memorized by the medical undergraduates had no relevance in clinical practice (51.21%), the decreased interest in learning the Applied Biochemistry was due to more amount of clinically irrelevant information taught to medical undergraduates (73.51%), there was a need to rethink for removing the diagrammatic biochemical cycles from curriculum for medical undergraduates (48.12%), the less learning of Applied Biochemistry or competencies would affect the clinical skills and knowledge of medical undergraduates (70.42%). The result of this study suggests that there is need for restructuring the Biochemistry curriculum with more clinical relevance. © 2016 by The International Union of Biochemistry and Molecular Biology, 44:230-240, 2016. © 2016 The International Union of Biochemistry and Molecular Biology.

Applying self-determination theory for improved understanding of physiotherapists' rationale for using research in clinical practice: a qualitative study in Sweden.

PubMed

Dannapfel, Petra; Peolsson, Anneli; Ståhl, Christian; Öberg, Birgitta; Nilsen, Per

2014-01-01

Physiotherapists are generally positive to evidence-based practice (EBP) and the use of research in clinical practice, yet many still base clinical decisions on knowledge obtained during their initial education and/or personal experience. Our aim was to explore motivations behind physiotherapists' use of research in clinical practice. Self-Determination Theory was applied to identify the different types of motivation for use of research. This theory posits that all behaviours lie along a continuum of relative autonomy, reflecting the extent to which a person endorses their actions. Eleven focus group interviews were conducted, involving 45 physiotherapists in various settings in Sweden. Data were analysed using qualitative content analysis and the findings compared with Self-Determination Theory using a deductive approach. Motivations underlying physiotherapists use of research in clinical practice were identified. Most physiotherapists expressed autonomous forms of motivation for research use, but some exhibited more controlled motivation. Several implications about how more evidence-based physiotherapy can be achieved are discussed, including the potential to tailor educational programs on EBP to better account for differences in motivation among participants, using autonomously motivated physiotherapists as change agents and creating favourable conditions to encourage autonomous motivation by way of feelings of competence, autonomy and a sense of relatedness.

Tensions in learning professional identities - nursing students' narratives and participation in practical skills during their clinical practice: an ethnographic study.

PubMed

Ewertsson, Mona; Bagga-Gupta, Sangeeta; Allvin, Renée; Blomberg, Karin

2017-01-01

Clinical practice is a pivotal part of nursing education. It provides students with the opportunity to put the knowledge and skills they have acquired from lectures into practice with real patients, under the guidance of registered nurses. Clinical experience is also essential for shaping the nursing students' identity as future professional nurses. There is a lack of knowledge and understanding of the ways in which students learn practical skills and apply knowledge within and across different contexts, i.e. how they apply clinical skills, learnt in the laboratory in university settings, in the clinical setting. The aim of this study was therefore to explore how nursing students describe, and use, their prior experiences related to practical skills during their clinical practice. An ethnographic case study design was used. Fieldwork included participant observations (82 h), informal conversations, and interviews ( n  = 7) that were conducted during nursing students' ( n  = 17) clinical practice at an emergency department at a university hospital in Sweden. The overarching theme identified was "Learning about professional identities with respect to situated power". This encompasses tensions in students' learning when they are socialized into practical skills in the nursing profession. This overarching theme consists of three sub-themes: "Embodied knowledge", "Divergent ways of assessing and evaluating knowledge" and "Balancing approaches". Nursing students do not automatically possess the ability to transfer knowledge from one setting to another; rather, their development is shaped by their experiences and interactions with others when they meet real patients. The study revealed different ways in which students navigated tensions related to power differentials. Reflecting on actions is a prerequisite for developing and learning practical skills and professional identities. This highlights the importance of both educators' and the preceptors' roles for socializing students in this process.

[Use of PubMed to improve evidence-based medicine in routine urological practice].

PubMed

Rink, M; Kluth, L A; Shariat, S F; Chun, F K; Fisch, M; Dahm, P

2013-03-01

Applying evidence-based medicine in daily clinical practice is the basis of patient-centered medicine and knowledge of accurate literature acquisition skills is necessary for informed clinical decision-making. PubMed is an easy accessible, free bibliographic database comprising over 21 million citations from the medical field, life-science journals and online books. The article summarizes the effective use of PubMed in routine urological clinical practice based on a common case scenario. This article explains the simple use of PubMed to obtain the best search results with the highest evidence. Accurate knowledge about the use of PubMed in routine clinical practice can improve evidence-based medicine and also patient treatment.

[Knowledge and adherence to bio-safety measures and biological accidents by nursing students during their clinical practice].

PubMed

Merino-de la Hoz, Felicitas; Durá-Ros, María Jesús; Rodríguez-Martín, Elías; González-Gómez, Silvia; Mariano López-López, Luis; Abajas-Bustillo, Rebeca; de la Horra-Gutiérrez, Inmaculada

2010-01-01

To identify the degree of knowledge and performance of bio-safety measures by nursing students and knowing the type of biological accidents suffered during their clinical practice. A cross-sectional study was conducted on the students of three Nursing courses held in May of 2008. Data was collected by an anonymous self-administered questionnaire, with a return of 54%. A total of 97% of students seemed to know the standard biosafety measures, and all of them (100%) stated that those measures must be applied to every patient. However, the reality of clinical practice shows that biosafety measures are only partially applied. An average of 60.2% implement the personal hygiene measures, 66.1% use physical barriers, and 44% use sharp materials safely. Around 32.25% of the students have suffered some biological accident, with a greater incidence in the second year: administering injections (24%), drawing blood samples with Venojet needles (18%) and recapping used needles (17%). The high level of knowledge shown by the students on standard precautions is not always shown in clinical practice. There are significant deficiencies in student safety practices: recapping of used needles continues to be one of the most common risk practices carried out. Copyright (c) 2009 Elsevier España, S.L. All rights reserved.

Implications of utility and deontology for the clinical nurse specialist.

PubMed

Ayres, L

1989-01-01

Faced with prospective payment plans and personnel shortages nurses in advanced clinical practice are under pressure to find practical solutions. These solutions may reflect the institutional philosophy of utility rather than the traditional nursing ethic of deontology, illustrating the need to examine the differences between utilitarian and deontological principles as they affect nursing practice. This paper discusses deontology and utility as they apply to nursing practice, considers how these different philosophical positions may affect advanced practitioners, and describes the current status of ethics in nursing.

Talk in Interaction in the Speech-Language Pathology Clinic: Bringing Theory to Practice through Discourse

ERIC Educational Resources Information Center

Leaby, Margaret M.; Walsh, Irene P.

2008-01-01

The importance of learning about and applying clinical discourse analysis to enhance the talk in interaction in the speech-language pathology clinic is discussed. The benefits of analyzing clinical discourse to explicate therapy dynamics are described.

Leading clinical handover improvement: a change strategy to implement best practices in the acute care setting.

PubMed

Clarke, Christina M; Persaud, Drepaul David

2011-03-01

Many contemporary acute care facilities lack safe and effective clinical handover practices resulting in patient transitions that are vulnerable to discontinuities in care, medical errors, and adverse patient safety events. This article is intended to supplement existing handover improvement literature by providing practical guidance for leaders and managers who are seeking to improve the safety and the effectiveness of clinical handovers in the acute care setting. A 4-stage change model has been applied to guide the application of strategies for handover improvement. Change management and quality improvement principles, as well as concepts drawn from safety science and high-reliability organizations, were applied to inform strategies. A model for handover improvement respecting handover complexity is presented. Strategies targeted to stages of change include the following: 1. Enhancing awareness of handover problems and opportunities with the support of strategic directions, accountability, end user involvement, and problem complexity recognition. 2. Identifying solutions by applying and adapting best practices in local contexts. 3. Implementing locally adapted best practices supported by communication, documentation, and training. 4. Institutionalizing practice changes through integration, monitoring, and active dissemination. Finally, continued evaluation at every stage is essential. Although gaps in handover process and function knowledge remain, efforts to improve handover safety and effectiveness are still possible. Continued evaluation is critical in building this understanding and to ensure that practice changes lead to improvements in patient safety, organizational effectiveness, and patient and provider satisfaction. Through handover knowledge building, fundamental changes in handover policies and practices may be possible.

Physiotherapy as bricolage: theorizing expert practice.

PubMed

Shaw, James A; DeForge, Ryan T

2012-08-01

Theories about how knowledge is sought and applied in clinical practice are often referred to as practice epistemologies, and have not been extensively explored in the physiotherapy profession. Tacit assumptions about what counts as physiotherapy knowledge thus form the basis for many approaches to gaining and using information in practice. The purpose of this paper is to propose a physiotherapy practice epistemology, through the notion of the bricoleur, which takes an alternative approach to understanding how knowledge might best be viewed in relation to physiotherapy. The term bricoleur refers to a handyman or handywoman who uses all tools and types of knowledge available. The notion of physiotherapists as bricoleurs recognizes that all practice knowledge is situated within social, cultural, and historical contexts that shape our beliefs about what counts as physiotherapy knowledge. This recognition leads physiotherapists who act as bricoleurs to embrace multiple epistemologies, discovering new ways of knowing and clinical reasoning strategies to provide a more holistic approach to physiotherapy practice. The relationships between expertise in clinical reasoning and the epistemology of the bricoleur are then addressed, explicating the utility of multiple epistemologies in achieving excellent physiotherapy care. A bricoleur's epistemology is then applied to the concept of expertise in physiotherapy, de-stabilizing the notion that a single authoritative approach to the practice of physiotherapy ought to be idealized.

Panning for Gold: A Clinician's Guide to Using Research

ERIC Educational Resources Information Center

Williams, Lee M.; Patterson, Jo Ellen; Miller, Richard B.

2006-01-01

The gap between research and clinical practice is one of the key challenges facing family therapy. Clinicians often fail to incorporate research findings into their practice because they do not know how to search, evaluate, or apply research to their clinical work. The purpose of this article is to help clinicians become better consumers of…

The Effect of Problem-Based Learning in Nursing Education: A Meta-Analysis

ERIC Educational Resources Information Center

Shin, In-Soo; Kim, Jung-Hee

2013-01-01

Problem-based learning (PBL) has been identified as an approach that improves the training of nurses by teaching them how to apply theory to clinical practice and by developing their problem-solving skills, which could be used to overcome environmental constraints within clinical practice. A consensus is emerging that there is a need for…

The Medical Ethics Curriculum in Medical Schools: Present and Future.

PubMed

Giubilini, Alberto; Milnes, Sharyn; Savulescu, Julian

2016-01-01

In this review article we describe the current scope, methods, and contents of medical ethics education in medical schools in Western English speaking countries (mainly the United Kingdom, the United States, and Australia). We assess the strengths and weaknesses of current medical ethics curricula, and students' levels of satisfaction with different teaching approaches and their reported difficulties in learning medical ethics concepts and applying them in clinical practice. We identify three main challenges for medical ethics education: counteracting the bad effects of the "hidden curriculum," teaching students how to apply ethical knowledge and critical thinking to real cases in clinical practice, and shaping future doctors' right character through ethics education. We suggest ways in which these challenges could be addressed. On the basis of this analysis, we propose practical guidelines for designing, implementing, teaching, and assessing a medical ethics program within a four-year medical course. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.

Clinical practice guidelines in hypertension: a review.

PubMed

Álvarez-Vargas, Mayita Lizbeth; Galvez-Olortegui, José Kelvin; Galvez-Olortegui, Tomas Vladimir; Sosa-Rosado, José Manuel; Camacho-Saavedra, Luis Arturo

2015-10-23

The aim of this study is the methodological evaluation of Clinical Practice Guidelines (CPG) in hypertension. This is the first in a series of review articles, analysis, assessment in methodology and content of clinical practice guidelines in Cardiology. Of all clinical practice guidelines, three were selected and the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was used to assess each guide. The guidelines obtained the lowest score in the domain of applicability (mean 43.8%); while the highest score was for clarity of presentation (mean 81.5%). The lowest percentage was found in the applicability domain (European guideline) and the highest of all scores was found in two domains: scope and purpose, and clarity of presentation (Canadian guideline). Assessing the quality of the clinical practice guidelines analyzed, the Canadian is one with the best scores obtained by applying the AGREE II instrument, and it is advised to be used without modifications.

A clinical governance framework for blood services.

PubMed

Williamson, L M; Benjamin, R J; Devine, D V; Katz, L M; Pink, J

2015-05-01

The elements of clinical governance, which ensure excellence in clinical care, can be applied to blood services. In this survey, their application in a range of blood providers was gauged, with the aim of identifying best practice and producing a generalizable framework. The Medical Directors of members of the Alliance of Blood Operators surveyed how different elements of clinical governance operated within their organizations and developed recommendations applicable in the blood service environment. The recommendations that emerged highlighted the importance of an organization's culture, with the delivery of optimal clinical governance being a corporate responsibility. Senior management must agree and promote a set of values to ensure that the system operates with the patient and donor at its heart. All staff should understand how their role fits into the 'journey to the patient', and a culture of openness promoted. Thus, reporting of errors and risks should be actively sought and praised, with penalties applied for concealment. Systems should exist to collect, analyse and escalate clinical outcomes, safety data, clinical risk assessments, incident reports and complaints to inform organizational learning. Clinical governance principles from general health care can be applied within blood services to complement good manufacturing practice. This requires leadership, accountability, an open culture and a drive for continuous improvement and excellence in clinical care. © 2015 International Society of Blood Transfusion.

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

Transforming practice into clinical scholarship.

PubMed

Limoges, Jacqueline; Acorn, Sonia

2016-04-01

The aims of this paper were to explicate clinical scholarship as synonymous with the scholarship of application and to explore the evolution of scholarly practice to clinical scholarship. Boyer contributed an expanded view of scholarship that recognized various approaches to knowledge production beyond pure research (discovery) to include the scholarship of integration, application and teaching. There is growing interest in using Boyer's framework to advance knowledge production in nursing but the discussion of clinical scholarship in relation to Boyer's framework is sparse. Discussion paper. Literature from 1983-2015 and Boyer's framework. When clinical scholarship is viewed as a synonym for Boyer's scholarship of application, it can be aligned to this well established framework to support knowledge generated in clinical practice. For instance, applying the three criteria for scholarship (documentation, peer review and dissemination) can ensure that the knowledge produced is rigorous, available for critique and used by others to advance nursing practice and patient care. Understanding the differences between scholarly practice and clinical scholarship can promote the development of clinical scholarship. Supporting clinical leaders to identify issues confronting nursing practice can enable scholarly practice to be transformed into clinical scholarship. Expanding the understanding of clinical scholarship and linking it to Boyer's scholarship of application can assist nurses to generate knowledge that addresses clinical concerns. Further dialogue about how clinical scholarship can address the theory-practice gap and how publication of clinical scholarship could be expanded given the goals of clinical scholarship is warranted. © 2016 John Wiley & Sons Ltd.

Hyperinflated Lungs: What Does It Mean?

MedlinePlus

... breathe: The importance of lung hyperinflation in COPD. Primary Care Respiratory Journal. 2013;22:101. O'Donnell DE, et al. Lung hyperinflation in COPD: Applying physiology to clinical practice. COPD Research and Practice. 2015; ...

Identifying and applying psychological theory to setting and achieving rehabilitation goals.

PubMed

Scobbie, Lesley; Wyke, Sally; Dixon, Diane

2009-04-01

Goal setting is considered to be a fundamental part of rehabilitation; however, theories of behaviour change relevant to goal-setting practice have not been comprehensively reviewed. (i) To identify and discuss specific theories of behaviour change relevant to goal-setting practice in the rehabilitation setting. (ii) To identify 'candidate' theories that that offer most potential to inform clinical practice. The rehabilitation and self-management literature was systematically searched to identify review papers or empirical studies that proposed a specific theory of behaviour change relevant to setting and/or achieving goals in a clinical context. Data from included papers were extracted under the headings of: key constructs, clinical application and empirical support. Twenty-four papers were included in the review which proposed a total of five theories: (i) social cognitive theory, (ii) goal setting theory, (iii) health action process approach, (iv) proactive coping theory, and (v) the self-regulatory model of illness behaviour. The first three of these theories demonstrated most potential to inform clinical practice, on the basis of their capacity to inform interventions that resulted in improved patient outcomes. Social cognitive theory, goal setting theory and the health action process approach are theories of behaviour change that can inform clinicians in the process of setting and achieving goals in the rehabilitation setting. Overlapping constructs within these theories have been identified, and can be applied in clinical practice through the development and evaluation of a goal-setting practice framework.

Psychiatric mental health evidence-based practice.

PubMed

Rice, Michael J

2008-05-01

This article is the first in a new column focusing on evidence-based practice (EBP) in psychiatric mental health nursing. The EBP movement was strongly influenced by a British epidemiologist, Dr. Cochrane, who advocated care based on randomized clinical controlled trials in the late 1900s. Although the majority of the EBP movement is directed toward developing clinical guidelines, the critical element focuses on the therapeutic relationship and clinical judgment associated with providing care. This column will address a clinical problem, define PICO questions, report knowledge base searches, and present existing evidence. Recommendations will be offered for potential interventions and suggestions for evaluating clinical outcomes. Nurses can no longer view clinical studies as academic exercises discarded on graduation and not applied to the clinical setting. Conscientiously applying what is known about treatments and interventions of ethical, if not legal, value is consistent with the professional definition of care. J Am Psychiatr Nurses Assoc, 2008; 14(2), 107-111. DOI: 10.1177/1078390308315798.

Manifesto: towards a clinically-oriented psychometrics.

PubMed

Vickers, Andrew J; Chen, Ling Y

2017-04-26

New technologies to collect patient - reported outcomes have substantially solved the challenge of integrating a questionnaire in a busy clinical practice. At Memorial Sloan Kettering, we have been collecting patient reported outcomes electronically for many years. Our experience confirms the predicted benefits of obtaining patient reported outcomes but has also raised serious concerns about whether instruments developed for the research setting are appropriate for routine clinical use. We summarize four principles for a clinically - relevant psychometrics. First, minimize patient burden: the use of a large number of items for a single domain may be of interest for research but additional items have little clinical utility. Secondly, use simplified language: patients who do not have good language skills are typically excluded from research studies but will nonetheless present in clinical practice. Third, avoid dumb questions: many questionnaire items are inappropriate when applied to a more general population. Fourth, what works for the group may not work for the individual: group level statistics used to validate survey instruments can obscure problems when applied to a subgroup of patients. There is a need for a clinically-oriented psychometrics to help design, test, and evaluate questionnaires that would be used in routine practice. Developing statistical methods to optimize questionnaires will be highly challenging but needed to bring the potential of patient reported outcomes into widespread clinical use.

Mentoring in the Clinical Setting to Improve Student Decision-Making Competence

ERIC Educational Resources Information Center

Stick-Mueller, Misty; Boesch, Ron; Silverman, Steven; Carpenter, Scott; Illingworth, Robert; Countryman, James

2010-01-01

Introduction: The physician-intern relationship can be difficult to develop. A new chiropractic intern in a teaching clinic undergoes a major transition from classroom to clinical practice and must learn to turn classroom knowledge into clinical application. The ability to start formulating clinical techniques and apply them on a patient is…

Towards integration of health economics into medical education and clinical practice in Saudi Arabia.

PubMed

Da'ar, Omar B; Al Shehri, Ali M

2015-04-01

In an era of expanding health sectors and rising costs, doctors are expected to have a working knowledge of health economics to better use resources and improve outcomes and quality of health care. This article recognizes the dearth of knowledge and application of economic analyses in medical education and clinical practice in Saudi Arabia. In particular, it highlights the desirability of knowledge of health economics in ensuring certain competencies in medical education and the rationale for inviting doctors to apply knowledge of economics in Saudi Arabia. In addition, the article discusses challenges that hinder integrating health economics into clinical practice. Furthermore, the article typifies some of the important economic phenomena that physicians need to discern. Besides, the article provides implications for incorporating economic analysis into medical education and clinical practice in Saudi Arabia. Finally, the article concludes by demonstrating how health economics can enhance doctors' knowledge and recommends the country to move towards integrating health economics into medical education and clinical practice for best practice.

Connecting clinical and actuarial prediction with rule-based methods.

PubMed

Fokkema, Marjolein; Smits, Niels; Kelderman, Henk; Penninx, Brenda W J H

2015-06-01

Meta-analyses comparing the accuracy of clinical versus actuarial prediction have shown actuarial methods to outperform clinical methods, on average. However, actuarial methods are still not widely used in clinical practice, and there has been a call for the development of actuarial prediction methods for clinical practice. We argue that rule-based methods may be more useful than the linear main effect models usually employed in prediction studies, from a data and decision analytic as well as a practical perspective. In addition, decision rules derived with rule-based methods can be represented as fast and frugal trees, which, unlike main effects models, can be used in a sequential fashion, reducing the number of cues that have to be evaluated before making a prediction. We illustrate the usability of rule-based methods by applying RuleFit, an algorithm for deriving decision rules for classification and regression problems, to a dataset on prediction of the course of depressive and anxiety disorders from Penninx et al. (2011). The RuleFit algorithm provided a model consisting of 2 simple decision rules, requiring evaluation of only 2 to 4 cues. Predictive accuracy of the 2-rule model was very similar to that of a logistic regression model incorporating 20 predictor variables, originally applied to the dataset. In addition, the 2-rule model required, on average, evaluation of only 3 cues. Therefore, the RuleFit algorithm appears to be a promising method for creating decision tools that are less time consuming and easier to apply in psychological practice, and with accuracy comparable to traditional actuarial methods. (c) 2015 APA, all rights reserved).

[Integration of clinical and biological data in clinical practice using bioinformatics].

PubMed

Coltell, Oscar; Arregui, María; Fabregat, Antonio; Portolés, Olga

2008-05-01

The aim of our work is to describe essential aspects of Medical Informatics, Bioinformatics and Biomedical Informatics, that are used in biomedical research and clinical practice. These disciplines have emerged from the need to find new scientific and technical approaches to manage, store, analyze and report data generated in clinical practice and molecular biology and other medical specialties. It can be also useful to integrate research information generated in different areas of health care. Moreover, these disciplines are interdisciplinary and integrative, two key features not shared by other areas of medical knowledge. Finally, when Bioinformatics and Biomedical Informatics approach to medical investigation and practice are applied, a new discipline, called Clinical Bioinformatics, emerges. The latter requires a specific training program to create a new professional profile. We have not been able to find a specific training program in Clinical Bioinformatics in Spain.

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

PubMed

Zhang, Y; Liu, X J

2016-04-09

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.

Configurations of leadership practices in hospital units.

PubMed

Meier, Ninna

2015-01-01

The purpose of this paper is to explore how leadership is practiced across four different hospital units. The study is a comparative case study of four hospital units, based on detailed observations of the everyday work practices, interactions and interviews with ten interdisciplinary clinical managers. Comparing leadership as configurations of practices across four different clinical settings, the author shows how flexible and often shared leadership practices were embedded in and central to the core clinical work in all units studied here, especially in more unpredictable work settings. Practices of symbolic work and emotional support to staff were particularly important when patients were severely ill. Based on a study conducted with qualitative methods, these results cannot be expected to apply in all clinical settings. Future research is invited to extend the findings presented here by exploring leadership practices from a micro-level perspective in additional health care contexts: particularly the embedded and emergent nature of such practices. This paper shows leadership practices to be primarily embedded in the clinical work and often shared across organizational or professional boundaries. This paper demonstrated how leadership practices are embedded in the everyday work in hospital units. Moreover, the analysis shows how configurations of leadership practices varied in four different clinical settings, thus contributing with contextual accounts of leadership as practice, and suggested "configurations of practice" as a way to carve out similarities and differences in leadership practices across settings.

Communities of clinical practice: the social organization of clinical learning.

PubMed

Egan, Tony; Jaye, Chrystal

2009-01-01

The social organization of clinical learning is under-theorized in the sociological literature on the social organization of health care. Professional scopes of practice and jurisdictions are formally defined by professional principles and standards and reflected in legislation; however, these are mediated through the day-to-day clinical activities of social groupings of clinical teams. The activities of health service providers typically occur within communities of clinical practice. These are also major sites for clinical curriculum delivery, where clinical students learn not only clinical skills but also how to be health professionals. In this article, we apply Wenger's model of social learning within organizations to curriculum delivery within a health service setting. Here, social participation is the basis of learning. We suggest that it offers a powerful framework for recognizing and explaining paradox and incongruence in clinical teaching and learning, and also for recognizing opportunities, and devising means, to add value to students' learning experiences.

Bridging the Gap between Research and Clinical Practice in Asymptomatic Alzheimer's Disease.

PubMed

Downing, A M; Yaari, R; Ball, D E; Selzler, K J; Devous, M D

2016-01-01

Due to the growing global health impact of Alzheimer's disease (AD), there is a greater need for interventions that prevent or delay the onset of clinical symptoms of this debilitating disease. Clinical trials for disease-modifying compounds in AD have shifted towards earlier stages in the spectrum of illness, including the stage prior to cognitive symptoms. A population of specific interest for clinical research includes individuals with evidence of Alzheimer's disease pathology who are asymptomatic (ADPa). The challenges and barriers regarding medical treatment of ADPa must be identified and addressed prior to the completion of a positive clinical trial in order to accelerate the translation of research findings to clinical practice. This report applies an existing public health impact model from Spencer and colleagues (2013) to evaluate the readiness of the clinical practice environment to treat ADPa individuals if a disease-modifying agent achieves approval. We contrast the current clinical practice environment with a potential future state through investigating the effectiveness, reach, feasibility, sustainability, and transferability of the practice of treating ADPa individuals.

Implementation Science Supports Core Clinical Competencies: An Overview and Clinical Example.

PubMed

Kirchner, JoAnn E; Woodward, Eva N; Smith, Jeffrey L; Curran, Geoffrey M; Kilbourne, Amy M; Owen, Richard R; Bauer, Mark S

2016-12-08

Instead of asking clinicians to work faster or longer to improve quality of care, implementation science provides another option. Implementation science is an emerging interdisciplinary field dedicated to studying how evidence-based practice can be adopted into routine clinical care. This article summarizes principles and methods of implementation science, illustrates how they can be applied in a routine clinical setting, and highlights their importance to practicing clinicians as well as clinical trainees. A hypothetical clinical case scenario is presented that explains how implementation science improves clinical practice. The case scenario is also embedded within a real-world implementation study to improve metabolic monitoring for individuals prescribed antipsychotics. Context, recipient, and innovation (ie, the evidence-based practice) factors affected improvement of metabolic monitoring. To address these factors, an external facilitator and a local quality improvement team developed an implementation plan involving a multicomponent implementation strategy that included education, performance reports, and clinician follow-up. The clinic remained compliant with recommended metabolic monitoring at 1-year follow up. Implementation science improves clinical practice by addressing context, recipient, and innovation factors and uses this information to develop and utilize specific strategies that improve clinical practice. It also enriches clinical training, aligning with core competencies by the Accreditation Council for Graduate Medical Education and American Boards of Medical Specialties. By learning how to change clinical practice through implementation strategies, clinicians are more able to adapt in complex systems of practice. © Copyright 2016 Physicians Postgraduate Press, Inc.

A Clinician-Centered Evaluation of the Usability of AHLTA and Automated Clinical Practice Guidelines at TAMC

DTIC Science & Technology

2011-03-31

evidence based medicine into clinical practice. It will decrease costs and enable multiple stakeholders to work in an open content/source environment to exchange clinical content, develop and test technology and explore processes in applied CDS. Design: Comparative study between the KMR infrastructure and capabilities developed as an open source, vendor agnostic solution for aCPG execution within AHLTA and the current DoD/MHS standard evaluating: H1: An open source, open standard KMR and Clinical Decision Support Engine can enable organizations to share domain

Competency in health care management: a training model in epidemiologic methods for assessing and improving the quality of clinical practice through evidence-based decision making.

PubMed

Hudak, R P; Jacoby, I; Meyer, G S; Potter, A L; Hooper, T I; Krakauer, H

1997-01-01

This article describes a training model that focuses on health care management by applying epidemiologic methods to assess and improve the quality of clinical practice. The model's uniqueness is its focus on integrating clinical evidence-based decision making with fundamental principles of resource management to achieve attainable, cost-effective, high-quality health outcomes. The target students are current and prospective clinical and administrative executives who must optimize decision making at the clinical and managerial levels of health care organizations.

[Application of role-play simulation in pre-clinical practice of the fourth grade students in department of endodontics].

PubMed

Zhu, Lin-lin; Qiu, Li-hong; Qu, Liu; Xue, Ming; Yan, Lu

2014-10-01

To apply role- play simulation in pre-clinical practice of the fourth grade students in department of endodontics. Thirty-two students were randomly divided into 2 groups, there were 16 students in each group. Students in one group were taught with role-play simulation while the other group with lecture-based learning method. The teaching effect was measured with examination and questionnaire survey. The data was analyzed by using SPSS 17.0 software package. There were no significant differences in basic knowledge, case analysis and oral examination between 2 groups (P>0.05), but there was significant difference in history taking and medical records writing, practical examination and total scores between 2 groups (P<0.05). The role-play simulation was generally approved by both teachers and students in experimental group. The abilities of the fourth grade students can be developed by role-play simulation in different aspects. Role-play simulation can be applied in pre-clinical practice of the fourth grade students in department of endodontics.

Mapping Evidence-Based Treatments for Children and Adolescents: Application of the Distillation and Matching Model to 615 Treatments from 322 Randomized Trials

ERIC Educational Resources Information Center

Chorpita, Bruce F.; Daleiden, Eric L.

2009-01-01

This study applied the distillation and matching model to 322 randomized clinical trials for child mental health treatments. The model involved initial data reduction of 615 treatment protocol descriptions by means of a set of codes describing discrete clinical strategies, referred to as practice elements. Practice elements were then summarized in…

[The quality of epidemiological research on pediatric refractive error and amblyopia in China needs to be improved].

PubMed

He, M G

2017-01-11

Over the past decade, great progress has been made in the clinical and epidemiological studies on refractive error and amblyopia in children with research findings published in international peer reviewed journals. This article reviews some of the essential publications so that the research findings could be learnt extensively, understood critically and objectively, and applied effectively to clinical practice. We aim to address the current limitations and shed light on clinical practice. (Chin J Ophthalmol, 2017, 53: 3-6) .

Thinking in clinical nursing practice: a study of critical care nurses' thinking applying the think-aloud, protocol analysis method.

PubMed

Han, Kyung-Ja; Kim, Hesook Suzie; Kim, Mae-Ja; Hong, Kyung-Ja; Park, Sungae; Yun, Soon-Nyoung; Song, Misoon; Jung, Yoenyi; Kim, Haewon; Kim, Dong-Oak Debbie; Choi, Heejung; Kim, Kyungae

2007-06-01

The purpose of the paper is to discover the patterns and processes of decision-making in clinical nursing practice. A set of think-aloud data from five critical care nurses during 40 to 50 minutes of caregiving in intensive care units were obtained and analyzed by applying the procedures recommended by Ericsson and Simon for protocol analysis. Four thinking processes before acting were identified to constitute various sorts of thoughts in which the nurses were engaged during patient care: reviewing, validation, consideration, rationalization, and action. In addition, three patterns of sequential streaming of thinking (short, intermediate, long) were identified to reveal various ways the nurses dealt with clinical situations involving nursing tasks and responsibilities. This study specifies the initial categories of thoughts for each of the processes and various patterns with which these processes are sequentially combined, providing insights into the ways nurses think about problems and address their concerns. The findings suggest that the thinking in clinical practice involves more than focused decision-making and reasoning, and needs to be examined from a broader perspective.

Varieties of clinical reasoning.

PubMed

Bolton, Jonathan W

2015-06-01

Clinical reasoning comprises a variety of different modes of inference. The modes that are practiced will be influenced by the sociological characteristics of the clinical settings and the tasks to be performed by the clinician. This article presents C.S. Peirce's typology of modes of inference: deduction, induction and abduction. It describes their differences and their roles as stages in scientific argument. The article applies the typology to reasoning in clinical settings. The article describes their differences, and their roles as stages in scientific argument. It then applies the typology to reasoning in typical clinical settings. Abduction is less commonly taught or discussed than induction and deduction. However, it is a common mode of inference in clinical settings, especially when the clinician must try to make sense of a surprising phenomenon. Whether abduction is followed up with deductive and inductive verification is strongly influenced by situational constraints and the cognitive and psychological stamina of the clinician. Recognizing the inevitability of abduction in clinical practice and its value to discovery is important to an accurate understanding of clinical reasoning. © 2015 John Wiley & Sons, Ltd.

National data elements for the clinical management of acute coronary syndromes.

PubMed

Chew, Derek P B; Allan, Roger M; Aroney, Constantine N; Sheerin, Noella J

2005-05-02

Patients with acute coronary syndromes represent a clinically diverse group and their care remains heterogeneous. These patients account for a significant burden of morbidity and mortality in Australia. Optimal patient outcomes depend on rapid diagnosis, accurate risk stratification and the effective implementation of proven therapies, as advocated by clinical guidelines. The challenge is in effectively applying evidence in clinical practice. Objectivity and standardised quantification of clinical practice are essential in understanding the evidence-practice gap. Observational registries are key to understanding the link between evidence-based medicine, clinical practice and patient outcome. Data elements for monitoring clinical management of patients with acute coronary syndromes have been adapted from internationally accepted definitions and incorporated into the National Health Data Dictionary, the national standard for health data definitions in Australia. Widespread use of these data elements will assist in the local development of "quality-of-care" initiatives and performance indicators, facilitate collaboration in cardiovascular outcomes research, and aid in the development of electronic data collection methods.

[Evidence-based medicine: the art of applying scientific knowledge in clinical practice].

PubMed

Lopes, A A

2000-01-01

This article was written with the objective of describing the concept of Evidence Based Medicine (EBM) and the competences required for its practice. EBM should be viewed as an integration of clinical experience with the ability to analyze and rationally apply the scientific information while taking care of patients. The application of methods and strategies to enhance the scientific background of the physician while taking into account the humanitarian values of the medical profession should contribute to improve the quality of the medical care that is offered in Brazil. The Medical Schools and Associations may play important roles in the promotion of EBM.

Does social marketing provide a framework for changing healthcare practice?

PubMed

Morris, Zoë Slote; Clarkson, Peter John

2009-07-01

We argue that social marketing can be used as a generic framework for analysing barriers to the take-up of clinical guidelines, and planning interventions which seek to enable this change. We reviewed the literature on take-up of clinical guidelines, in particular barriers and enablers to change; social marketing principles and social marketing applied to healthcare. We then applied the social marketing framework to analyse the literature and to consider implications for future guideline policy to assess its feasibility and accessibility. There is sizeable extant literature on healthcare practitioners' non-compliance with clinical guidelines. This is an international problem common to a number of settings. The reasons for poor levels of take up appear to be well understood, but not addressed adequately in practice. Applying a social marketing framework brings new insights to the problem." We show that a social marketing framework provides a useful solution-focused framework for systematically understanding barriers to individual behaviour change and designing interventions accordingly. Whether the social marketing framework provides an effective means of bringing about behaviour change remains an empirical question which has still to be tested in practice. The analysis presented here provides strong motivation to begin such testing.

Applying risk adjusted cost-effectiveness (RAC-E) analysis to hospitals: estimating the costs and consequences of variation in clinical practice.

PubMed

Karnon, Jonathan; Caffrey, Orla; Pham, Clarabelle; Grieve, Richard; Ben-Tovim, David; Hakendorf, Paul; Crotty, Maria

2013-06-01

Cost-effectiveness analysis is well established for pharmaceuticals and medical technologies but not for evaluating variations in clinical practice. This paper describes a novel methodology--risk adjusted cost-effectiveness (RAC-E)--that facilitates the comparative evaluation of applied clinical practice processes. In this application, risk adjustment is undertaken with a multivariate matching algorithm that balances the baseline characteristics of patients attending different settings (e.g., hospitals). Linked, routinely collected data are used to analyse patient-level costs and outcomes over a 2-year period, as well as to extrapolate costs and survival over patient lifetimes. The study reports the relative cost-effectiveness of alternative forms of clinical practice, including a full representation of the statistical uncertainty around the mean estimates. The methodology is illustrated by a case study that evaluates the relative cost-effectiveness of services for patients presenting with acute chest pain across the four main public hospitals in South Australia. The evaluation finds that services provided at two hospitals were dominated, and of the remaining services, the more effective hospital gained life years at a low mean additional cost and had an 80% probability of being the most cost-effective hospital at realistic cost-effectiveness thresholds. Potential determinants of the estimated variation in costs and effects were identified, although more detailed analyses to identify specific areas of variation in clinical practice are required to inform improvements at the less cost-effective institutions. Copyright © 2012 John Wiley & Sons, Ltd.

Research into practice: Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Nottinghamshire, Derbyshire, Lincolnshire (NDL).

PubMed

Rowley, Emma; Morriss, Richard; Currie, Graeme; Schneider, Justine

2012-05-03

To address the problem of translation from research-based evidence to routine healthcare practice, the Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire, and Lincolnshire (CLAHRC-NDL) was funded by the National Institute for Health Research as one of nine CLAHRCs across England. This paper outlines the underlying theory and its application that CLAHRC-NDL has adopted, as a case example that might be generalised to practice outside the CLAHRC, in comparison to alternative models of implementation. Conventional approaches to health research frequently generate evidence in isolation from the environment in which it is intended for use. The premise of the CLAHRC-NDL model is that barriers to implementation can be overcome if knowledge is co-produced by academic and clinical service staff, taking account of the organisational context in which it is to be applied. This approach is founded on organisational learning theory, recognising that change is a social and political phenomenon. Evidence is produced in real time, taking full account of the environment in which it is to be implemented. To support this process, senior health service staff are seconded to the CLAHRC as 'diffusion fellows' (DFs) to actively bridge the research to practice gap by being a full member of both the research team and their area of clinical practice. To facilitate innovation and embed change in the local health community, existing communities of practice are enhanced and new ones are fostered around specific themes. Our approach has been adopted by 16 clinical research studies in the areas of mental health, children and young people, primary care, and stroke rehabilitation. The CLAHRC-NDL model of implementation applies organisational learning theory by addressing the social and situational barriers and enablers to implementation, and adopting a philosophy of co-production. Two key mechanisms for translation of innovation have been utilised: DFs, to actively bridge the research to practice gap, and communities of practice, to underpin and sustain improvements in healthcare. The model shows promising results in putting research into practice, which may be transferable to other healthcare contexts.

Research into practice: Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Nottinghamshire, Derbyshire, Lincolnshire (NDL)

PubMed Central

2012-01-01

Background To address the problem of translation from research-based evidence to routine healthcare practice, the Collaboration for Leadership in Applied Health Research and Care for Nottinghamshire, Derbyshire, and Lincolnshire (CLAHRC-NDL) was funded by the National Institute for Health Research as one of nine CLAHRCs across England. This paper outlines the underlying theory and its application that CLAHRC-NDL has adopted, as a case example that might be generalised to practice outside the CLAHRC, in comparison to alternative models of implementation. Discussion Conventional approaches to health research frequently generate evidence in isolation from the environment in which it is intended for use. The premise of the CLAHRC-NDL model is that barriers to implementation can be overcome if knowledge is co-produced by academic and clinical service staff, taking account of the organisational context in which it is to be applied. This approach is founded on organisational learning theory, recognising that change is a social and political phenomenon. Evidence is produced in real time, taking full account of the environment in which it is to be implemented. To support this process, senior health service staff are seconded to the CLAHRC as ‘diffusion fellows’ (DFs) to actively bridge the research to practice gap by being a full member of both the research team and their area of clinical practice. To facilitate innovation and embed change in the local health community, existing communities of practice are enhanced and new ones are fostered around specific themes. Our approach has been adopted by 16 clinical research studies in the areas of mental health, children and young people, primary care, and stroke rehabilitation. Summary The CLAHRC-NDL model of implementation applies organisational learning theory by addressing the social and situational barriers and enablers to implementation, and adopting a philosophy of co-production. Two key mechanisms for translation of innovation have been utilised: DFs, to actively bridge the research to practice gap, and communities of practice, to underpin and sustain improvements in healthcare. The model shows promising results in putting research into practice, which may be transferable to other healthcare contexts. PMID:22553966

Safe clinical practice for patients hospitalised in a suicidal crisis: a study protocol for a qualitative case study

PubMed Central

Berg, Siv Hilde; Rørtveit, Kristine; Walby, Fredrik A; Aase, Karina

2017-01-01

Introduction Suicide prevention in psychiatric care is arguably complex and incompletely understood as a patient safety issue. A resilient healthcare approach provides perspectives through which to understand this complexity by understanding everyday clinical practice. By including suicidal patients and healthcare professionals as sources of knowledge, a deeper understanding of what constitutes safe clinical practice can be achieved. Methods This planned study aims to adopt the perspective of resilient healthcare to provide a deeper understanding of safe clinical practice for suicidal patients in psychiatric inpatient care. It will describe the experienced components and conditions of safe clinical practice and the experienced practice of patient safety. The study will apply a descriptive case study approach consisting of qualitative semistructured interviews and focus groups. The data sources are hospitalised patients in a suicidal crisis and healthcare professionals in clinical practice. Ethics and dissemination This study was approved by the Regional Ethics Committee (2016/34). The results will be disseminated through scientific articles, a PhD dissertation, and national and international conferences. These findings can generate knowledge to be integrated into the practice of safety for suicidal inpatients in Norway and to improve the feasibility of patient safety measures. Theoretical generalisations can be drawn regarding safe clinical practice by taking into account the experiences of patients and healthcare professionals. Thus, this study can inform the conceptual development of safe clinical practice for suicidal patients. PMID:28132001

The role of clinician emotion in clinical reasoning: Balancing the analytical process.

PubMed

Langridge, Neil; Roberts, Lisa; Pope, Catherine

2016-02-01

This review paper identifies and describes the role of clinicians' memory, emotions and physical responses in clinical reasoning processes. Clinical reasoning is complex and multi-factorial and key models of clinical reasoning within musculoskeletal physiotherapy are discussed, highlighting the omission of emotion and subsequent physical responses and how these can impact upon a clinician when making a decision. It is proposed that clinicians should consider the emotions associated with decision-making, especially when there is concern surrounding a presentation. Reflecting on practice in the clinical environment and subsequently applying this to a patient presentation should involve some acknowledgement of clinicians' physical responses, emotions and how they may play a part in any decision made. Presenting intuition and gut-feeling as separate reasoning methods and how these processes co-exist with other more accepted reasoning such as hypothetico-deductive is also discussed. Musculoskeletal physiotherapy should consider the elements of feelings, emotions and physical responses when applying reflective practice principles. Furthermore, clinicians dealing with difficult and challenging presentations should look at the emotional as well as the analytical experience when justifying decisions and learning from practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

Clinical pharmacokinetics: perceptions of hospital pharmacists in Qatar about how it was taught and how it is applied.

PubMed

Kheir, Nadir; Awaisu, Ahmed; Gad, Hoda; Elazzazy, Shereen; Jibril, Farah; Gajam, Mawadda

2015-12-01

The application of clinical pharmacokinetics (PK) is essential when providing pharmaceutical care. Appropriate application of PK monitoring results in improved patient outcomes including decreased mortality, length of treatment, length of hospital stay, and adverse effects of drug therapy. Despite the well-documented evidence of benefits of clinical PK services, many pharmacists find it challenging to apply PK in clinical practice. To evaluate pharmacists' training backgrounds, attitude, practices, and perceived barriers pertaining to the application of PK in clinical practice in Qatar. All hospitals under Hamad Medical Corporation, the main healthcare provider in Qatar. This was a cross-sectional, descriptive study that was conducted between October 2012 and January 2013, using a self-administered web-based survey. Pharmacists were eligible to participate if they: (1) were working as full-time hospital pharmacists and; (2) have been in practice for at least 1 year. PK contents learned in undergraduate curriculum; perception towards the PK contents and instructions received in the undergraduate curriculum and; application of PK in current clinical practice. A total of 112 pharmacists responded to the questionnaire. The majority of the respondents (n = 91; 81.3 %) reported that they had received PK course(s) in their undergraduate curriculum. Similarly, the majority (70-80 %) of them agreed that the undergraduate PK courses or contents they received were important and relevant to their current practice. The pharmacists identified spending more time on dispensing and inventory issues rather than clinical practice, scarce resources, and manual rather than computerized PK calculations as some of the barriers they encountered in learning about PK and its application. The characteristics of the surveyed pharmacists such as gender, age, highest academic degree, and country of graduation did not influence the pharmacists' perception and attitudes towards PK teaching and application (p > 0.05). PK course contents were perceived to lack depth and relevance to practice, and pharmacist had no experiential training that included aspects of PK. These, and other issues, result in poor application of PK in practice.

Applying openEHR's Guideline Definition Language to the SITS international stroke treatment registry: a European retrospective observational study.

PubMed

Anani, Nadim; Mazya, Michael V; Chen, Rong; Prazeres Moreira, Tiago; Bill, Olivier; Ahmed, Niaz; Wahlgren, Nils; Koch, Sabine

2017-01-10

Interoperability standards intend to standardise health information, clinical practice guidelines intend to standardise care procedures, and patient data registries are vital for monitoring quality of care and for clinical research. This study combines all three: it uses interoperability specifications to model guideline knowledge and applies the result to registry data. We applied the openEHR Guideline Definition Language (GDL) to data from 18,400 European patients in the Safe Implementation of Treatments in Stroke (SITS) registry to retrospectively check their compliance with European recommendations for acute stroke treatment. Comparing compliance rates obtained with GDL to those obtained by conventional statistical data analysis yielded a complete match, suggesting that GDL technology is reliable for guideline compliance checking. The successful application of a standard guideline formalism to a large patient registry dataset is an important step toward widespread implementation of computer-interpretable guidelines in clinical practice and registry-based research. Application of the methodology gave important results on the evolution of stroke care in Europe, important both for quality of care monitoring and clinical research.

Exploring the scope of expanding advanced nursing practice in nurse-led clinics: a multiple-case study.

PubMed

Shiu, Ann T Y; Lee, Diana T F; Chau, Janita P C

2012-08-01

This article is a report on a study to explore the development of expanding advanced nursing practice in nurse-led clinics in Hong Kong. Nurse-led clinics serviced by advanced practice nurses, a common international practice, have been adopted in Hong Kong since 1990s. Evaluations consistently show that this practice has good clinical outcomes and contributes to containing healthcare cost. However, similar to the international literature, it remains unclear as to what the elements of good advanced nursing practice are, and which directions Hong Kong should adopt for further development of such practice. A multiple-case study design was adopted with six nurse-led clinics representing three specialties as six case studies, and including two clinics each from continence, diabetes and wound care. Each case had four embedded units of analysis. They included non-participant observation of nursing activities (9 days), nurse interviews (N = 6), doctor interviews (N = 6) and client interviews (N = 12). The data were collected in 2009. Within- and cross-case analyses were conducted. The cross-case analysis demonstrated six elements of good advanced nursing practice in nurse-led clinics, and showed a great potential to expand the practice by reshaping four categories of current boundaries, including community-hospital, wellness-illness, public-private and professional-practice boundaries. From these findings, we suggest a model to advance the scope of advanced nursing practice in nurse-led clinics. The six elements may be applied as audit criteria for evaluation of advanced nursing practice in nurse-led clinics, and the proposed model provides directions for expanding such practice in Hong Kong and beyond. © 2011 Blackwell Publishing Ltd.

Analysis of adverse events as a contribution to safety culture in the context of practice development

PubMed

Hoffmann, Susanne; Frei, Irena Anna

2017-01-01

Background: Analysing adverse events is an effective patient safety measure. Aim: We show, how clinical nurse specialists have been enabled to analyse adverse events with the „Learning from Defects-Tool“ (LFD-Tool). Method: Our multi-component implementation strategy addressed both, the safety knowledge of clinical nurse specialists and their attitude towards patient safety. The culture of practice development was taken into account. Results: Clinical nurse specialists relate competency building on patient safety due to the application of the LFD-tool. Applying the tool, fosters the reflection of adverse events in care teams. Conclusion: Applying the „Learning from Defects-Tool“ promotes work-based learning. Analysing adverse events with the „Learning from Defects-Tool“ contributes to the safety culture in a hospital.

Cross-sectional study to examine evidence-based practice skills and behaviors of physical therapy graduates: is there a knowledge-to-practice gap?

PubMed

Manns, Patricia J; Norton, Amy V; Darrah, Johanna

2015-04-01

Curricula changes in physical therapist education programs in Canada emphasize evidence-based practice skills, including literature retrieval and evaluation. Do graduates use these skills in practice? The aim of this study was to evaluate the use of research information in the clinical decision making of therapists with different years of experience and evidence-based practice preparation. Perceptions about evidence-based practice were explored qualitatively. A cross-sectional study with 4 graduating cohorts was conducted. Eighty physical therapists representing 4 different graduating cohorts participated in interviews focused on 2 clinical scenarios. Participants had varying years of clinical experience (range=1-15 years) and academic knowledge of evidence-based practice skills. Therapists discussed the effectiveness of interventions related to the scenarios and identified the sources of information used to reach decisions. Participants also answered general questions related to evidence-based practice knowledge. Recent graduates demonstrated better knowledge of evidence-based practice skills compared with therapists with 6 to 15 years of clinical experience. However, all groups used clinical experience most frequently as their source of information for clinical decisions. Research evidence was infrequently included in decision making. This study used a convenience sample of therapists who agreed to volunteer for the study. The results suggest a knowledge-to-practice gap; graduates are not using the new skills to inform their practice. Tailoring academic evidence-based activities more to the time constraints of clinical practice may help students to be more successful in applying evidence in practice. Academic programs need to do more to create and nurture environments in both academic and clinical settings to ensure students practice using evidence-based practice skills across settings. © 2015 American Physical Therapy Association.

Evidence-Based Best Practices for Outpatient Management of Warfarin.

PubMed

Rose, Adam J; Vaiana, Mary

2018-06-01

Many best practices have been described for organizing a clinic to manage warfarin. Although these practices may have face validity, they may not be based on empirical analysis. Here, we describe our decade-long effort to apply the Structure-Process-Outcome model of quality measurement as a basis for measuring and improving outpatient warfarin management in the Veterans Health Administration. The purpose of the article is to raise awareness of this body of work with pharmacists who could potentially incorporate the findings of this work into their own practice settings. We conclude with concrete suggestions for immediate implementation in clinical settings.

From school to work: promoting the application of pre-qualification interprofessional education in the clinical workplace.

PubMed

Murray-Davis, Beth; Marshall, Michelle; Gordon, Frances

2012-09-01

The rationale for Interprofessional Education (IPE) is based on the assumption it will improve practice. Despite evidence that it may modify attitudes and provide knowledge and skills for collaboration, there is little evidence about whether these skills can be transferred to practice. The aim of this research was to explore how midwifery students apply pre-qualification IPE learning to practice and to understand the factors in the clinical workplace that facilitate or hinder this application. A purposive sample of students, educators, Heads of Midwifery and new midwives from four universities throughout the United Kingdom participated in semi-structured interviews and focus groups. Emerging themes were developed using the principles of Grounded Theory. Participants articulated ways in which the clinical environment either promoted or prevented IPE in practice. The extent to which the clinical institution promoted IPE was made visible through the support for students during placements; the support for new midwives; and the evolution of professional roles. Buy-in for the IPE agenda in the workplace influences the ability of new midwives to apply IPE competencies to professional practice. The benefits of a theoretical foundation in interprofessional skills may be lost if students and new midwives find themselves working in contexts that do not make collaboration a priority. Copyright © 2011 Elsevier Ltd. All rights reserved.

The predictive validity of selection for entry into postgraduate training in general practice: evidence from three longitudinal studies

PubMed Central

Patterson, Fiona; Lievens, Filip; Kerrin, Máire; Munro, Neil; Irish, Bill

2013-01-01

Background The selection methodology for UK general practice is designed to accommodate several thousand applicants per year and targets six core attributes identified in a multi-method job-analysis study Aim To evaluate the predictive validity of selection methods for entry into postgraduate training, comprising a clinical problem-solving test, a situational judgement test, and a selection centre. Design and setting A three-part longitudinal predictive validity study of selection into training for UK general practice. Method In sample 1, participants were junior doctors applying for training in general practice (n = 6824). In sample 2, participants were GP registrars 1 year into training (n = 196). In sample 3, participants were GP registrars sitting the licensing examination after 3 years, at the end of training (n = 2292). The outcome measures include: assessor ratings of performance in a selection centre comprising job simulation exercises (sample 1); supervisor ratings of trainee job performance 1 year into training (sample 2); and licensing examination results, including an applied knowledge examination and a 12-station clinical skills objective structured clinical examination (OSCE; sample 3). Results Performance ratings at selection predicted subsequent supervisor ratings of job performance 1 year later. Selection results also significantly predicted performance on both the clinical skills OSCE and applied knowledge examination for licensing at the end of training. Conclusion In combination, these longitudinal findings provide good evidence of the predictive validity of the selection methods, and are the first reported for entry into postgraduate training. Results show that the best predictor of work performance and training outcomes is a combination of a clinical problem-solving test, a situational judgement test, and a selection centre. Implications for selection methods for all postgraduate specialties are considered. PMID:24267856

The predictive validity of selection for entry into postgraduate training in general practice: evidence from three longitudinal studies.

PubMed

Patterson, Fiona; Lievens, Filip; Kerrin, Máire; Munro, Neil; Irish, Bill

2013-11-01

The selection methodology for UK general practice is designed to accommodate several thousand applicants per year and targets six core attributes identified in a multi-method job-analysis study To evaluate the predictive validity of selection methods for entry into postgraduate training, comprising a clinical problem-solving test, a situational judgement test, and a selection centre. A three-part longitudinal predictive validity study of selection into training for UK general practice. In sample 1, participants were junior doctors applying for training in general practice (n = 6824). In sample 2, participants were GP registrars 1 year into training (n = 196). In sample 3, participants were GP registrars sitting the licensing examination after 3 years, at the end of training (n = 2292). The outcome measures include: assessor ratings of performance in a selection centre comprising job simulation exercises (sample 1); supervisor ratings of trainee job performance 1 year into training (sample 2); and licensing examination results, including an applied knowledge examination and a 12-station clinical skills objective structured clinical examination (OSCE; sample 3). Performance ratings at selection predicted subsequent supervisor ratings of job performance 1 year later. Selection results also significantly predicted performance on both the clinical skills OSCE and applied knowledge examination for licensing at the end of training. In combination, these longitudinal findings provide good evidence of the predictive validity of the selection methods, and are the first reported for entry into postgraduate training. Results show that the best predictor of work performance and training outcomes is a combination of a clinical problem-solving test, a situational judgement test, and a selection centre. Implications for selection methods for all postgraduate specialties are considered.

From Theory to Practice: An Illustrative Case for Selecting Evidence-Based Practices and Building Implementation Capacity in Three Canadian Health Jurisdictions

ERIC Educational Resources Information Center

Duda, Michelle A.; Riopelle, Richard J.; Brown, Jacquie

2013-01-01

Using principles of Applied Implementation Science, this paper examines strategies for systematically selecting and operationalising National clinical practice guidelines and intentionally creating implementation supports to ensure high fidelity use and sustainable application and outcomes. In the spirit of participatory action research, key…

Caught between a rock and a hard place: An intrinsic single case study of nurse researchers' experiences of the presence of a nursing research culture in clinical practice.

PubMed

Berthelsen, Connie Bøttcher; Hølge-Hazelton, Bibi

2018-04-01

To explore how nurse researchers in clinical positions experience the presence of a nursing research culture in clinical practice. Higher demands in the hospitals for increasing the quality of patient care engender a higher demand for the skills of health professionals and evidence-based practice. However, the utilisation of nursing research in clinical practice is still limited. Intrinsic single case study design underlined by a constructivist perspective. Data were produced through a focus group interview with seven nurse researchers employed in clinical practice in two university hospitals in Zealand, Denmark, to capture the intrinsic aspects of the concept of nursing research culture in the context of clinical practice. A thematic analysis was conducted based on Braun and Clarke's theoretical guideline. "Caught between a rock and a hard place" was constructed as the main theme describing how nurse researchers in clinical positions experience the presence of a nursing research culture in clinical practice. The main theme was supported by three subthemes: Minimal academic tradition affects nursing research; Minimal recognition from physicians affects nursing research; and Moving towards a research culture. The nurse researchers in this study did not experience the presence of a nursing research culture in clinical practice, however; they called for more attention on removing barriers against research utilisation, promotion of applied research and interdisciplinary research collaboration, and passionate management support. The results of this case study show the pressure which nurse researchers employed in clinical practice are exposed to, and give examples on how to accommodate the further development of a nursing research culture in clinical practice. © 2017 John Wiley & Sons Ltd.

Through the eyes of the student: Best practices in clinical facilitation.

PubMed

Muthathi, Immaculate S; Thurling, Catherine H; Armstrong, Susan J

2017-08-28

Clinical facilitation is an essential part of the undergraduate nursing curriculum. A number of studies address the issue of clinical facilitation in South Africa, but there remains a lack of knowledge and understanding regarding what students perceive as best practice in clinical facilitation of their learning. To determine what type of clinical facilitation undergraduate students believe should be offered by clinical facilitators (nurse educators, professional nurses and clinical preceptors) in the clinical area in order to best facilitate their learning. A qualitative, exploratory and descriptive study was conducted. Purposive sampling was performed to select nursing students from the second, third and fourth year of studies from a selected nursing education institution in Johannesburg. The sampling resulted in one focus group for each level of nursing, namely second, third and fourth year nursing students. Interviews were digitally recorded and transcribed verbatim, thematic data analysis was used and trustworthiness was ensured by applying credibility, dependability, confirmability and transferability. The data revealed that participants differentiated between best practices in clinical facilitation in the clinical skills laboratory and clinical learning environment. In the clinical skills laboratory, pre-contact preparation, demonstration technique and optimising group learning were identified as best practices. In the clinical learning environment, a need for standardisation of procedures in simulation and practice, the allocation and support for students also emerged. There is a need for all nurses involved in undergraduate nursing education to reflect on how they approach clinical facilitation, in both clinical skills laboratory and clinical learning environment. There is also a need to improve consistency in clinical practices between the nursing education institution and the clinical learning environment so as to support students' adaptation to clinical practice.

The Ethics of Clinical Care and the Ethics of Clinical Research: Yin and Yang.

PubMed

Kowalski, Charles J; Hutchinson, Raymond J; Mrdjenovich, Adam J

2017-02-01

The Belmont Report's distinction between research and the practice of accepted therapy has led various authors to suggest that these purportedly distinct activities should be governed by different ethical principles. We consider some of the ethical consequences of attempts to separate the two and conclude that separation fails along ontological, ethical, and epistemological dimensions. Clinical practice and clinical research, as with yin and yang, can be thought of as complementary forces interacting to form a dynamic system in which the whole exceeds the sum of its parts. Just as effective clinical practice cannot exist without clinical research, meaningful clinical research requires the context of clinical practice. We defend this thesis by triangulation, that is, by outlining how multiple investigators have reached this conclusion on the basis of varied theoretical and applied approaches. More confidence can be placed in a result if different methods/viewpoints have led to that result. © The Author 2017. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

77 FR 13513 - Modernizing the Regulation of Clinical Trials and Approaches to Good Clinical Practice; Public...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-07

...The Food and Drug Administration (FDA) is announcing a 2-day public hearing to obtain input from interested persons on FDA's scope and direction in modernizing the regulations, policies, and practices that apply to the conduct of clinical trials of FDA-regulated products. Clinical trials are a critical source of evidence to inform medical policy and practice, and effective regulatory oversight is needed to ensure that human subjects are protected and resulting clinical trial data are credible and accurate. FDA is aware of concerns within the clinical trial community that certain regulations and policies applicable to the conduct of clinical trials may result in inefficiencies or increased cost and may not facilitate the use of innovative methods and technological advances to improve clinical trial quality. The Agency is involved in an effort to modernize the regulatory framework that governs clinical trials and approaches to good clinical practice (GCP). The purpose of this hearing is to solicit public input from a broad group of stakeholders on the scope and direction of this effort, including encouraging the use of innovative models that may enhance the effectiveness and efficiency of the clinical trial enterprise.

Isavuconazole Concentration in Real-world Practice: Consistency with Results from Clinical Trials.

PubMed

Andes, David; Kovanda, Laura; Desai, A; Kitt, Theresa; Zhao, M; Walsh, Thomas J

2018-05-07

Clinical use of voriconazole, posaconazole, and itraconazole revealed the need for therapeutic drug monitoring (TDM) of plasma concentrations of these antifungal agents. This need for TDM was not evident from clinical trials of these drugs. In order to establish if this requirement also applies to isavuconazole, we examined the plasma concentrations of 283 samples receiving isavuconazole in clinical practice and compared the values to those from clinical trials. The concentration distributions from real-world use and clinical trials were nearly identical (>1 μg/mL in 90% of patients). These findings suggest that routine TDM may not be required for isavuconazole in most instances. Copyright © 2018 American Society for Microbiology.

Safe clinical practice for patients hospitalised in a suicidal crisis: a study protocol for a qualitative case study.

PubMed

Berg, Siv Hilde; Rørtveit, Kristine; Walby, Fredrik A; Aase, Karina

2017-01-27

Suicide prevention in psychiatric care is arguably complex and incompletely understood as a patient safety issue. A resilient healthcare approach provides perspectives through which to understand this complexity by understanding everyday clinical practice. By including suicidal patients and healthcare professionals as sources of knowledge, a deeper understanding of what constitutes safe clinical practice can be achieved. This planned study aims to adopt the perspective of resilient healthcare to provide a deeper understanding of safe clinical practice for suicidal patients in psychiatric inpatient care. It will describe the experienced components and conditions of safe clinical practice and the experienced practice of patient safety. The study will apply a descriptive case study approach consisting of qualitative semistructured interviews and focus groups. The data sources are hospitalised patients in a suicidal crisis and healthcare professionals in clinical practice. This study was approved by the Regional Ethics Committee (2016/34). The results will be disseminated through scientific articles, a PhD dissertation, and national and international conferences. These findings can generate knowledge to be integrated into the practice of safety for suicidal inpatients in Norway and to improve the feasibility of patient safety measures. Theoretical generalisations can be drawn regarding safe clinical practice by taking into account the experiences of patients and healthcare professionals. Thus, this study can inform the conceptual development of safe clinical practice for suicidal patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Implementing guidelines: Proposed definitions of neuropsychology services in pediatric oncology.

PubMed

Baum, Katherine T; Powell, Stephanie K; Jacobson, Lisa A; Gragert, Marsha N; Janzen, Laura A; Paltin, Iris; Rey-Casserly, Celiane M; Wilkening, Greta N

2017-08-01

Several organizations have published guidelines for the neuropsychological care of survivors of childhood cancer. However, there is limited consensus in how these guidelines are applied. The model of neuropsychology service delivery is further complicated by the variable terminology used to describe recommended services. In an important first step to translate published guidelines into clinical practice, this paper proposes definitions for specific neuropsychological processes and services, with the goal of facilitating consistency across sites to foster future clinical program development and to clarify clinical practice guidelines. © 2017 Wiley Periodicals, Inc.

Exploring factors related to the translation of collaborative research learning experiences into clinical practice: Opportunities and tensions.

PubMed

Fletcher, Simon; Whiting, Cheryl; Boaz, Annette; Reeves, Scott

2017-07-01

Providing training opportunities to develop research skills for clinical staff has been prioritised in response to the need for improving the evidence base underpinning the delivery of care. By exploring the experiences of a number of former participants of a multidisciplinary postgraduate research course, this article explores the factors that have enabled and impeded staff to translate their learnt research skills into clinical practice. Adopting an exploratory case study approach, 16 interviews with 5 cohorts of Masters by Research in Clinical Practice (MResCP) graduates were undertaken. The interviews explored graduates' course experiences and their subsequent attempts to undertake clinical research. Analysis of the data indicated that although participants valued their interactions with colleagues from different professions and felt they gained useful research skills/knowledge, upon returning to clinical practice, they encountered a number of barriers which restricted their ability to apply their research expertise. Professional isolation, issues of hierarchy, and a lack of organisational support were key to limiting their ability to undertake clinical research. Further work is needed to explore in more depth how (i) these barriers can be overcome and (ii) how taught collaborative research skills can be more effectively translated into practice.

Quality improvement in New Zealand healthcare. Part 3: achieving effective care through clinical audit.

PubMed

Seddon, Mary; Buchanan, John

2006-08-04

In this third article in the Series on quality improvement, we examine the effectiveness of dimension of healthcare quality. To satisfy this dimension, two equally important facets must be attended to. First the best available evidence must be sought through research, and second that evidence must be applied--this second function is the domain of quality improvement activities generally and clinical audit in particular. Clinical audit is one of the main tools to establish whether the best evidence is being used in practice, as it compares actual practice to a standard of practice. Clinical audit identifies any gaps between what is done and what should be done, and rectifies any deficiencies in the actual processes of care. In this article, the steps involved in a clinical audit, how it is different to research, and the question of whether clinical audit requires ethical approval are explored.

Practicing Handoffs Early: Applying a Clinical Framework in the Anatomy Laboratory

ERIC Educational Resources Information Center

Lazarus, Michelle D.; Dos Santos, Jason A.; Haidet, Paul M.; Whitcomb, Tiffany L.

2016-01-01

The anatomy laboratory provides an ideal environment for the integration of clinical contexts as the willed-donor is often regarded as a student's "first patient." This study evaluated an innovative approach to peer teaching in the anatomy laboratory using a clinical handoff context. The authors introduced the "Situation,…

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

[The Nutritional Care Experience of a Post-Operative Periampullary Cancer Patient With Cachexia].

PubMed

Liou, Yan-Ting; Chiang, Pin-Yi; Shun, Shiow-Ching

2016-04-01

Cachexia is one of the most widely overlooked of the syndromes that are experienced by cancer patients. This syndrome is especially prevalent among patients with gastroenterology tract cancer. Although the National Comprehensive Cancer Network (NCCN) issued palliative-care practice guidelines for cachexia in 2015, guidelines have yet to be issued for the clinical setting. The authors reviewed the literature and applied their clinical experience to create an approach for identifying the degree of cachexia in a post-operative patient with periampullary cancer. This approach assesses the nutritional status, physical status, laboratory results, and gastrointestinal system functions of the patient using the Cachexia Assessment Scale (CAS) and NCCN Practice Guidelines for Cachexia. The patient improved under nursing care with an increase in nutritional intake and physical activity facilitating their process of post-surgical physical recovery. The authors hope that this experience using the combined CAS-NCCN Practice Guidelines will help clinical caregivers better understand how to apply the relevant guidelines in clinical settings. The developed approach may help nurses assess the comprehensive nutrition status of patients and related factors in order to provide interventions that will decrease the progression of cachexia effectively and promote quality of life.

Interpretation of medical information acts by UK occupational physicians.

PubMed

Batty, Lucia; Glozier, Nick; Holland-Elliott, Kevin

2009-05-01

Difficulties arise in applying the Data Protection Act 1998 and the Access to Medical Reports Act 1988 in occupational health practice. There is no guidance on detailed aspects of applying these Acts in practice and consistent advice has proved difficult to obtain. To audit the understanding and practice of UK occupational physicians to see if a consensus view existed. A postal questionnaire sent to all UK-based Society of Occupational Medicine (SOM) members between December 2005 and June 2006. Responses were analysed using the SPSS 13.0 software. Responses were received from 726 SOM members, a response rate of 48%. The study revealed wide variation and a limited consensus in practice. Significant differences existed between doctors with a Diploma in Occupational Medicine and those with higher Faculty qualifications, between part-time and full-time practitioners and between doctors who qualified pre- and post-1974. The audit revealed wide variation in responding to clinical scenarios in relation to both the Access to Medical Reports and the Data Protection Acts. The findings have implications for clinical practice, policy and research. The majority of respondents reported that national guidance is needed.

Culturally Competent Practice: A Mixed Methods Study Among Students, Academics and Alumni of Clinical Psychology Master’s Programs in the Netherlands

PubMed Central

Geerlings, Lennie R. C.; Thompson, Claire L.; Kraaij, Vivian; Keijsers, Ger P. J.

2018-01-01

This is the first research into preparation for multicultural clinical psychology practice in Europe. It applies the theory of multicultural counselling competency (MCC) to a case study in the Netherlands. It was hypothesized that cross-cultural practice experience, identification as a cultural minority, and satisfaction with cultural training was associated with MCC. The Multicultural Awareness Knowledge and Skills Survey was completed by 106 participants (22 students, 10 academics, 74 alumni) from clinical psychology masters’ programs. MANOVA detected a main effect of cross-cultural experience on MCC for all groups and universities. The data were enriched with exploratory qualitative data from 14 interviews (5 students, 5 academics, 4 alumni). Interpretative Phenomenological Analysis revealed three themes: limitations of clinical psychology, strategies for culturally competent practice, and strategies for cultural competency development. These outcomes suggest that cultural competency continues to require attention in master’s programs. The paper makes recommendations for further research enquiry related to training clinical psychologists to practice in Europe’s multicultural societies. PMID:29899800

Substance use disorder and compulsory commitment to care: a care-ethical decision-making framework.

PubMed

Nicolini, Marie; Vandenberghe, Joris; Gastmans, Chris

2017-11-29

In the era of deinstitutionalisation of psychiatric patients, steady or even increasing rates of compulsory commitment to care (CCC) are an intriguing phenomenon to analyse. From a clinical, legal and ethical perspective, CCC continues to be a controversial practice in psychiatry, and perhaps even more so when applied to patients with severe substance use disorder (SUD). Several reasons make it controversial. The lack of consensus about the benefits of CCC and professional disagreement about what mental illness and autonomy mean in the case of SUD make it difficult to apply ethically sound clinical decision-making in CCC. Also, the medico-legal framework underlying CCC use sometimes appears to foster the use of reductionist clinical evaluation. Layered on top of these issues is how stakeholders view coercion. There is a discrepancy between clinicians' and patients' perception of coercion, which leads to clinician-patient differences on whether CCC is necessary. Moreover, the way in which the evaluation is typically carried out influences patients' perception of coercion and subsequently their motivation for participating fully in treatment. In this article, we explore the value of care ethics, often applied to care practices such as nursing, when applied to more procedural medical practices, such as decision-making regarding CCC. The care-ethical approach views decision-making as part of a dynamic care process, within which the lived experience, interpretative dialogue and promotion of dignity are core features. Embracing this new framework means a paradigm shift in when the therapeutic relationship begins, namely, investing in it occurs while conducting an evaluation for a possible CCC procedure. Unlike in current typical evaluations, early cultivation of the therapeutic relationship enables the patient to participate in the definition of his needs, reduces perceived coercion and negative emotions and enhances treatment motivation. Finally, implications of this novel approach for clinical practice are formulated and discussed. © 2017 Nordic College of Caring Science.

Ambulatory Morning Report: A Case-Based Method of Teaching EBM Through Experiential Learning.

PubMed

Luciano, Gina L; Visintainer, Paul F; Kleppel, Reva; Rothberg, Michael B

2016-02-01

Evidence-based medicine (EBM) skills are important to daily practice, but residents generally feel unskilled incorporating EBM into practice. The Kolb experiential learning theory, as applied to curricular planning, offers a unique methodology to help learners build an EBM skill set based on clinical experiences. We sought to blend the learner-centered, case-based merits of the morning report with an experientially based EBM curriculum. We describe and evaluate a patient-centered ambulatory morning report combining the User's Guides to the Medical Literature approach to EBM and experiential learning theory in the internal medicine department at Baystate Medical Center. The Kolb experiential learning theory postulates that experience transforms knowledge; within that premise we designed a curriculum to build EBM skills incorporating residents' patient encounters. By developing structured clinical questions based on recent clinical problems, residents activate prior knowledge. Residents acquire new knowledge through selection and evaluation of an article that addresses the structured clinical questions. Residents then apply and use new knowledge in future patient encounters. To assess the curriculum, we designed an 18-question EBM test, which addressed applied knowledge and EBM skills based on the User's Guides approach. Of the 66 residents who could participate in the curriculum, 61 (92%) completed the test. There was a modest improvement in EBM knowledge, primarily during the first year of training. Our experiential curriculum teaches EBM skills essential to clinical practice. The curriculum differs from traditional EBM curricula in that ours blends experiential learning with an EBM skill set; learners use new knowledge in real time.

Tips for Teachers of Evidence-based Medicine: Clinical Prediction Rules (CPRs) and Estimating Pretest Probability

PubMed Central

McGinn, Thomas; Jervis, Ramiro; Wisnivesky, Juan; Keitz, Sheri

2008-01-01

Background Clinical prediction rules (CPR) are tools that clinicians can use to predict the most likely diagnosis, prognosis, or response to treatment in a patient based on individual characteristics. CPRs attempt to standardize, simplify, and increase the accuracy of clinicians’ diagnostic and prognostic assessments. The teaching tips series is designed to give teachers advice and materials they can use to attain specific educational objectives. Educational Objectives In this article, we present 3 teaching tips aimed at helping clinical learners use clinical prediction rules and to more accurately assess pretest probability in every day practice. The first tip is designed to demonstrate variability in physician estimation of pretest probability. The second tip demonstrates how the estimate of pretest probability influences the interpretation of diagnostic tests and patient management. The third tip exposes learners to various examples and different types of Clinical Prediction Rules (CPR) and how to apply them in practice. Pilot Testing We field tested all 3 tips with 16 learners, a mix of interns and senior residents. Teacher preparatory time was approximately 2 hours. The field test utilized a board and a data projector; 3 handouts were prepared. The tips were felt to be clear and the educational objectives reached. Potential teaching pitfalls were identified. Conclusion Teaching with these tips will help physicians appreciate the importance of applying evidence to their every day decisions. In 2 or 3 short teaching sessions, clinicians can also become familiar with the use of CPRs in applying evidence consistently in everyday practice. PMID:18491194

Applying health information technology and team-based care to residency education.

PubMed

Brown, Kristy K; Master-Hunter, Tara A; Cooke, James M; Wimsatt, Leslie A; Green, Lee A

2011-01-01

Training physicians capable of practicing within the Patient-centered Medical Home (PCMH) is an emerging area of scholarly inquiry within residency education. This study describes an effort to integrate PCMH principles into teaching practices within a university-based residency setting and evaluates the effect on clinical performance. Using participant feedback and clinical data extracted from an electronic clinical quality management system, we retrospectively examined performance outcomes at two family medicine residency clinics over a 7-year period. Instructional approaches were identified and clinical performance patterns analyzed. Alumni ratings of the practice-based curriculum increased following institution of the PCMH model. Clinical performance outcomes indicated improvements in the delivery of clinical care to patients. Implementation of instructional methodologies posed some challenges to residency faculty, particularly in development of consistent scheduling of individualized feedback sessions. Residents required the greatest support and guidance in managing point-of-care clinical reminders during patient encounters. Teaching practices that take into consideration the integration of team-based care and use of electronic health technologies can successfully be used to deliver residency education in the context of the PCMH model. Ongoing assessment provides important information to residency directors and faculty in support of improving the quality of clinical instruction.

[Experts consensus of dental esthetic photography].

PubMed

2017-05-09

Clinical photography in esthetic dentistry is an essential skill in clinical practice. It is widely applied clinically in multiple fields related to esthetic dentistry. Society of Esthetic Dentistry of Chinese Stomatological Association established a consensus for clinical photography and standards for images in esthetic dentistry in order to standardize domestic dental practitioners' procedure, and meet the demands of diagnosis and design in modern esthetic dentistry. It was also developed to facilitate domestic and international academic communication. Sixteen commonly used images in practice, which are of apparent importance in guiding esthetic analysis, design and implementation, are proposed in the standards. This consensus states the clinical significance of these images and the standard protocol of acquiring them.

A Model of Teaching-Learning Transactions in Generalist-Specialist Consultations

ERIC Educational Resources Information Center

Shershneva, Marianna B.; Carnes, Molly; Bakken, Lori L.

2006-01-01

Introduction: A new paradigm in continuing medical education is characterized by emphasis on physicians' learning in practice. Consistent with this paradigm, our study examined a subset of clinical practice--generalist-specialist consultations--from an educational perspective. Methods: We applied the grounded-theory method with semistructured…

Stresses and Challenges for New Graduates in Hospitals.

ERIC Educational Resources Information Center

Oermann, Marilyn H.; Garvin, Michael F.

2002-01-01

Recent nursing graduates (n=46) rated stresses and challenges in clinical practice. Stressors included not feeling competent/confident, making mistakes due to increased workload, and encountering new situations. Challenges included applying knowledge to practice and acquiring new skills. Most emotions were positive but anxiety was frequent. Ways…

Therapy Talk: Analyzing Therapeutic Discourse

ERIC Educational Resources Information Center

Leahy, Margaret M.

2004-01-01

Therapeutic discourse is the talk-in-interaction that represents the social practice between clinician and client. This article invites speech-language pathologists to apply their knowledge of language to analyzing therapy talk and to learn how talking practices shape clinical roles and identities. A range of qualitative research approaches,…

The group-as-a-whole-object relations model of group psychotherapy.

PubMed

Rosen, D; Stukenberg, K W; Saeks, S

2001-01-01

The authors review the theoretical basis of group psychotherapy performed at The Menninger Clinic and demonstrate how the theory has been put into practice on two different types of inpatient units. The fundamental elements of the theory and practice used can be traced to object relations theory as originally proposed by Melanie Klein. Her work with individuals was directly applied to working with groups by Ezriel and Bion, who focused on interpreting group tension. More modern approaches have reintegrated working with individual concerns while also attending to the group-as-a-whole. Historically, these principles have been applied to long-term group treatment. The authors apply the concepts from the group-as-a-whole literature to short- and medium-length inpatient groups with open membership. They offer clinical examples of the application of these principles in short-term inpatient settings in groups with open membership.

Clinical Natural Language Processing in languages other than English: opportunities and challenges.

PubMed

Névéol, Aurélie; Dalianis, Hercules; Velupillai, Sumithra; Savova, Guergana; Zweigenbaum, Pierre

2018-03-30

Natural language processing applied to clinical text or aimed at a clinical outcome has been thriving in recent years. This paper offers the first broad overview of clinical Natural Language Processing (NLP) for languages other than English. Recent studies are summarized to offer insights and outline opportunities in this area. We envision three groups of intended readers: (1) NLP researchers leveraging experience gained in other languages, (2) NLP researchers faced with establishing clinical text processing in a language other than English, and (3) clinical informatics researchers and practitioners looking for resources in their languages in order to apply NLP techniques and tools to clinical practice and/or investigation. We review work in clinical NLP in languages other than English. We classify these studies into three groups: (i) studies describing the development of new NLP systems or components de novo, (ii) studies describing the adaptation of NLP architectures developed for English to another language, and (iii) studies focusing on a particular clinical application. We show the advantages and drawbacks of each method, and highlight the appropriate application context. Finally, we identify major challenges and opportunities that will affect the impact of NLP on clinical practice and public health studies in a context that encompasses English as well as other languages.

Plain Language Summary: Earwax (Cerumen Impaction)

PubMed

Krouse, Helene J; Magit, Anthony E; O'Connor, Sarah; Schwarz, Seth R; Walsh, Sandra A

2017-01-01

This plain language summary serves as an overview in explaining earwax (cerumen). The summary applies to patients older than 6 months with a clinical diagnosis of earwax impaction and is based on the 2017 update of the Clinical Practice Guideline: Earwax (Cerumen Impaction). The evidence-based guideline includes research that supports diagnosis and treatment of earwax impaction. The guideline was developed to improve care by health care providers for managing earwax impaction by creating clear recommendations to use in medical practice.

Quality management of clinical-practical instruction for Practical Year medical students in Germany - proposal for a catalogue of criteria from the German Society of Medical Education.

PubMed

Raes, Patricia; Angstwurm, Matthias; Berberat, Pascal; Kadmon, Martina; Rotgans, Jerome; Streitlein-Böhme, Irmgard; Burckhardt, Gerhard; Fischer, Martin R

2014-01-01

Amended in 2013, the current version of the German Medical Licensure Regulation contains structural specifications that are also required of non-university institutions involved in Practical Year clinical training. The criteria are worded in relatively general terms. Furthermore, not all of the structural specifications can be readily applied to every subject area. In order to ensure commensurability in Practical Year instruction in Germany, not least in light of recently introduced Practical Year mobility, it is necessary to define consistent quality criteria for Practical Year training. The authors therefore propose a catalogue of criteria for the quality management process in Practical Year instruction facilities. In January 2014, the board of directors of the German Society for Medical Education decided to establish a committee comprised of representatives from various German medical faculties. In a process similar to the Delphi methodology, the group developed criteria for structure, process and outcome quality in Practical Year training in Germany. The criteria developed for structure, process and outcome quality apply to Practical Year training in academic teaching hospitals and university medical centres. Furthermore, modalities for review are proposed. The present catalogue of criteria is intended to contribute to the formation of a basis for the most consistent quality standards possible for Practical Year instruction in Germany.

Using basic statistics on the individual patient's own numeric data.

PubMed

Hart, John

2012-12-01

This theoretical report gives an example for how coefficient of variation (CV) and quartile analysis (QA) to assess outliers might be able to be used to analyze numeric data in practice for an individual patient. A patient was examined for 8 visits using infrared instrumentation for measurement of mastoid fossa temperature differential (MFTD) readings. The CV and QA were applied to the readings. The participant also completed the Short Form-12 health perception survey on each visit, and these findings were correlated with CV to determine if CV had outcomes support (clinical significance). An outlier MFTD reading was observed on the eighth visit according to QA that coincided with the largest CV value for the MFTDs. Correlations between the Short Form-12 and CV were low to negligible, positive, and statistically nonsignificant. This case provides an example of how basic statistical analyses could possibly be applied to numerical data in chiropractic practice for an individual patient. This might add objectivity to analyzing an individual patient's data in practice, particularly if clinical significance of a clinical numerical finding is unknown.

Defining and Applying a Functionality Approach to Intellectual Disability

ERIC Educational Resources Information Center

Luckasson, R.; Schalock, R. L.

2013-01-01

Background: The current functional models of disability do not adequately incorporate significant changes of the last three decades in our understanding of human functioning, and how the human functioning construct can be applied to clinical functions, professional practices and outcomes evaluation. Methods: The authors synthesise current…

Linguistic analysis of discourse in aphasia: A review of the literature.

PubMed

Bryant, Lucy; Ferguson, Alison; Spencer, Elizabeth

This review examined previous research applications of linguistic discourse analysis to assess the language of adults with aphasia. A comprehensive literature search of seven databases identified 165 studies that applied linguistic measures to samples of discourse collected from people with aphasia. Analysis of methodological applications revealed an increase in published research using linguistic discourse analysis over the past 40 years, particularly to measure the generalisation of therapy outcomes to language in use. Narrative language samples were most frequently subject to analysis though all language genres were observed across included studies. A total of 536 different linguistic measures were applied to examine language behaviours. Growth in the research use of linguistic discourse analysis and suggestions that this growth may be reflected in clinical practice requires further investigation. Future research directions are discussed to investigate clinical use of discourse analysis and examine the differences that exist between research and clinical practice.

Co-Designing Mobile Apps to Assist in Clinical Nursing Education: A Study Protocol.

PubMed

O'Connor, Siobhan; Andrews, Tom

2016-01-01

Mobile applications (apps) to train health professionals is gaining momentum as the benefits of mobile learning (mLearning) are becoming apparent in complex clinical environments. However, most educational apps are generic, off-the-shelf pieces of software that do not take into consideration the unique needs of nursing students. The proposed study will apply a user-centred design process to create a tailored mobile app for nursing students to learn and apply clinical skills in practice. The app will be piloted and evaluated to understand how nursing students use mobile technology in clinical settings to support their learning and educational needs.

Integrating research into clinical internship training bridging the science/practice gap in pediatric psychology.

PubMed

McQuaid, Elizabeth L; Spirito, Anthony

2012-03-01

Existing literature highlights a critical gap between science and practice in clinical psychology. The internship year is a "capstone experience"; training in methods of scientific evaluation should be integrated with the development of advanced clinical competencies. We provide a rationale for continued exposure to research during the clinical internship year, including, (a) critical examination and integration of the literature regarding evidence-based treatment and assessment, (b) participation in faculty-based and independent research, and (c) orientation to the science and strategy of grantsmanship. Participation in research provides exposure to new empirical models and can foster the development of applied research questions. Orientation to grantsmanship can yield an initial sense of the "business of science." Internship provides an important opportunity to examine the challenges to integrating the clinical evidence base into professional practice; for that reason, providing research exposure on internship is an important strategy in training the next generation of pediatric psychologists.

Quality assurance and the need to evaluate interventions and audit programme outcomes.

PubMed

Zhao, Min; Vaartjes, Ilonca; Klipstein-Grobusch, Kerstin; Kotseva, Kornelia; Jennings, Catriona; Grobbee, Diederick E; Graham, Ian

2017-06-01

Evidence-based clinical guidelines provide standards for the provision of healthcare. However, these guidelines have been poorly implemented in daily practice. Clinical audit is a quality improvement tool to promote quality of care in daily practice and to improve outcomes through the systematic review of care delivery and implementation of changes. A major priority in the management of subjects with cardiovascular disease (CVD) management is secondary prevention by controlling cardiovascular risk factors and providing appropriate medical treatment. Clinical audits can be applied to monitor modifiable risk factors and evaluate quality improvements of CVD management in daily practice. Existing clinical audits have provided an overview of the burden of risk factors in subjects with CVD and reflect real-world risk factor recording and management. However, consistent and representative data from clinic audits are still insufficient to fully monitor quality improvement of CVD management. Data are lacking in particular from low- and middle-income countries, limiting the evaluation of CVD management quality by clinical audit projects in many settings. To support the development of clinical standards, monitor daily practice performance, and improve quality of care in CVD management at national and international levels, more widespread clinical audits are warranted.

The cost to successfully apply for level 3 medical home recognition

PubMed Central

Mottus, Kathleen; Reiter, Kristin; Mitchell, C. Madeline; Donahue, Katrina E.; Gabbard, Wilson M.; Gush, Kimberly

2016-01-01

BACKGROUND The NCQA Patient Centered Medical Home (PCMH) recognition program provides practices an opportunity to implement Medical home activities. Understanding the costs to apply for recognition may enable practices to plan their work. METHODS Practice coaches identified 5 exemplar practices that received level 3 recognition (3 pediatric and 2 family medicine practices). This analysis focuses on 4 that received 2011 recognition. Clinical, informatics and administrative staff participated in 2–3 hour interviews. We collected the time required to develop, implement and maintain required activities. We categorized costs as: 1) non-personnel, 2) developmental 3) those to implement activities 4) those to maintain activities, 5) those to document the work and 6) consultant costs. Only incremental costs were included and are presented as costs per full-time equivalent provider (pFTE) RESULTS Practice size ranged from 2.5 – 10.5 pFTE’s, payer mixes from 7–43 % Medicaid. There was variation in the distribution of costs by activity by practice; but the costs to apply were remarkably similar ($11,453–$15,977 pFTE). CONCLUSION The costs to apply for 2011 recognition were noteworthy. Work to enhance care coordination and close loops were highly valued. Financial incentives were key motivators. Future efforts to minimize the burden of low value activities could benefit practices. PMID:26769879

Practice Parameter for Telepsychiatry with Children and Adolescents

ERIC Educational Resources Information Center

Journal of the American Academy of Child & Adolescent Psychiatry, 2008

2008-01-01

Parameter for the usage of telepsychiatry to provide services to children and adolescents is developed using clinical consensus and existing scientific evidence. Telepsychiatry is the result of applying telemedicine, a mode of health care delivery that uses telecommunications, to psychiatry. The parameter's use for determining best practices in…

Application of evidence-based dentistry: from research to clinical periodontal practice.

PubMed

Kwok, Vivien; Caton, Jack G; Polson, Alan M; Hunter, Paul G

2012-06-01

Dentists need to make daily decisions regarding patient care, and these decisions should essentially be scientifically sound. Evidence-based dentistry is meant to empower clinicians to provide the most contemporary treatment. The benefits of applying the evidence-based method in clinical practice include application of the most updated treatment and stronger reasoning to justify the treatment. A vast amount of information is readily accessible with today's digital technology, and a standardized search protocol can be developed to ensure that a literature search is valid, specific and repeatable. It involves developing a preset question (population, intervention, comparison and outcome; PICO) and search protocol. It is usually used academically to perform commissioned reviews, but it can also be applied to answer simple clinical queries. The scientific evidence thus obtained can then be considered along with patient preferences and values, clinical patient circumstances and the practitioner's experience and judgment in order to make the treatment decision. This paper describes how clinicians can incorporate evidence-based methods into patient care and presents a clinical example to illustrate the process. © 2012 John Wiley & Sons A/S.

Application of augmented reality for inferior alveolar nerve block anesthesia: A technical note

PubMed Central

2017-01-01

Efforts to apply augmented reality (AR) technology in the medical field include the introduction of AR techniques into dental practice. The present report introduces a simple method of applying AR during an inferior alveolar nerve block, a procedure commonly performed in dental clinics. PMID:28879340

Application of augmented reality for inferior alveolar nerve block anesthesia: A technical note.

PubMed

Won, Yu-Jin; Kang, Sang-Hoon

2017-06-01

Efforts to apply augmented reality (AR) technology in the medical field include the introduction of AR techniques into dental practice. The present report introduces a simple method of applying AR during an inferior alveolar nerve block, a procedure commonly performed in dental clinics.

The impact of training and working conditions on junior doctors’ intention to leave clinical practice

PubMed Central

2014-01-01

Background The shortage of physicians is an evolving problem throughout the world. In this study we aimed to identify to what extent junior doctors’ training and working conditions determine their intention to leave clinical practice after residency training. Methods A prospective cohort study was conducted in 557 junior doctors undergoing residency training in German hospitals. Self-reported specialty training conditions, working conditions and intention to leave clinical practice were measured over three time points. Scales covering training conditions were assessed by structured residency training, professional support, and dealing with lack of knowledge; working conditions were evaluated by work overload, job autonomy and social support, based on the Demand–Control–Support model. Multivariate ordinal logistic regression analyses with random intercept for longitudinal data were applied to determine the odds ratio of having a higher level of intention to leave clinical practice. Results In the models that considered training and working conditions separately to predict intention to leave clinical practice we found significant baseline effects and change effects. After modelling training and working conditions simultaneously, we found evidence that the change effect of job autonomy (OR 0.77, p = .005) was associated with intention to leave clinical practice, whereas for the training conditions, only the baseline effects of structured residency training (OR 0.74, p = .017) and dealing with lack of knowledge (OR 0.74, p = .026) predicted intention to leave clinical practice. Conclusions Junior doctors undergoing specialty training experience high workload in hospital practice and intense requirements in terms of specialty training. Our study indicates that simultaneously improving working conditions over time and establishing a high standard of specialty training conditions may prevent junior doctors from considering leaving clinical practice after residency training. PMID:24942360

Clinical PhD graduate student views of their scientist-practitioner training.

PubMed

VanderVeen, Joseph W; Reddy, L Felice; Veilleux, Jennifer C; January, Alicia M; DiLillo, David

2012-09-01

The goal of the scientist-practitioner (S-P) training model is to produce clinical psychologists equipped to integrate and utilize both science and practice in the clinical and research domains. However, much has been written regarding the possible shortcomings of S-P training and whether clinical psychology graduate students are actually gaining the knowledge and skills to integrate science and practice during graduate training and beyond (Chang, Lee, & Hargreaves, 2008; Gelso, 2006; Merlo, Collins, & Bernstein, 2008; Phillips, 1993). As such, the present study assessed ratings of satisfaction, perception of ability, and use of the S-P training model within 653 clinical psychology graduate students enrolled in programs that are members of the Council of University Directors of Clinical Psychology. Findings suggest that students are consistently trained in the integration of science and practice and have confidence in their abilities to apply the S-P integration to research and clinical work. However, despite understanding the ways in which science can influence practice, over one third of students reported that they rarely use science-based decisions when informing clients of the clinical services they will be providing. The implications of these results support the need for a more detailed evaluation of clinical psychology graduate students as well as the use of research-informed practice and the process of providing clients with information they need to make informed choices about treatment. © 2012 Wiley Periodicals, Inc.

Effectiveness of empathy in general practice: a systematic review

PubMed Central

Derksen, Frans; Bensing, Jozien; Lagro-Janssen, Antoine

2012-01-01

Background Empathy as a characteristic of patient–physician communication in both general practice and clinical care is considered to be the backbone of the patient–physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice. This literature review explores the effectiveness of empathy in general practice. Effects that are discussed are: patient satisfaction and adherence, feelings of anxiety and stress, patient enablement, diagnostics related to information exchange, and clinical outcomes. Aim To review the existing literature concerning all studies published in the last 15 years on the effectiveness of physician empathy in general practice. Design and setting Systematic literature search. Method Searches of PubMed, EMBASE, and PsychINFO databases were undertaken, with citation searches of key studies and papers. Original studies published in English between July 1995 and July 2011, containing empirical data about patient experience of GPs’ empathy, were included. Qualitative assessment was applied using Giacomini and Cook’s criteria. Results After screening the literature using specified selection criteria, 964 original studies were selected; of these, seven were included in this review after applying quality assessment. There is a good correlation between physician empathy and patient satisfaction and a direct positive relationship with strengthening patient enablement. Empathy lowers patients’ anxiety and distress and delivers significantly better clinical outcomes. Conclusion Although only a small number of studies could be used in this search, the general outcome seems to be that empathy in the patient–physician communication in general practice is of unquestionable importance. PMID:23336477

The Psychiatric Cultural Formulation: Applying Medical Anthropology in Clinical Practice

PubMed Central

Aggarwal, Neil Krishan

2014-01-01

This paper considers revisions to the DSM-IV Outline for Cultural Formulation from the perspective of clinical practice. First, the paper explores the theoretical development of the Cultural Formulation. Next, a case presentation demonstrates challenges in its actual implementation. Finally, the paper recommends a set of questions for the clinician on barriers to care and countertransference. The development of a standardized, user-friendly format can increase the Cultural Formulation’s utilization among all psychiatrists beyond those specializing in cultural psychiatry. PMID:22418398

Extravasation of radiographic contrast media: prevention, diagnosis, and treatment.

PubMed

Tonolini, Massimo; Campari, Alessandro; Bianco, Roberto

2012-01-01

Contrast media extravasation represents a not unusual problem in radiological practice. Incidence, patient-, and procedure-related risk factors, pathogenesis, and clinical manifestations of extravasation injuries are discussed with a review of recent literature, and a practical preventive approach is proposed. A diagnostic and therapeutic protocol, to be applied whenever contrast extravasation is detected, includes radiographic assessment of compartmentalization, antidote application, local care, and clinical follow-up; indications for surgical consultation and adverse event reporting are provided. Copyright © 2012 Mosby, Inc. All rights reserved.

How to apply the ICF and ICF core sets for low back pain.

PubMed

Stier-Jarmer, Marita; Cieza, Alarcos; Borchers, Michael; Stucki, Gerold

2009-01-01

To introduce the International Classification of Functioning, Disability and Health (ICF) as conceptual model and classification and the ICF Core Sets as a way to specify functioning for a specific health condition such as Low Back Pain, and to illustrate the application of the ICF and ICF Core Sets in the context of clinical practice, the planning and reporting of studies and the comparison of health status measures. A decision-making and consensus process was performed to develop the ICF Core Sets for Low Back Pain, the linking procedure was applied as basis for the content comparison of health-status measures and the Rehab-Cycle was used to exemplify the application of the ICE and ICF Core Sets in clinical practice. Two different ICF Core Sets, namely, a comprehensive and a brief, are presented, three different health-status measures were linked to the ICF and compared and a case example of a patient with Low back Pain was described based on the Rehab-Cycle. The ICF is a promising new framework and classification to assess the impact of Low Back Pain. The ICF and practical tools, such as the ICF Core Sets for Low Back Pain, are useful for clinical practice, outcome and rehabilitation research, education, health statistics, and regulation.

The face, the future, and dental practice: how research in craniofacial biology will influence patient care.

PubMed

Townsend, G C; Brook, A H

2014-06-01

It has been a privilege to assemble a group of Australian and international researchers to produce a special issue of the Australian Dental Journal that reflects the cutting edge of research in different aspects of craniofacial biology, and also considers how these advances will influence future education and practice within dentistry. The aim of this special issue is to provide a collection of concept papers and critical reviews on key topics that cover both fundamental and applied research in craniofacial biology and to consider the clinical implications. To do this, four questions have been addressed that lead to the four sections of this issue. These are: How have we come to the present exciting position in craniofacial biology with breakthroughs over the past 50 years? What are current fundamental research topics that are helping us to understand more about craniofacial and general development, possibly leading to future clinical developments? What are the current applied research topics that will influence future clinical practice? Looking forward, what new developments in craniofacial biology may come about that will change the face of dental education and practice? The refereed papers in this special issue are grouped into the four sections that seek to respond to these demanding questions. © 2014 Australian Dental Association.

An Interactive Diagnosis Approach for Supporting Clinical Nursing Courses

ERIC Educational Resources Information Center

Wei, Chun-Wang; Lin, Yi-Chun; Lin, Yen-Ting

2016-01-01

Clinical resources in nursing schools are always insufficient for satisfying the practice requirements of each student at the same time during a formal course session. Although several studies have applied information and communication technology to develop computer-based learning tools for addressing this problem, most of these developments lack…

Is the Information about a Test Important? Applying the Methods of Evidence-Based Medicine to the Clinical Examination of Swallowing

ERIC Educational Resources Information Center

Rosenbek, John C.; McCullough, Gary H.; Wertz, Robert T.

2004-01-01

A hotly debated topic in oropharyngeal dysphagia is the Clinical Swallowing Examination's (CSE) importance in clinical practice. That debate can profit from the application of evidence-based medicine's (EBM) principles and procedures. These can guide both appropriate data collection and interpretation as will be demonstrated in the present report.…

Clinical teaching based on principles of cognitive apprenticeship: views of experienced clinical teachers.

PubMed

Stalmeijer, Renée E; Dolmans, Diana H J M; Snellen-Balendong, Hetty A M; van Santen-Hoeufft, Marijke; Wolfhagen, Ineke H A P; Scherpbier, Albert J J A

2013-06-01

To explore (1) whether an instructional model based on principles of cognitive apprenticeship fits with the practice of experienced clinical teachers and (2) which factors influence clinical teaching during clerkships from an environmental, teacher, and student level as perceived by the clinical teachers themselves. The model was designed to apply directly to teaching behaviors of clinical teachers and consists of three phases, advocating teaching behaviors such as modeling, creating a safe learning environment, coaching, knowledge articulation, and exploration. A purposive sample of 17 experienced clinical teachers from five different disciplines and four different teaching hospitals took part in semistructured individual interviews. Two researchers independently performed a thematic analysis of the interview transcripts. Coding was discussed within the research team until consensus was reached. All participants recognized the theoretical model as a structured picture of the practice of teaching activities during both regular and senior clerkships. According to participants, modeling and creating a safe learning environment were fundamental to the learning process of both regular and senior clerkship students. Division of teaching responsibilities, longer rotations, and proactive behavior of teachers and students ensured that teachers were able to apply all steps in the model. The theoretical model can offer valuable guidance in structuring clinical teaching activities and offers suggestions for the design of effective clerkships.

Clinical Utility of Quantitative Imaging

PubMed Central

Rosenkrantz, Andrew B; Mendiratta-Lala, Mishal; Bartholmai, Brian J.; Ganeshan, Dhakshinamoorthy; Abramson, Richard G.; Burton, Kirsteen R.; Yu, John-Paul J.; Scalzetti, Ernest M.; Yankeelov, Thomas E.; Subramaniam, Rathan M.; Lenchik, Leon

2014-01-01

Quantitative imaging (QI) is increasingly applied in modern radiology practice, assisting in the clinical assessment of many patients and providing a source of biomarkers for a spectrum of diseases. QI is commonly used to inform patient diagnosis or prognosis, determine the choice of therapy, or monitor therapy response. Because most radiologists will likely implement some QI tools to meet the patient care needs of their referring clinicians, it is important for all radiologists to become familiar with the strengths and limitations of QI. The Association of University Radiologists Radiology Research Alliance Quantitative Imaging Task Force has explored the clinical application of QI and summarizes its work in this review. We provide an overview of the clinical use of QI by discussing QI tools that are currently employed in clinical practice, clinical applications of these tools, approaches to reporting of QI, and challenges to implementing QI. It is hoped that these insights will help radiologists recognize the tangible benefits of QI to their patients, their referring clinicians, and their own radiology practice. PMID:25442800

Digital pathology in nephrology clinical trials, research, and pathology practice.

PubMed

Barisoni, Laura; Hodgin, Jeffrey B

2017-11-01

In this review, we will discuss (i) how the recent advancements in digital technology and computational engineering are currently applied to nephropathology in the setting of clinical research, trials, and practice; (ii) the benefits of the new digital environment; (iii) how recognizing its challenges provides opportunities for transformation; and (iv) nephropathology in the upcoming era of kidney precision and predictive medicine. Recent studies highlighted how new standardized protocols facilitate the harmonization of digital pathology database infrastructure and morphologic, morphometric, and computer-aided quantitative analyses. Digital pathology enables robust protocols for clinical trials and research, with the potential to identify previously underused or unrecognized clinically useful parameters. The integration of digital pathology with molecular signatures is leading the way to establishing clinically relevant morpho-omic taxonomies of renal diseases. The introduction of digital pathology in clinical research and trials, and the progressive implementation of the modern software ecosystem, opens opportunities for the development of new predictive diagnostic paradigms and computer-aided algorithms, transforming the practice of renal disease into a modern computational science.

Applying a family systems lens to proxy decision making in clinical practice and research.

PubMed

Rolland, John S; Emanuel, Linda L; Torke, Alexia M

2017-03-01

When patients are incapacitated and face serious illness, family members must make medical decisions for the patient. Medical decision sciences give only modest attention to the relationships among patients and their family members, including impact that these relationships have on the decision-making process. A review of the literature reveals little effort to systematically apply a theoretical framework to the role of family interactions in proxy decision making. A family systems perspective can provide a useful lens through which to understand the dynamics of proxy decision making. This article considers the mutual impact of family systems on the processes and outcomes of proxy decision making. The article first reviews medical decision science's evolution and focus on proxy decision making and then reviews a family systems approach, giving particular attention to Rolland's Family Systems Illness Model. A case illustrates how clinical practice and how research would benefit from bringing family systems thinking to proxy decisions. We recommend including a family systems approach in medical decision science research and clinical practices around proxy decisions making. We propose that clinical decisions could be less conflicted and less emotionally troubling for families and clinicians if family systems approaches were included. This perspective opens new directions for research and novel approaches to clinical care. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Implementing human factors in clinical practice.

PubMed

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

2015-05-01

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. 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. 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. 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Using lesson study to integrate information literacy throughout the curriculum.

PubMed

Stombaugh, Angie; Sperstad, Rita; Vanwormer, Arin; Jennings, Eric; Kishel, Hans; Vogh, Bryan

2013-01-01

To develop evidence-based practice skills, students need to be capable of retrieving various levels of scholarly information, evaluating its usefulness, and applying it to clinical practice. The authors discuss the process of developing an information literacy curriculum for a cohort of students over a 5-semester nursing program using lesson study.

Instructional Supervision: Applying Tools and Concepts. 2nd Edition

ERIC Educational Resources Information Center

Zepeda, Sally J.

2007-01-01

The first edition of this book was highly regarded by both professors and students for its practicality and its: (1) coverage of tools & strategies to help supervisors work effectively with teachers; (2) up-to-date approach to clinical supervision which includes teacher portfolios, action research, peer coaching, and other innovative practices;…

Teaching trainers to incorporate evidence-based medicine (EBM) teaching in clinical practice: the EU-EBM project.

PubMed

Thangaratinam, Shakila; Barnfield, Gemma; Weinbrenner, Susanne; Meyerrose, Berit; Arvanitis, Theodoros N; Horvath, Andrea R; Zanrei, Gianni; Kunz, Regina; Suter, Katja; Walczak, Jacek; Kaleta, Anna; Oude Rengerink, Katrien; Gee, Harry; Mol, Ben W J; Khan, Khalid S

2009-09-10

Evidence based medicine (EBM) is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However, clinical teachers lack confidence in teaching EBM in workplace and are often unsure of the existing opportunities for teaching EBM in the clinical setting. There is a need for continuing professional development (CPD) courses that train clinical trainers to teach EBM through on-the-job training by demonstration of applied EBM real time in clinical practice. We developed such a course to encourage clinically relevant teaching of EBM in post-graduate education in various clinical environments. We devised an e-learning course targeting trainers with EBM knowledge to impart educational methods needed to teach application of EBM teaching in commonly used clinical settings. The curriculum development group comprised experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions in seven European countries. The e-learning sessions were designed to allow participants (teachers) to undertake the course in the workplace during short breaks within clinical activities. An independent European steering committee provided input into the process. The curriculum defined specific learning objectives for teaching EBM by exploiting educational opportunities in six different clinical settings. The e-modules incorporated video clips that demonstrate practical and effective methods of EBM teaching in everyday clinical practice. The course encouraged focussed teaching activities embedded within a trainer's personal learning plan and documentation in a CPD portfolio for reflection. This curriculum will help senior clinicians to identify and make the best use of available opportunities in everyday practice in clinical situations to teach various steps of EBM and demonstrate their applicability to clinical practice. Once fully implemented, the ultimate outcome of this pilot project will be a European qualification in teaching EBM, which will be used by doctors, hospitals, professional bodies responsible for postgraduate qualifications and continuing medical education.

Teaching trainers to incorporate evidence-based medicine (EBM) teaching in clinical practice: the EU-EBM project

PubMed Central

Thangaratinam, Shakila; Barnfield, Gemma; Weinbrenner, Susanne; Meyerrose, Berit; Arvanitis, Theodoros N; Horvath, Andrea R; Zanrei, Gianni; Kunz, Regina; Suter, Katja; Walczak, Jacek; Kaleta, Anna; Rengerink, Katrien Oude; Gee, Harry; Mol, Ben WJ; Khan, Khalid S

2009-01-01

Background Evidence based medicine (EBM) is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However, clinical teachers lack confidence in teaching EBM in workplace and are often unsure of the existing opportunities for teaching EBM in the clinical setting. There is a need for continuing professional development (CPD) courses that train clinical trainers to teach EBM through on-the-job training by demonstration of applied EBM real time in clinical practice. We developed such a course to encourage clinically relevant teaching of EBM in post-graduate education in various clinical environments. Methods We devised an e-learning course targeting trainers with EBM knowledge to impart educational methods needed to teach application of EBM teaching in commonly used clinical settings. The curriculum development group comprised experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions in seven European countries. The e-learning sessions were designed to allow participants (teachers) to undertake the course in the workplace during short breaks within clinical activities. An independent European steering committee provided input into the process. Results The curriculum defined specific learning objectives for teaching EBM by exploiting educational opportunities in six different clinical settings. The e-modules incorporated video clips that demonstrate practical and effective methods of EBM teaching in everyday clinical practice. The course encouraged focussed teaching activities embedded within a trainer's personal learning plan and documentation in a CPD portfolio for reflection. Conclusion This curriculum will help senior clinicians to identify and make the best use of available opportunities in everyday practice in clinical situations to teach various steps of EBM and demonstrate their applicability to clinical practice. Once fully implemented, the ultimate outcome of this pilot project will be a European qualification in teaching EBM, which will be used by doctors, hospitals, professional bodies responsible for postgraduate qualifications and continuing medical education. PMID:19744327

Psychotherapy for neurologists.

PubMed

Hobday, Gabrielle S; Gabbard, Glen O

2009-07-01

Psychotherapy has traditionally been regarded as the purview of psychiatry rather than neurology. Yet, the doctor-patient relationship is fundamental to both specialties, and the principles that derive from psychotherapy theory and practice apply to that relationship regardless of the specialty. It is common knowledge that a large proportion of patients seen in the context of the practice of medicine have some kind of emotional disturbance. Moreover, patients with organic disease may also have significant emotional difficulties that complicate both the primary illness and its treatment. This experience inevitably has drawn attention to the need for the nonpsychiatric physician to have an understanding and proficiency in psychiatric diagnosis and psychotherapeutic principles. In this article, we consider basic psychotherapeutic principles that are useful in the everyday practice of neurologists and other nonpsychiatric physicians. These skills are important not only for practical reasons, but also because responsiveness to their emotional distress is essential to maintain empathy and caring as cornerstones of the art of medicine. With the use of clinical examples to illustrate these principles, we hope that readers can apply them to their own clinical experiences.

Using flash cards to engage Indonesian nursing students in reflection on their practice.

PubMed

Wanda, Dessie; Fowler, Cathrine; Wilson, Valerie

2016-03-01

Reflective practice is now widely used as a critical learning tool in undergraduate and postgraduate nursing programs in most developed countries. However in developing countries, reflective practice is in its infancy. To introduce reflective practice to postgraduate students in an Indonesian nursing education institution. This paper presents the positive meanings of reflection and reflective practice experienced by the students and the way they used reflection within their practice. A descriptive qualitative study was conducted to explore the meaning of reflection or reflective practice using flashcards. A clinical reflective practice model taking into consideration Indonesian culture was developed and applied during students' clinical placement. A few weeks post clinical placement, 21 students participated in an evaluation session. The meaning of reflection or reflective practice was explored using flash cards containing images of people and environment with different situations and events. Students were asked to choose a card that represented their viewpoints about reflective practice and share it with the group. Data were digitally captured and analyzed using thematic analysis. Reflection provided a positive experience for the students. In their own words, they discussed their journey of using reflection during the clinical placement period. The use of reflection was identified as expanding their view of nursing practice, providing a safe place to explore their experiences and clarity when they encountered challenging situations during their clinical practice. Reflecting on practice experiences resulted in increased self-awareness, and enhanced their learning. The findings indicate that reflective practice can be implemented successfully in Indonesia and may have value for other Eastern countries that share similar cultural characteristics. The use of flash cards assisted the students describe through stories their experiences of participating in this reflective practice program. Copyright © 2015 Elsevier Ltd. All rights reserved.

An evidence-based approach to the management of low back pain and sciatica: how the evidence is applied in clinical cases.

PubMed

Goh, L; Bawendi, A; Samanta, J; Samanta, A

2003-09-01

Low back pain and sciatica are common complaints that affect a major proportion of the population at some time in their lives. The treatment and management of this condition may vary widely. The present paper aims to provide an evidence-based approach to the management of low back pain and sciatica, and demonstrates how to search for the evidence and how to apply it practically in individual patients. The principles underlying evidence-based medicine are explained. The practice of evidence-based medicine requires initial formulation of the appropriate clinical question, followed by searching databases for relevant evidence. Finally evidence needs to be applied on a patient-specific basis. Best Evidence, the Cochrane Library, Embase and Medline were searched to obtain quality controlled information regarding the management of low back pain and sciatica. Current evidence shows that an active exercise programme promotes early recovery. This may allow patients to resume an active and sportive lifestyle. Epidural corticosteroid injections may help to resolve additional troublesome symptoms of sciatica. Two clinical cases are used to show how evidence-based medicine can be individualized to specific patients. A patient-focused strategy combining best evidence and clinical expertise is suggested as the mainstay for the management of low back pain.

[Discussion on quantum entanglement theory and acupuncture].

PubMed

Wang, Jun; Wu, Bin; Chen, Sheng

2017-11-12

The quantum entanglement is a new discovery of modern physics and has drawn a widely attention in the world. After learning the quantum entanglement, the authors have found that many characteristics of quantum are reflected in TCM, acupuncture theory and clinical practice. For example, the quantum entanglement phenomenon is mutually verified with the holism, yinyang doctrine, the theory of primary, secondary, root and knot in TCM, etc. It can be applied to interpret the clinical situations which is difficult to be explained in clinical practice, such as the instant effect of acupuncture, multi-point stimulation in one disorder and the points with specific effects. On the basis of the discovery above, the quantum entanglement theory achieved the mutual treatment among the relatives in acupuncture clinical practice and the therapeutic effects were significant. The results suggest that the coupling relationship in quantum entanglement presents between the diseases and the acupoints in the direct relative. The authors believe that the discovery in this study contributes to the exploration on the approaches to the acupuncture treatment in clinical practice and enrich the ideas on the disease prevention.

The insight and challenge of reflexive practice in an ethnographic study of black traumatically injured patients in Philadelphia.

PubMed

Jacoby, Sara F

2017-07-01

The integrity of critical ethnography requires engagement in reflexive practice at all phases of the research process. In this discussion paper, I explore the insights and challenges of reflexive practice in an ethnographic study of the recovery experiences of black trauma patients in a Philadelphia hospital. Observation and interviews were conducted with twelve patients who were admitted to trauma-designated units of the hospital over the course of a year. During fieldwork, I learned the ways that my background as a professional nurse structured my way of being in clinical space and facilitated a particular interpretation of clinical culture. In analysis, reflection on subjectivities through which I designed this ethnographic research allowed me to see beyond my preconceived and theoretically informed perspective to permit unexpected features of the field to emerge. Reflexive practice also guided my reconciliation of key practical and epistemological differences between clinical ethnographic research and the anthropologic tradition in which it is rooted. I conclude that with careful reflection to the subjectivities that influence the research process, interdisciplinary clinically relevant applied interpretations of critical ethnographic work can be used to generate detailed knowledge across contexts in clinical care, nursing practice, and patient experiences. © 2016 John Wiley & Sons Ltd.

An Integrative Professional Theory and Practice Paper: Personal Reflections from the Journey through Clinical Pastoral Education.

PubMed

McLean, Gillian

2015-12-01

CPE is an experience-based approach to learning spiritual care which combines clinical care with qualified supervision, in-class education and group reflection (CASC--http://www.spiritualcare.ca/). Through didactic seminars, group presentations and personal reading there is opportunity for the student to acquire, apply and integrate relevant theoretical information into their practice. Written for my CPE Specialist application, this paper describes how, through the course of advanced CPE education, I learn to utilize and integrate theory into my clinical work. Beginning with three strands--authenticity, listening and storytelling--I then discuss how the behavioural sciences and theology inform my practice. Focusing on empathy, I speak of the application of disclosure, the use of counter-transference as a diagnostic tool, and the place of therapeutic termination. Group theory, family systems theory, theological reflection, liturgical ministry, and multi-faith practices are considered. © The Author(s) 2015.

Pesticides

MedlinePlus

... This agency determines how pesticides are applied during farming and how much pesticide residue can remain in ... al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 157.

Implementation science theories to inform efforts for de-implementation of urologic oncology care practices resulting in overuse and misuse.

PubMed

Nielsen, Matthew E; Birken, Sarah A

2018-05-01

The field of implementation science has been conventionally applied in the context of increasing the application of evidence-based practices into clinical care, given evidence of underusage of appropriate interventions in many settings. Increasingly, however, there is recognition of the potential for similar frameworks to inform efforts to reduce the application of ineffective or potentially harmful practices. In this article, we provide some examples of clinical scenarios in which the quality problem may be overuse and misuse, and review relevant theories and frameworks that may inform improvement activities. Copyright © 2018 Elsevier Inc. All rights reserved.

SAFETY: an integrated clinical reasoning and reflection framework for undergraduate nursing students.

PubMed

Hicks Russell, Bedelia; Geist, Melissa J; House Maffett, Jenny

2013-01-01

Nurse educators can no longer focus on imparting to students knowledge that is merely factual and content specific. Activities that provide students with opportunities to apply concepts in real-world scenarios can be powerful tools. Nurse educators should take advantage of student-patient interactions to model clinical reasoning and allow students to practice complex decision making throughout the entire curriculum. In response to this change in nursing education, faculty in a pediatric course designed a reflective clinical reasoning activity based on the SAFETY template, which is derived from the National Council of State Boards of Nursing RN practice analysis. Students were able to prioritize key components of nursing care, as well as integrate practice issues such as delegation, Health Insurance Portability and Accountability Act violations, and questioning the accuracy of orders. SAFETY is proposed as a framework for integration of content knowledge, clinical reasoning, and reflection on authentic professional nursing concerns. Copyright 2012, SLACK Incorporated.

Profitability of a university-based clinic using benchmark time lengths for clinical encounters.

PubMed

Penneys, N S; Glaser, D A

1997-11-01

Reductions in reimbursement are applied to all physicians in a region equally. However, physicians do not practice in equivalent situations. For example, there are few fiscal allowances for academic functions associated with teaching and administration. Furthermore, university-based physicians may practice in clinical venues that cannot be as efficient as nonuniversity sites. Unavoidable inefficiencies may include (1) the costs of maintaining one historical record for a large noncontiguous practice; (2) university-required holiday schedules and sick leave, making university personnel less productive; (3) noncompetitive overhead rates assigned to clinic components by university financial offices; (4) university-based accounting systems that are not designed for effective cost control and the timely generation of useful management information; and (5) poorly managed billing services. Until now, declining reimbursements have generally led to sufficient efficiencies in delivery so that revenues and expenses can be in equilibrium.

The Cost to Successfully Apply for Level 3 Medical Home Recognition.

PubMed

Halladay, Jacqueline R; Mottus, Kathleen; Reiter, Kristin; Mitchell, C Madeline; Donahue, Katrina E; Gabbard, Wilson M; Gush, Kimberly

2016-01-01

The National Committee for Quality Assurance patient-centered medical home recognition program provides practices an opportunity to implement medical home activities. Understanding the costs to apply for recognition may enable practices to plan their work. Practice coaches identified 5 exemplar practices (3 pediatric and 2 family medicine practices) that received level 3 recognition. This analysis focuses on 4 that received recognition in 2011. Clinical, informatics, and administrative staff participated in 2- to 3-hour interviews. We determined the time required to develop, implement, and maintain required activities. We categorized costs as (1) nonpersonnel, (2) developmental, (3) those used to implement activities, (4) those used to maintain activities, (5) those to document the work, and (6) consultant costs. Only incremental costs were included and are presented as costs per full-time equivalent (pFTE) provider. Practice size ranged from 2.5 to 10.5 pFTE providers, and payer mixes ranged from 7% to 43% Medicaid. There was variation in the distribution of costs by activity by practice, but the costs to apply were remarkably similar ($11,453-15,977 pFTE provider). The costs to apply for 2011 recognition were noteworthy. Work to enhance care coordination and close loops were highly valued. Financial incentives were key motivators. Future efforts to minimize the burden of low-value activities could benefit practices. © Copyright 2016 by the American Board of Family Medicine.

Advanced practice nurses core competencies: a framework for developing and testing an advanced practice nurse discharge intervention.

PubMed

Cooke, Liz; Gemmill, Robin; Grant, Marcia

2008-01-01

The purpose of this paper was to describe evidenced-based interventions as implemented by advanced practice nurses (APNs) conducting intervention research with a vulnerable population of blood and marrow transplant patients. In addition, each of the 6 core competencies of the APN role identified by Hamric are outlined and applied using a patient case study. These competencies are the following: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and professional leadership, collaboration, and ethical decision making. This article chronicles a typical patient's journey through a post-hospital discharge nursing research study involving APNs as "intervention nurses" and discusses the various aspects of the APN core competencies throughout the process.

Current Role of Blood and Urine Biomarkers in the Clinical Care of Adults with Congenital Heart Disease.

PubMed

Rajpal, Saurabh; Alshawabkeh, Laith; Opotowsky, Alexander R

2017-06-01

There is an increasing number of adult patients with congenital heart disease (CHD). While several biomarkers have been validated and integrated into general cardiology clinical practice, these tests are often applied to adults with CHD in the absence of disease-specific validation. Although these patients are often grouped into a single population, there is heterogeneous pathophysiology, variable disease chronicity, extensive multisystem involvement, and a low event rate relative to acquired heart disease. These stand as challenges to systematic investigation and clinical application of biomarkers for adults with CHD. This paper reviews recent studies investigating the use of biomarkers in this population, with emphasis on biomarkers applied in clinical adult CHD care. A handful of biomarkers have been integrated into adult CHD practice, such as iron studies in cyanotic heart disease and stool alpha-1 antitrypsin for diagnosis of protein losing enteropathy in the Fontan circulation. Use of kidney and liver tests has been studied in prognostication of adult CHD patients. A few other biomarkers like natriuretic peptides and troponins seem likely to provide useful information in other ACHD situations based on limited disease-specific data and extrapolation from acquired heart disease. More research is needed to support the robust validity of most existing clinical biomarkers in adult congenital cardiology practice. Until data from larger, prospectively enrolled cohorts are available, clinical use of biomarkers in these patients will require careful interpretation with attention to underlying pathophysiology, as well as detailed understanding of potential pitfalls of specific assays and clinical contexts.

Understanding critical care nurses' autonomy in Jordan.

PubMed

Maharmeh, Mahmoud

2017-10-02

Purpose The aim of this study was to describe Jordanian critical care nurses' experiences of autonomy in their clinical practice. Design/methodology/approach A descriptive correlational design was applied using a self-reported cross-sectional survey. A total of 110 registered nurses who met the eligibility criteria participated in this study. The data were collected by a structured questionnaire. Findings A majority of critical care nurses were autonomous in their decision-making and participation in decisions to take action in their clinical settings. Also, they were independent to develop their own knowledge. The study identified that their autonomy in action and acquired knowledge were influenced by a number of factors such as gender and area of practice. Practical implications Nurse's autonomy could be increased if nurses are made aware of the current level of autonomy and explore new ways to increase empowerment. This could be offered through classroom lectures that concentrate on the concept of autonomy and its implication in practice. Nurses should demonstrate autonomous nursing care at the same time in the clinical practice. This could be done through collaboration between educators and clinical practice to help merge theory to practice. Originality/value Critical care nurses were more autonomous in action and knowledge base. This may negatively affect the quality of patient care and nurses' job satisfaction. Therefore, improving nurses' clinical decision-making autonomy could be done by the support of both hospital administrators and nurses themselves.

Oncology of Reptiles: Diseases, Diagnosis, and Treatment.

PubMed

Christman, Jane; Devau, Michael; Wilson-Robles, Heather; Hoppes, Sharman; Rech, Raquel; Russell, Karen E; Heatley, J Jill

2017-01-01

Based on necropsy review, neoplasia in reptiles has a comparable frequency to that of mammals and birds. Reptile neoplasia is now more frequently diagnosed in clinical practice based on increased use of advanced diagnostic techniques and improvements in reptilian husbandry allowing greater longevity of these species. This article reviews the current literature on neoplasia in reptiles, and focuses on advanced diagnostics and therapeutic options for reptilian patientssuffering neoplastic disease. Although most applied clinical reptile oncology is translated from dog and cat oncology, considerations specific to reptilian patients commonly encountered in clinical practice (turtles, tortoises, snakes, and lizards) are presented. Copyright © 2016 Elsevier Inc. All rights reserved.

Improving Injury Prevention Through Health Information Technology

PubMed Central

Haegerich, Tamara M.; Sugerman, David E.; Annest, Joseph L.; Klevens, Joanne; Baldwin, Grant T.

2015-01-01

Health information technology is an emerging area of focus in clinical medicine with the potential to improve injury and violence prevention practice. With injuries being the leading cause of death for Americans aged 1–44 years, greater implementation of evidence-based preventive services, referral to community resources, and real-time surveillance of emerging threats is needed. Through a review of the literature and capturing of current practice in the field, this paper showcases how health information technology applied to injury and violence prevention can lead to strengthened clinical preventive services, more rigorous measurement of clinical outcomes, and improved injury surveillance, potentially resulting in health improvement. PMID:25441230

The Effect of Clinical Simulation with Debriefing for Meaningful Learning in Courses of Nursing Theory and Practicum on Student Knowledge and Perception of Instruction

ERIC Educational Resources Information Center

Shea, Kathleen

2015-01-01

Nursing students are expected to apply knowledge from lectures and laboratories to the clinical setting. One major challenge of nursing educators is facilitating the transfer of knowledge to the clinical-practice setting. Simulation-based education provides students with an experiential-learning activity within the context of a simulated clinical…

[General and ethical considerations for the informed consent process: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)].

PubMed

Thibert, Jean-Baptiste; Polomeni, Alice; Yakoub-Agha, Ibrahim; Bordessoule, Dominique

2016-11-01

Informed consent is not restricted to clinical research and must be applied to high-risk care such as hematopoietic stem cell transplantation. If standardized informed consent might improve inequalities in medical practices between different transplantation centers, it is strongly recommended that it be adapted with an honest dialogue between physicians and patients and physicians and donors. In an attempt to harmonize clinical practices among French hematopoietic stem cell transplantation centers, the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) held its sixth annual workshop series in September 2015 in Lille. This event brought together practitioners from across the country. The purpose of this paper is to highlight the French law concerning patients' rights and ethical practices for an informed consent process to be applied to care or research. Copyright © 2016 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Can Nursing Students Practice What Is Preached? Factors Impacting Graduating Nurses' Abilities and Achievement to Apply Evidence-Based Practices.

PubMed

Blackman, Ian R; Giles, Tracey M

2017-04-01

In order to meet national Australian nursing registration requisites, nurses need to meet competency requirements for evidence-based practices (EBPs). A hypothetical model was formulated to explore factors that influenced Australian nursing students' ability and achievement to understand and employ EBPs related to health care provision. A nonexperimental, descriptive survey method was used to identify self-reported EBP efficacy estimates of 375 completing undergraduate nursing students. Factors influencing participants' self-rated EBP abilities were validated by Rasch analysis and then modeled using the partial least squares analysis (PLS Path) program. Graduating nursing students' ability to understand and apply EBPs for clinical improvement can be directly and indirectly predicted by eight variables including their understanding in the analysis, critique and synthesis of clinically based nursing research, their ability to communicate research to others and whether they had actually witnessed other staff delivering EBP. Forty-one percent of the variance in the nursing students' self-rated EBP efficacy scores is able to be accounted for by this model. Previous exposure to EBP studies facilitates participants' confidence with EBP, particularly with concurrent clinical EBP experiences. © 2017 Sigma Theta Tau International.

Multicultural Grand Rounds: Competency-Based Training Model for Clinical Psychology Graduate Students

ERIC Educational Resources Information Center

Stites, Shana D.; Warholic, Christina L.

2014-01-01

Preparing students to enter the field of psychology as competent professionals requires that multicultural practices be infused into all areas of training. This article describes how the Grand Rounds model was adapted to a graduate clinical psychology training program to foster applied learning in multicultural competence. This extension of Grand…

The Good Clinical Practice guideline and its interpretation - perceptions of clinical trial teams in sub-Saharan Africa.

PubMed

Vischer, N; Pfeiffer, C; Joller, A; Klingmann, I; Ka, A; Kpormegbe, S K; Burri, C

2016-08-01

To explore the advantages and challenges of working with the Good Clinical Practice (GCP)-International Conference of Harmonization (ICH) E6 guideline and its interpretation from the perspective of clinical trial teams based in sub-Saharan Africa. We conducted 60 key informant interviews with clinical trial staff at different levels in clinical research centres in Kenya, Ghana, Burkina Faso and Senegal and thematically analysed the responses. Clinical trial teams perceived working with ICH-GCP as highly advantageous and regarded ICH-GCP as applicable to their setting and efficiently applied. Only for informed consent did some clinical trial staff (one-third) perceive the guideline as insufficiently applicable. Specific challenges included meeting the requirements for written and individual consent, conditions for impartial witnesses for illiterates or legally acceptable representatives for children, guaranteeing voluntary participation and ensuring full understanding of the consent given. It was deemed important to have ICH-GCP compliance monitored by relevant ethics committees and regulatory authorities, without having guidelines applied overcautiously. Clinical trial teams in sub-Saharan Africa perceived GCP as a helpful guideline, despite having been developed by northern organisations and despite the high administrative burden of implementing it. To mitigate consent challenges, we suggest adapting GCP and making use of the flexibility it offers. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Forensic psychology and correctional psychology: Distinct but related subfields of psychological science and practice.

PubMed

Neal, Tess M S

2018-02-12

This article delineates 2 separate but related subfields of psychological science and practice applicable across all major areas of the field (e.g., clinical, counseling, developmental, social, cognitive, community). Forensic and correctional psychology are related by their historical roots, involvement in the justice system, and the shared population of people they study and serve. The practical and ethical contexts of these subfields is distinct from other areas of psychology-and from one another-with important implications for ecologically valid research and ethically sound practice. Forensic psychology is a subfield of psychology in which basic and applied psychological science or scientifically oriented professional practice is applied to the law to help resolve legal, contractual, or administrative matters. Correctional psychology is a subfield of psychology in which basic and applied psychological science or scientifically oriented professional practice is applied to the justice system to inform the classification, treatment, and management of offenders to reduce risk and improve public safety. There has been and continues to be great interest in both subfields-especially the potential for forensic and correctional psychological science to help resolve practical issues and questions in legal and justice settings. This article traces the shared and separate developmental histories of these subfields, outlines their important distinctions and implications, and provides a common understanding and shared language for psychologists interested in applying their knowledge in forensic or correctional contexts. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A practical guide to propensity score analysis for applied clinical research.

PubMed

Lee, Jaehoon; Little, Todd D

2017-11-01

Observational studies are often the only viable options in many clinical settings, especially when it is unethical or infeasible to randomly assign participants to different treatment régimes. In such case propensity score (PS) analysis can be applied to accounting for possible selection bias and thereby addressing questions of causal inference. Many PS methods exist, yet few guidelines are available to aid applied researchers in their conduct and evaluation of a PS analysis. In this article we give an overview of available techniques for PS estimation and application, balance diagnostic, treatment effect estimation, and sensitivity assessment, as well as recent advances. We also offer a tutorial that can be used to emulate the steps of PS analysis. Our goal is to provide information that will bring PS analysis within the reach of applied clinical researchers and practitioners. Copyright © 2017 Elsevier Ltd. All rights reserved.

Management of Dentin Hypersensitivity by National Dental Practice-Based Research Network practitioners: results from a questionnaire administered prior to initiation of a clinical study on this topic.

PubMed

Kopycka-Kedzierawski, Dorota T; Meyerowitz, Cyril; Litaker, Mark S; Chonowski, Sidney; Heft, Marc W; Gordan, Valeria V; Yardic, Robin L; Madden, Theresa E; Reyes, Stephanie C; Gilbert, Gregg H

2017-01-13

Dentin hypersensitivity (DH) is a common problem encountered in clinical practice. The purpose of this study was to identify the management approaches for DH among United States dentists. One hundred eighty five National Dental Practice-Based Research Network clinicians completed a questionnaire regarding their preferred methods to diagnose and manage DH in the practice setting, and their beliefs about DH predisposing factors. Almost all dentists (99%) reported using more than one method to diagnose DH. Most frequently, they reported using spontaneous patient reports coupled with excluding other causes of oral pain by direct clinical examination (48%); followed by applying an air blast (26%), applying cold water (12%), and obtaining patient reports after dentist's query (6%). In managing DH, the most frequent first choice was desensitizing, over-the-counter (OTC), potassium nitrate toothpaste (48%), followed by fluorides (38%), and glutaraldehyde/HEMA (3%). A total of 86% of respondents reported using a combination of products when treating DH, most frequently using fluoride varnish and desensitizing OTC potassium nitrate toothpaste (70%). The most frequent predisposing factor leading to DH, as reported by the practitioners, was recessed gingiva (66%), followed by abrasion, erosion, abfraction/attrition lesions (59%) and bruxism (32%). The majority of network practitioners use multiple methods to diagnose and manage DH. Desensitizing OTC potassium nitrate toothpaste and fluoride formulations are the most widely used products to manage DH in dental practice setting.

Advanced imaging techniques in brain tumors

PubMed Central

2009-01-01

Abstract Perfusion, permeability and magnetic resonance spectroscopy (MRS) are now widely used in the research and clinical settings. In the clinical setting, qualitative, semi-quantitative and quantitative approaches such as review of color-coded maps to region of interest analysis and analysis of signal intensity curves are being applied in practice. There are several pitfalls with all of these approaches. Some of these shortcomings are reviewed, such as the relative low sensitivity of metabolite ratios from MRS and the effect of leakage on the appearance of color-coded maps from dynamic susceptibility contrast (DSC) magnetic resonance (MR) perfusion imaging and what correction and normalization methods can be applied. Combining and applying these different imaging techniques in a multi-parametric algorithmic fashion in the clinical setting can be shown to increase diagnostic specificity and confidence. PMID:19965287

On the Assessment of Paramedic Competence: A Narrative Review with Practice Implications.

PubMed

Tavares, W; Boet, S

2016-02-01

Paramedicine is experiencing significant growth in scope of practice, autonomy, and role in the health care system. Despite clinical governance models, the degree to which paramedicine ultimately can be safe and effective will be dependent on the individuals the profession deems suited to practice. This creates an imperative for those responsible for these decisions to ensure that assessments of paramedic competence are indeed accurate, trustworthy, and defensible. The purpose of this study was to explore and synthesize relevant theoretical foundations and literature informing best practices in performance-based assessment (PBA) of competence, as it might be applied to paramedicine, for design or evaluation of assessment programs. A narrative review methodology was applied to focus intentionally, but broadly, on purpose relevant, theoretically derived research that could inform assessment protocols in paramedicine. Primary and secondary studies from a number of health professions that contributed to and informed best practices related to the assessment of paramedic clinical competence were included and synthesized. Multiple conceptual frameworks, psychometric requirements, and emerging lines of research are forwarded. Seventeen practice implications are derived to promote understanding as well as best practices and evaluation criteria for educators, employers, and/or licensing/certifying bodies when considering the assessment of paramedic competence. The assessment of paramedic competence is a complex process requiring an understanding, appreciation for, and integration of conceptual and psychometric principles. The field of PBA is advancing rapidly with numerous opportunities for research.

Biothermal Model of Patient for Brain Hypothermia Treatment

NASA Astrophysics Data System (ADS)

Wakamatsu, Hidetoshi; Gaohua, Lu

A biothermal model of patient is proposed and verified for the brain hypothermia treatment, since the conventionally applied biothermal models are inappropriate for their unprecedented application. The model is constructed on the basis of the clinical practice of the pertinent therapy and characterized by the mathematical relation with variable ambient temperatures, in consideration of the clinical treatments such as the vital cardiopulmonary regulation. It has geometrically clear representation of multi-segmental core-shell structure, database of physiological and physical parameters with a systemic state equation setting the initial temperature of each compartment. Its step response gives the time constant about 3 hours in agreement with clinical knowledge. As for the essential property of the model, the dynamic temperature of its face-core compartment is realized, which corresponds to the tympanic membrane temperature measured under the practical anesthesia. From the various simulations consistent with the phenomena of clinical practice, it is concluded that the proposed model is appropriate for the theoretical analysis and clinical application to the brain hypothermia treatment.

Integrating Research Into Clinical Internship Training Bridging the Science/Practice Gap in Pediatric Psychology

PubMed Central

Spirito, Anthony

2012-01-01

Existing literature highlights a critical gap between science and practice in clinical psychology. The internship year is a “capstone experience”; training in methods of scientific evaluation should be integrated with the development of advanced clinical competencies. We provide a rationale for continued exposure to research during the clinical internship year, including, (a) critical examination and integration of the literature regarding evidence-based treatment and assessment, (b) participation in faculty-based and independent research, and (c) orientation to the science and strategy of grantsmanship. Participation in research provides exposure to new empirical models and can foster the development of applied research questions. Orientation to grantsmanship can yield an initial sense of the “business of science.” Internship provides an important opportunity to examine the challenges to integrating the clinical evidence base into professional practice; for that reason, providing research exposure on internship is an important strategy in training the next generation of pediatric psychologists. PMID:22286345

Values-based practice in mental health and psychiatry.

PubMed

Woodbridge-Dodd, Kim

2012-11-01

Values-based practice (VBP) challenges traditions of clinical practice and moral decision-making and the literature published over the last 18 months demonstrates a growing momentum for its use. The VBP model has become part of the narrative of health and social care practice. It features in a range of publications and has been subject to philosophical analysis in relation to its theoretical rigour, and applied to clinical practice through education and training, implementation in the field and policy development. From a philosophical perspective the model faces several challenges; from a practice perspective it is welcomed as a necessary partner to Evidence-Based Practice. Both perspectives suggest VBP requires significant adjustment to professional ideas of good practice, expectations of the clinician service user relationship and notions of what constitutes good care. VBP is both a solution and a problem for clinicians. Whether VBP is seen as providing a much needed clinical skill for working with the complexity of mental health and psychiatry which is steeped in values or a solution to a dominant sociopolitical neoliberal ideology demand for choice and personalization of care, VBP will require clinicians to make personal changes to their values base that reach to the depths of their professional identity.

Evolution of Quality Assurance for Clinical Immunohistochemistry in the Era of Precision Medicine. Part 3: Technical Validation of Immunohistochemistry (IHC) Assays in Clinical IHC Laboratories.

PubMed

Torlakovic, Emina E; Cheung, Carol C; D'Arrigo, Corrado; Dietel, Manfred; Francis, Glenn D; Gilks, C Blake; Hall, Jacqueline A; Hornick, Jason L; Ibrahim, Merdol; Marchetti, Antonio; Miller, Keith; van Krieken, J Han; Nielsen, Soren; Swanson, Paul E; Vyberg, Mogens; Zhou, Xiaoge; Taylor, Clive R

2017-03-01

Validation of immunohistochemistry (IHC) assays is a subject that is of great importance to clinical practice as well as basic research and clinical trials. When applied to clinical practice and focused on patient safety, validation of IHC assays creates objective evidence that IHC assays used for patient care are "fit-for-purpose." Validation of IHC assays needs to be properly informed by and modeled to assess the purpose of the IHC assay, which will further determine what sphere of validation is required, as well as the scope, type, and tier of technical validation. These concepts will be defined in this review, part 3 of the 4-part series "Evolution of Quality Assurance for Clinical Immunohistochemistry in the Era of Precision Medicine."

Communities of Practice for Senior Volunteers: A Mutual Engagement Perspective

ERIC Educational Resources Information Center

Gau, Wen-Bing

2011-01-01

Although the concept of communities of practice (CoPs) has been applied to many fields, the application within the context of the senior citizens' interaction must be different from those in the vocational arena. In Toy Clinic Shops (TCSs) in Taiwan, senior volunteers together sharpen their skills of repairing toys for school children, which can…

Team Learning to Narrow the Gap between Healthcare Knowledge and Practice

ERIC Educational Resources Information Center

Anand, Tejwansh S.

2014-01-01

This study explored team-based learning in teams of healthcare professionals working on making meaning of evidence-based clinical guidelines in their field to apply them within their practice setting. The research based team learning models posited by Kasl, Marsick, and Dechant (1997) and Edmondson, Dillon, and Roloff (2007) were used as the…

Recent Innovations in the Changing Criterion Design: Implications for Research and Practice in Special Education

ERIC Educational Resources Information Center

McDougall, Dennis; Hawkins, Jacqueline; Brady, Michael; Jenkins, Amelia

2006-01-01

This article illustrates (a) 2 recent innovations in the changing criterion research design, (b) how these innovations apply to research and practice in special education, and (c) how clinical needs influence design features of the changing criterion design. The first innovation, the range-bound changing criterion, is a very simple variation of…

Addressing the Research-to-Practice Gap in Autism Treatments: Applying an Effectiveness Research Model to the Picture Exchange Communication System

ERIC Educational Resources Information Center

Greenberg, Alissa L.

2011-01-01

Despite expansive improvements in both treatments and research, the majority of persons with autism use non-empirically supported interventions. One way to decrease the research-to-practice gap involves increasing the direct applicability of research findings to clinical settings. Effectiveness research achieves this goal by identifying treatments…

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. © 2016 Pharmacotherapy Publications, Inc.

Barriers for integrating personalized medicine into clinical practice: a qualitative analysis.

PubMed

Najafzadeh, Mehdi; Davis, Jennifer C; Joshi, Pamela; Marra, Carlo

2013-04-01

Personalized medicine-tailoring interventions based on individual's genetic information-will likely change routine clinical practice in the future. Yet, how practitioners plan to apply genetic information to inform medical decision making remains unclear. We aimed to investigate physician's perception about the future role of personalized medicine, and to identify the factors that influence their decision in using genetic testing in their practice. We conducted three semi-structured focus groups in three health regions (Fraser, Vancouver coastal, and Interior) in British Columbia, Canada. In the focus groups, participants discussed four topics on personalized medicine: (i) physicians' general understanding, (ii) advantages and disadvantages, (iii) potential impact and role in future clinical practice, and (iv) perceived barriers to integrating personalized medicine into clinical practice. Approximately 36% (n = 9) of physicians self-reported that they were not familiar with the concept of personalized medicine. After introducing the concept, the majority of physicians (68%, n = 19 of 28) were interested in incorporating personalized medicine in their practice, provided they have access to the necessary knowledge and tools. Participants mostly believed that genetic developments will directly affect their practice in the future. The key concerns highlighted were physician's access to clinical guidelines and training opportunities for the use of genetic testing and data interpretation. Despite the challenges that personalized medicine can create, in general, physicians in the focus groups expressed strong interest in using genetic information in their practice if they have access to the necessary knowledge and tools. Copyright © 2013 Wiley Periodicals, Inc.

TU-C-218-01: Effective Medical Imaging Physics Education.

PubMed

Sprawls, P

2012-06-01

A practical and applied knowledge of physics and the associated technology is required for the clinically effective and safe use of the various medical imaging modalities. This is needed by all involved in the imaging process, including radiologists, especially residents in training, technologists, and physicists who provide consultation on optimum and safe procedures and as educators for the other imaging professionals. This area of education is undergoing considerable change and evolution for three reasons: 1. Increasing capabilities and complexity of medical imaging technology and procedures, 2.Expanding scope and availability of educational resources, especially on the internet, and 3. A significant increase in our knowledge of the mental learning process and the design of learning activities to optimize effectiveness and efficiency, especially for clinically applied physics. This course will address those three issues by providing guidance on establishing appropriate clinically focused learning outcomes, a review of the brain function for enhancing clinically applied physics, and the design and delivery of effective learning activities beginning with the classroom and continuing through learning physics during the clinical practice of radiology. Characteristics of each type of learning activity will be considered with respect to effectiveness and efficiency in achieving appropriate learning outcomes. A variety of available resources will be identified and demonstrated for use in the different phases of learning process. A major focus is on enhancing the role of the medical physicist in clinical radiology both as a resource and educator with contemporary technology being the tool, but not the teacher. 1. Develop physics learning objectives that will support effective and safe medical imaging procedures. 2. Understand specific brain functions that are involved in learning and applying physics. 3. Describe the characteristics and development of mental knowledge structures for applied clinical physics. 4. List the established levels of learning and associate each with specific functions that can be performed. 5. Analyze the different types of learning activities (classroom, individual study, clinical, etc.) with respect to effectiveness and efficiency. 6. Design and Provide a comprehensive physics education program with each activity optimized with respect to outcomes and available resources. © 2012 American Association of Physicists in Medicine.

Donepezil treatment and Alzheimer disease: can the results of randomized clinical trials be applied to Alzheimer disease patients in clinical practice?

PubMed

Tinklenberg, Jared R; Kraemer, Helena C; Yaffe, Kristine; Ross, Leslie; Sheikh, Javaid; Ashford, John W; Yesavage, Jerome A; Taylor, Joy L

2007-11-01

To determine if results from randomized clinical trials of donepezil in Alzheimer disease (AD) patients can be applied to AD patients in clinical practice by comparing the findings from a Nordic one-year randomized AD donepezil trial with data from a one-year prospective, observational study of AD patients. AD patients from a consortium of California sites were systematically followed for at least one year. Their treatment regimens, including prescription of donepezil, were determined by their individual physician according to his or her usual criteria. The 148 California patients treated with donepezil had a one-year decline of 1.3 (3.5 SD) points on the Mini-Mental State Exam compared to a decline of 3.3 (4.4 SD) in the 158 AD patients who received no anti-Alzheimer drugs. The Mini-Mental State Exam decline in Nordic sample was approximately 0.25 points for the 91 patients receiving donepezil and approximately 2.2 for the 98 placebo patients. The overall effect sizes were estimated at about 0.49 in both studies. The California data were further analyzed using propensity methods; after taking into account differences that could bias prescribing decisions, benefits associated with taking donepezil remained. A comparison of a randomized clinical trial of donepezil in AD patients and this observational study indicates that if appropriate methodological and statistical precautions are undertaken, then results from randomized clinical trials can be predictive with AD patients in clinical practice. This California study supports the modest effectiveness of donepezil in AD patients having clinical characteristics similar to those of the Nordic study.

[Ethical issues of treatment with embryonic steam cells].

PubMed

Siluianova, I V

2007-01-01

Review of ethical issues related to the application of embryonic steam cells (SC) for the treatment of different diseases is presented. On the background of ethical considerations, limits and possibilities as well as advantages and shortcomings of using steam cells in the clinical practice are discussed. On the basis of analysis of scientific reference data and ethical side of the given issue, it may be concluded that the principle "don't harm" must be applied also and especially for the use if this particular type of treatment in the clinical practice.

OSHA regulations: how they relate to ophthalmic practice.

PubMed

Garber, N

1992-01-01

The OSHA regulations, which took effect March 6, 1992, require that all employees be trained in infection control practices when they are hired, their job description changes, or the standards for universal precautions are revised. An explanation, provided to inform employees where a copy of the OSHA standard can be reviewed should be available at each clinical and surgical site, and OSHA regulation definitions must also be posted. The OSHA regulation applies to any clinical, housekeeping, or administrative staff that has any potential risk of exposure to blood or other potentially infectious substances.

School-based pediatric physical therapists' perspectives on evidence-based practice.

PubMed

Schreiber, Joe; Stern, Perri; Marchetti, Gregory; Provident, Ingrid; Turocy, Paula Sammarone

2008-01-01

This study described the current knowledge, beliefs, attitudes, and practices of a group of school-based pediatric physical therapists regarding evidence-based practice (EBP). Five practitioners participated in this project. Each was interviewed individually and in a group and completed a quantitative survey. All of the participants had a positive attitude toward EBP and believed that it should be an important element of clinical practice. Knowledge and practice were more variable, with several individuals reporting a lack of confidence in this area and an inability to routinely implement EBP. These participants were more likely to rely on colleagues, interaction with their supervisor, and professional experience to aid in decision making than research evidence. Pediatric physical therapists face numerous challenges accessing, analyzing, and applying research evidence. It is critical for the profession to identify optimal ways to support practitioners in this aspect of clinical practice.

Hereditary arrhythmias and cardiomyopathies: decision-making about genetic testing.

PubMed

Louis, Clauden; Calamaro, Emily; Vinocur, Jeffrey M

2018-01-01

The modern field of clinical genetics has advanced beyond the traditional teachings familiar to most practicing cardiologists. Increased understanding of the roles of genetic testing may improve uptake and appropriateness of use. Clinical genetics has become integral to the management of patients with hereditary arrhythmia and cardiomyopathy diagnoses. Depending on the condition, genetic testing may be useful for diagnosis, prognosis, treatment, family screening, and reproductive planning. However, genetic testing is a powerful tool with potential for underuse, overuse, and misuse. In the absence of a substantial body of literature on how these guidelines are applied in clinical practice, we use a case-based approach to highlight key lessons and pitfalls. Importantly, in many scenarios genetic testing has become the standard of care supported by numerous class I recommendations; genetic counselors can improve accessibility to and appropriate use and application of testing. Optimal management of hereditary arrhythmias and cardiomyopathies incorporates genetic testing, applied as per consensus guidelines, with involvement of a multidisciplinary team.

Study and classification of the abdominal adiposity throughout the application of the two-dimensional predictive equation Garaulet et al., in the clinical practice.

PubMed

Piernas Sánchez, C M; Morales Falo, E M; Zamora Navarro, S; Garaulet Aza, M

2010-01-01

The excess of visceral abdominal adipose tissue is one of the major concerns in obesity and its clinical treatment. To apply the two-dimensional predictive equation proposed by Garaulet et al. to determine the abdominal fat distribution and to compare the results with the body composition obtained by multi-frequency bioelectrical impedance analysis (M-BIA). We studied 230 women, who underwent anthropometry and M-BIA. The predictive equation was applied. Multivariate lineal and partial correlation analyses were performed with control for BMI and % body fat, using SPSS 15.0 with statistical significance P < 0.05. Overall, women were considered as having subcutaneous distribution of abdominal fat. Truncal fat, regional fat and muscular mass were negatively associated with VA/SA(predicted), while the visceral index obtained by M-BIA was positively correlated with VA/SA(predicted). The predictive equation may be useful in the clinical practice to obtain an accurate, costless and safe classification of abdominal obesity.

Evaluating the effects of variation in clinical practice: a risk adjusted cost-effectiveness (RAC-E) analysis of acute stroke services.

PubMed

Pham, Clarabelle; Caffrey, Orla; Ben-Tovim, David; Hakendorf, Paul; Crotty, Maria; Karnon, Jonathan

2012-08-21

Methods for the cost-effectiveness analysis of health technologies are now well established, but such methods may also have a useful role in the context of evaluating the effects of variation in applied clinical practice. This study illustrates a general methodology for the comparative analysis of applied clinical practice at alternative institutions--risk adjusted cost-effectiveness (RAC-E) analysis--with an application that compares acute hospital services for stroke patients admitted to the main public hospitals in South Australia. Using linked, routinely collected data on all South Australian hospital separations from July 2001 to June 2008, an analysis of the RAC-E of services provided at four metropolitan hospitals was undertaken using a decision analytic framework. Observed (plus extrapolated) and expected lifetime costs and survival were compared across patient populations, from which the relative cost-effectiveness of services provided at the different hospitals was estimated. Unadjusted results showed that at one hospital patients incurred fewer costs and gained more life years than at the other hospitals (i.e. it was the dominant hospital). After risk adjustment, the cost minimizing hospital incurred the lowest costs, but with fewer life-years gained than one other hospital. The mean incremental cost per life-year gained of services provided at the most effective hospital was under $20,000, with an associated 65% probability of being cost-effective at a $50,000 per life year monetary threshold. RAC-E analyses can be used to identify important variation in the costs and outcomes associated with clinical practice at alternative institutions. Such data provides an impetus for further investigation to identify specific areas of variation, which may then inform the dissemination of best practice service delivery and organisation.

First-order logic theory for manipulating clinical practice guidelines applied to comorbid patients: a case study.

PubMed

Michalowski, Martin; Wilk, Szymon; Tan, Xing; Michalowski, Wojtek

2014-01-01

Clinical practice guidelines (CPGs) implement evidence-based medicine designed to help generate a therapy for a patient suffering from a single disease. When applied to a comorbid patient, the concurrent combination of treatment steps from multiple CPGs is susceptible to adverse interactions in the resulting combined therapy (i.e., a therapy established according to all considered CPGs). This inability to concurrently apply CPGs has been shown to be one of the key shortcomings of CPG uptake in a clinical setting1. Several research efforts are underway to address this issue such as the K4CARE2 and GuideLine INteraction Detection Assistant (GLINDA)3 projects and our previous research on applying constraint logic programming to developing a consistent combined therapy for a comorbid patient4. However, there is no generalized framework for mitigation that effectively captures general characteristics of the problem while handling nuances such as time and ordering requirements imposed by specific CPGs. In this paper we propose a first-order logic-based (FOL) approach for developing a generalized framework of mitigation. This approach uses a meta-algorithm and entailment properties to mitigate (i.e., identify and address) adverse interactions introduced by concurrently applied CPGs. We use an illustrative case study of a patient suffering from type 2 diabetes being treated for an onset of severe rheumatoid arthritis to show the expressiveness and robustness of our proposed FOL-based approach, and we discuss its appropriateness as the basis for the generalized theory.

The integration of behavioral health interventions in children's health care: services, science, and suggestions.

PubMed

Kolko, David J; Perrin, Ellen

2014-01-01

Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This article examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices, and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and address methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare.

The gap between currently available evidence and awareness in clinical practice of wound care: It is the time to shower earlier.

PubMed

Yu, Ya-Hsuan; Chao, Sylvia; Lin, Yen-Kuang; Chou, Yun-Yun; Liao, Hsun-Hsiang; Loh, El-Wui; Wong, Chung-Shun; Tam, Ka-Wai

2018-03-01

A postoperative water-forbidden strategy has been used for many decades. However, evidence shows that early contact with water postoperatively does not increase the infection rate. Our study evaluated the gap between currently available evidence and awareness in clinical practice of postoperative wound care. We conducted a systematic review to compare the outcomes between postoperative water-contact and water-forbidden groups. PubMed, EMBASE, and Cochrane databases were searched. A meta-analysis was conducted to calculate a pooled effect size by using random-effects models. On the basis of pooling results, a questionnaire survey was conducted to evaluate the gap from systematic review to clinical practice by clinical staff and patients. We reviewed 12 trials including 4,086 patients. Incidence of infection and wound complications did not differ significantly between water-contact and water-forbidden groups. Satisfaction was significantly higher in water-contact group than in water-forbidden group (risk ratio: 17.33; 95% confidence interval, 11.11-27.03). A survey of clinicians showed that awareness, acceptance of the evidence, and the current water-contact strategy differed among departments. However, many clinicians showed no willingness to apply the water-contact strategy for various reasons. A survey of patients showed low awareness of the issue and variety in willingness to contact water. Water-forbidden strategy causes inconvenience to patients. However, a majority of patients and clinicians still hesitated to apply the early water-contact strategy, even after viewing the results of the current review. Establishment of local clinical practice guidelines, advocacy from authorities, and promotion by social media for this strategy are warranted. Copyright © 2018 Elsevier Inc. All rights reserved.

The effects of a spiritual learning program on improving spiritual health and clinical practice stress among nursing students.

PubMed

Hsiao, Ya-Chu; Chiang, Hui-Ying; Lee, Hsiang-Chun; Chen, Su-Hui

2012-12-01

Numerous studies have indicated an association between spirituality and health outcomes. However, little information is available about interventions that have been shown to enhance spiritual health and decrease stress. This study examined the effects of a spiritual learning program (SLP) on nursing student-perceived spiritual health and clinical practice stress. A convenience sample of nursing students currently enrolled at a nursing school in northern Taiwan were recruited to participate in this quasiexperimental study as participants to experimental and control groups via simple random sampling. Results from a spiritual health scale and a perceived clinical practice stress scale, together with the score for clinical nursing practice, were compared between the groups. Baseline data were collected from all participants. The experimental group participated in 8 weeks of 50-minute per week SLP, which included lectures, discussion, reflection, and spiritual practices. A second data set was collected from all participants after the intervention. A third data set was collected after all participants had performed 4 weeks of nursing clinical practice. Participants were all women. Average age was 19.4 years (SD = 1.3 years). Generalized estimating equation analysis showed SLP to have a significant short-term effect on improving the total score for spiritual health (p < .01). Significantly greater improvement in clinical practice stress scores was also seen in the experimental group as compared with the control group (all p < .05). The experimental group obtained a higher score of the final clinical practice than the control group (t = 3.771, p < .001). The SLP may encourage participants to see stressors as meaningful events that are connected to individual life purposes. The program developed in this study may be used to improve spiritual health and reduce stress in nursing students' clinical practice. This SLP may be referenced when designing similar spirituality-related courses and applied to nursing student counseling.

Data governance for health care providers.

PubMed

Andronis, Katerina; Moysey, Kevin

2013-01-01

Data governance is characterised from broader definitions of governance. These characteristics are then mapped to a framework that provides a practical representation of the concepts. This representation is further developed with operating models and roles. Several information related scenarios covering both clinical and non-clinical domains are considered in information terms and then related back to the data governance framework. This assists the reader in understanding how data governance would help address the issues or achieve a better outcome. These elements together enable the reader to gain an understanding of the data governance framework and how it applies in practice. Finally, some practical advice is offered for establishing and operating data governance as well as approaches for justifying the investment.

Implementation strategies of Systems Medicine in clinical research and home care for cardiovascular disease patients.

PubMed

Montecucco, Fabrizio; Carbone, Federico; Dini, Frank Lloyd; Fiuza, Manuela; Pinto, Fausto J; Martelli, Antonietta; Palombo, Domenico; Sambuceti, Gianmario; Mach, François; De Caterina, Raffaele

2014-11-01

Insights from the "-omics" science have recently emphasized the need to implement an overall strategy in medical research. Here, the development of Systems Medicine has been indicated as a potential tool for clinical translation of basic research discoveries. Systems Medicine also gives the opportunity of improving different steps in medical practice, from diagnosis to healthcare management, including clinical research. The development of Systems Medicine is still hampered however by several challenges, the main one being the development of computational tools adequate to record, analyze and share a large amount of disparate data. In addition, available informatics tools appear not yet fully suitable for the challenge because they are not standardized, not universally available, or with ethical/legal concerns. Cardiovascular diseases (CVD) are a very promising area for translating Systems Medicine into clinical practice. By developing clinically applied technologies, the collection and analysis of data may improve CV risk stratification and prediction. Standardized models for data recording and analysis can also greatly broaden data exchange, thus promoting a uniform management of CVD patients also useful for clinical research. This advance however requires a great organizational effort by both physicians and health institutions, as well as the overcoming of ethical problems. This narrative review aims at providing an update on the state-of-art knowledge in the area of Systems Medicine as applied to CVD, focusing on current critical issues, providing a road map for its practical implementation. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Development of clinical sites.

PubMed

O'Brien, Mary

2015-02-01

Clinical experiences are vital to all types of healthcare educational programs. Supervised clinical experiences provide the opportunity for the learner to apply didactic knowledge and theory to real world situations and hone skills necessary for entry into practice. Nurse anesthesia programs utilize a wide variety of clinical sites to expose student registered nurse anesthetists to experiences that will prepare them clinically, academically and professionally to enter practice as a Certified Registered Nurse Anesthetist. This article describes the process of developing a clinical site. A thorough evaluation will determine the types of experiences meant to be offered at the site, the resources available to house and educate the students, and how to evaluate the effectiveness of the clinical site. Open communication between the clinical coordinator and the program director or designee is essential to ensure success of the clinical site. The Council on Accreditation of Nurse Anesthesia Educational Programs has resources available to guide those interested in becoming a clinical site, as well as for program administrators who seek to add new experiences to their programs.

An evaluation of an interprofessional practice-based learning environment using student reflections.

PubMed

Housley, Cora L; Neill, Kathryn K; White, Lanita S; Tedder, Andrea T; Castleberry, Ashley N

2018-01-01

The 12th Street Health and Wellness Center is an interprofessional, student-led, community-based clinic. Students from all University of Arkansas for Medical Sciences colleges work together to provide healthcare services for residents of an underserved community. Interprofessional student teams assess patients and present to an interprofessional preceptor team. At the conclusion of clinic, teams reflect on their experience. The objective of this study is to generate key themes from the end of clinic reflections to describe learning outcomes in an interprofessional practice environment. Student teams were asked to reflect on what they learned about patient care and interprofessional practice while volunteering at the clinic. Three hundred eighty reflection statements were assessed using the constant comparative approach with open coding by three researchers who identified and categorised themes by selecting key phrases from reflections. Eight themes emerged from this process which illuminated students' self-perceived development during practice-based learning and interprofessional collaboration. Key phrases were also coded to the four core Interprofessional Education Collaborative competency domains. These results suggest learners' perception that the Center is a practice-based environment that provides an opportunity to learn, integrate, and apply interprofessional curricular content.

Long-Term Stability of Membership in a Wechsler Intelligence Scale for Children--Third Edition (WISC-III) Subtest Core Profile Taxonomy

ERIC Educational Resources Information Center

Borsuk, Ellen R.; Watkins, Marley W.; Canivez, Gary L.

2006-01-01

Although often applied in practice, clinically based cognitive subtest profile analysis has failed to achieve empirical support. Nonlinear multivariate subtest profile analysis may have benefits over clinically based techniques, but the psychometric properties of these methods must be studied prior to their implementation and interpretation. The…

Entry-Level Athletic Trainers' Perceived Adequacy of Clinical Education in Preparation for Confident Professional Practice

ERIC Educational Resources Information Center

Shinew, Kayla A.

2011-01-01

Athletic training educators are responsible for giving athletic training students a proper environment in which they have opportunities to apply didactic knowledge using critical thinking and decision making skills in a real world context (Radtke, 2008). Clinical education needs to play an integral role in developing athletic training students…

Strategic planning applied to quality in asthma management for children.

PubMed

Goonan, K J; Healy, J M; Jordan, H S; Zazzali, J L; Horowitz, M

1993-01-01

This strategic plan translates the HCHP vision statement into a working plan for one major clinical condition--asthma in children. It is a working plan for clinicians and managers across specialties and levels. The results of the projects will improve in a measurable way significant clinical practice and outcomes, in keeping with the FY 1993 strategic goals.

The second 'D.D.S.' degree: a formula for practice success.

PubMed

Paquette, Jacinthe M; Sheets, Cherilyn G

2004-09-01

Planning for success is critical in clinical dentistry and in the management of a dental practice. Dentists need to apply basic business principles to planning their dental careers as they develop a vision, deliver quality products and services, and surpass patients,' staff members' and their own expectations. By applying general business management principles, dental practices can develop a logical, systematic approach to the management of a professional services business. For many dental professionals, these concepts were not learned in an undergraduate dental educational program and need to be mastered after professional school. Ideally, each dentist will establish a philosophical course that provides direction to the practice of dentistry. For a private dental practitioner, part of his or her goal is to create a tangible, transferable asset and a solid business plan that can benefit the practitioner in the present, as well as in the future practice transition.

Clinical peripherality: development of a peripherality index for rural health services.

PubMed

Swan, Gillian M; Selvaraj, Sivasubramaniam; Godden, David J

2008-01-25

The configuration of rural health services is influenced by geography. Rural health practitioners provide a broader range of services to smaller populations scattered over wider areas or more difficult terrain than their urban counterparts. This has implications for training and quality assurance of outcomes. This exploratory study describes the development of a "clinical peripherality" indicator that has potential application to remote and rural general practice communities for planning and research purposes. Profiles of general practice communities in Scotland were created from a variety of public data sources. Four candidate variables were chosen that described demographic and geographic characteristics of each practice: population density, number of patients on the practice list, travel time to nearest specialist led hospital and travel time to Health Board administrative headquarters. A clinical peripherality index, based on these variables, was derived using factor analysis. Relationships between the clinical peripherality index and services offered by the practices and the staff profile of the practices were explored in a series of univariate analyses. Factor analysis on the four candidate variables yielded a robust one-factor solution explaining 75% variance with factor loadings ranging from 0.83 to 0.89. Rural and remote areas had higher median values and a greater scatter of clinical peripherality indices among their practices than an urban comparison area. The range of services offered and the profile of staffing of practices was associated with the peripherality index. Clinical peripherality is determined by the nature of the practice and its location relative to secondary care and administrative and educational facilities. It has features of both gravity model-based and travel time/accessibility indicators and has the potential to be applied to training of staff for rural and remote locations and to other aspects of health policy and planning. It may assist planners in conceptualising the effects on general practices of centralising specialist clinical services or administrative and educational facilities.

Clinical peripherality: development of a peripherality index for rural health services

PubMed Central

Swan, Gillian M; Selvaraj, Sivasubramaniam; Godden, David J

2008-01-01

Background The configuration of rural health services is influenced by geography. Rural health practitioners provide a broader range of services to smaller populations scattered over wider areas or more difficult terrain than their urban counterparts. This has implications for training and quality assurance of outcomes. This exploratory study describes the development of a "clinical peripherality" indicator that has potential application to remote and rural general practice communities for planning and research purposes. Methods Profiles of general practice communities in Scotland were created from a variety of public data sources. Four candidate variables were chosen that described demographic and geographic characteristics of each practice: population density, number of patients on the practice list, travel time to nearest specialist led hospital and travel time to Health Board administrative headquarters. A clinical peripherality index, based on these variables, was derived using factor analysis. Relationships between the clinical peripherality index and services offered by the practices and the staff profile of the practices were explored in a series of univariate analyses. Results Factor analysis on the four candidate variables yielded a robust one-factor solution explaining 75% variance with factor loadings ranging from 0.83 to 0.89. Rural and remote areas had higher median values and a greater scatter of clinical peripherality indices among their practices than an urban comparison area. The range of services offered and the profile of staffing of practices was associated with the peripherality index. Conclusion Clinical peripherality is determined by the nature of the practice and its location relative to secondary care and administrative and educational facilities. It has features of both gravity model-based and travel time/accessibility indicators and has the potential to be applied to training of staff for rural and remote locations and to other aspects of health policy and planning. It may assist planners in conceptualising the effects on general practices of centralising specialist clinical services or administrative and educational facilities. PMID:18221533

Part of the fabric and mostly right: an ethnography of ethics in clinical practice.

PubMed

Doran, Evan; Fleming, Jennifer; Jordens, Christopher; Stewart, Cameron L; Letts, Julie; Kerridge, Ian H

2015-06-15

To describe how ethics is practised in a health care setting, and to ascertain whether there was interest in establishing clinical ethics support services. Observations and interviews undertaken between April and November 2012 in a large NSW urban hospital with newborn care, maternity and oncology departments and analysed by coding and categorising the data. Key themes in the participants' attitudes to professional ethics were identified. Ethics is not typically an explicit feature of clinical deliberations, and clinicians tend to apply basic ethical principles when ethical problems are identified. They also discuss difficult decisions with colleagues, and try to resolve ethical differences by discussion. Participants judged the ethics of clinical practice to be "mostly right", primarily because ethics is "part of the fabric" of everyday clinical work that aspires to "optimising care". Nevertheless, most clinicians would welcome ethics support because ethics is integral to health care practice, is not always "done well", and may be the source of conflict. Ethics is very much a part of the fabric of clinical practice, and the ethical challenges that arise in patient care in this particular setting are generally managed adequately. However, many clinicians have concerns about the ethical aspects of some practices and decisions, and believe that access to expert ethics support would be useful. Helping clinicians to provide ethically sound patient care should be a priority for health care providers across Australia.

Applying the RE-AIM Framework to Evaluate the Dissemination and Implementation of Clinical Practice Guidelines for Sexually Transmitted Infections.

PubMed

Jeong, Heon-Jae; Jo, Heui-Sug; Oh, Moo-Kyung; Oh, Hyung-Won

2015-07-01

Clinical practice guidelines (CPG) are one of the most effective ways to translate evidence of medical improvement into everyday practice. This study evaluated the dissemination and implementation of the Sexually Transmitted Infections-Korean Guidelines (STIKG) by applying the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework. A survey questionnaire was administered to clinicians via the internet. Among the 332 respondents, 190 (57.2%) stated that they were aware of STIKG and 107 (33.2%) implemented STIKG in their practice. The odds that a physician was exposed to STIKG (dissemination) were 2.61 times greater among physicians with previous training or education for any CPG than those who did not. Clinicians who indicated that STIKG were easy to understand were 4.88 times more likely to implement STIKG in their practice than those who found them not so easy. When a clinician's workplace had a supporting system for CPG use, the odds of implementation was 3.76 times higher. Perceived level of effectiveness of STIKG did not significantly influence their implementation. The findings of this study suggest that, ultimately, knowing how to engage clinicians in CPG implementation is as important as how to disseminate such guidelines; moreover, easy-to-use guidelines and institutional support are key factors.

A French network of bipolar expert centres: a model to close the gap between evidence-based medicine and routine practice.

PubMed

Henry, Chantal; Etain, Bruno; Mathieu, Flavie; Raust, Aurélie; Vibert, Jean-Francois; Scott, Jan; Leboyer, Marion

2011-06-01

Bipolar disorders are a major public health concern. Efforts to provide optimal care by general practitioners and psychiatrists are undermined by the complexity of the disorder and difficulties in applying clinical practice guidelines and new research findings to the spectrum of cases seen in day to day practice. A national network of bipolar expert centres was established. Each centre has established strong links to local health services and provides support to clinicians in delivering personalized care plans derived from systematic case assessments undertaken at the centre. A common set of diagnostic and clinical assessment tools has been adopted at eight centres. Evaluations are undertaken by trained assessors and cross-centre reliability is monitored. A web application, e-bipolar© is used to record data in a common computerized medical file. Anonymized data is entered into a shared national database for use in multi-centre audit and research. Instead of offering treatment advice based on clinical practice guidelines recommendations for selected sub-populations of patients (a 'top-down' approach), the French bipolar network offers systematic, comprehensive, longitudinal, and multi-dimensional assessments of cases representative of general bipolar populations. This 'bottom-up' strategy may offer a more efficient and effective way to transfer knowledge and share expertise as the referrer can appreciate the rationale underpinning suggested treatment protocols and more readily apply such principles and approaches to other cases. The network also builds an infrastructure for clinical cohort and comparative-effectiveness research on more representative patient populations. Copyright © 2010 Elsevier B.V. All rights reserved.

Integrating Science and Engineering to Implement Evidence-Based Practices in Health Care Settings.

PubMed

Wu, Shinyi; Duan, Naihua; Wisdom, Jennifer P; Kravitz, Richard L; Owen, Richard R; Sullivan, J Greer; Wu, Albert W; Di Capua, Paul; Hoagwood, Kimberly Eaton

2015-09-01

Integrating two distinct and complementary paradigms, science and engineering, may produce more effective outcomes for the implementation of evidence-based practices in health care settings. Science formalizes and tests innovations, whereas engineering customizes and optimizes how the innovation is applied tailoring to accommodate local conditions. Together they may accelerate the creation of an evidence-based healthcare system that works effectively in specific health care settings. We give examples of applying engineering methods for better quality, more efficient, and safer implementation of clinical practices, medical devices, and health services systems. A specific example was applying systems engineering design that orchestrated people, process, data, decision-making, and communication through a technology application to implement evidence-based depression care among low-income patients with diabetes. We recommend that leading journals recognize the fundamental role of engineering in implementation research, to improve understanding of design elements that create a better fit between program elements and local context.

Clinical complexity and Occam's razor: navigating between Scylla and Charibdy of the geriatric practice. A case of secondary hypertension in a very old patient.

PubMed

Turco, Renato; Torpilliesi, Tiziana; Morghen, Sara; Bellelli, Giuseppe; Trabucchi, Marco

2009-05-01

The clinical approach toward elderly patients is often very complex and associated with an increased risk of medical errors. This case report is an example of how various objective (related to patient) and subjective (related to physicians) factors may influence the optimal diagnostic approach in elderly frail patients. We also discuss geriatric practice, which must be characterized by the intellectual honesty to refuse any sort of prejudices (such as ageism) and by the skill to navigate between the Scylla (ie, viewing clinical problems as unrelated to each other) and the Charibdy (ie, applying the Occam's razor principle) of the patient's complexity.

Clarifying assumptions to enhance our understanding and assessment of clinical reasoning.

PubMed

Durning, Steven J; Artino, Anthony R; Schuwirth, Lambert; van der Vleuten, Cees

2013-04-01

Deciding on a diagnosis and treatment is essential to the practice of medicine. Developing competence in these clinical reasoning processes, commonly referred to as diagnostic and therapeutic reasoning, respectively, is required for physician success. Clinical reasoning has been a topic of research for several decades, and much has been learned. However, there still exists no clear consensus regarding what clinical reasoning entails, let alone how it might best be taught, how it should be assessed, and the research and practice implications therein.In this article, the authors first discuss two contrasting epistemological views of clinical reasoning and related conceptual frameworks. They then outline four different theoretical frameworks held by medical educators that the authors believe guide educators' views on the topic, knowingly or not. Within each theoretical framework, the authors begin with a definition of clinical reasoning (from that viewpoint) and then discuss learning, assessment, and research implications. The authors believe these epistemologies and four theoretical frameworks also apply to other concepts (or "competencies") in medical education.The authors also maintain that clinical reasoning encompasses the mental processes and behaviors that are shared (or evolve) between the patient, physician, and the environment (i.e., practice setting). Clinical reasoning thus incorporates components of all three factors (patient, physician, environment). The authors conclude by outlining practical implications and potential future areas for research.

Training in neurology.

PubMed

Aminoff, Michael J

2008-05-13

The training of clinical neurologists is undergoing profound change. Increasing subspecialization within neurology, the widening separation of clinical neurology from other branches of internal medicine, limitations of exposure to training in internal medicine, mandated restrictions in working hours, and attempts to shorten the training period are likely to have adverse effects on the next generation of clinical neurologists. Despite the need for a broad base in general medicine, discussed here, the exposure of neurology trainees to general medical disorders is diminishing. An emphasis on an algorithmic approach to patient management rather than on educating residents to use their reasoning faculties when applying new techniques and knowledge to clinical practice may adversely affect patient care. Neurologists require broad-based training in neurology, internal medicine, and psychiatry, to ensure excellence in clinical practice. It is time to question again whether they are receiving the training that they need.

Evidence-based practice instruction by faculty members and librarians in North American optometry and ophthalmology programs.

PubMed

MacDonald, Katherine A; Hrynchak, Patricia K; Spafford, Marlee M

2014-07-01

North American optometry and ophthalmology faculty members and vision science librarians were surveyed online (14% response rate) about teaching evidence-based practice (EBP). Similar to studies of other health care programs, all five EBP steps (Ask, Acquire, Appraise, Apply, Assess) were taught to varying degrees. Optometry and ophthalmology EBP educators may want to place further emphasis on (1) the Apply and Assess steps, (2) faculty- and student-generated questions and self-assessment in clinical settings, (3) online teaching strategies, (4) programmatic integration of EBP learning objectives, and (5) collaboration between faculty members and librarians.

Quantitative Imaging in Cancer Clinical Trials

PubMed Central

Yankeelov, Thomas E.; Mankoff, David A.; Schwartz, Lawrence H.; Lieberman, Frank S.; Buatti, John M.; Mountz, James M.; Erickson, Bradley J.; Fennessy, Fiona M.M.; Huang, Wei; Kalpathy-Cramer, Jayashree; Wahl, Richard L.; Linden, Hannah M.; Kinahan, Paul; Zhao, Binsheng; Hylton, Nola M.; Gillies, Robert J.; Clarke, Laurence; Nordstrom, Robert; Rubin, Daniel L.

2015-01-01

As anti-cancer therapies designed to target specific molecular pathways have been developed, it has become critical to develop methods to assess the response induced by such agents. While traditional, anatomic CT and MRI exams are useful in many settings, there is increasing evidence that these methods cannot answer the fundamental biological and physiological questions essential for assessment and, eventually, prediction of treatment response in the clinical trial setting, especially in the critical period soon after treatment is initiated. To optimally apply advances in quantitative imaging methods to trials of targeted cancer therapy, new infrastructure improvements are needed that incorporate these emerging techniques into the settings where they are most likely to have impact. In this review, we first elucidate the needs for therapeutic response assessment in the era of molecularly targeted therapy and describe how quantitative imaging can most effectively provide scientifically and clinically relevant data. We then describe the tools and methods required to apply quantitative imaging and provide concrete examples of work making these advances practically available for routine application in clinical trials. We conclude by proposing strategies to surmount barriers to wider incorporation of these quantitative imaging methods into clinical trials and, eventually, clinical practice. Our goal is to encourage and guide the oncology community to deploy standardized quantitative imaging techniques in clinical trials to further personalize care for cancer patients, and to provide a more efficient path for the development of improved targeted therapies. PMID:26773162

Is current clinical practice modified about intraoperative breast irradiation?

PubMed

Massa, Michela; Franchelli, Simonetta; Panizza, Renzo; Massa, Tiberio

2016-04-01

After the results obtained in the two randomized clinical trial, the ELIOT trial and the TARGIT-A trial, a heated debate is going on concerning the question of applying intraoperative radiotherapy (IORT) instead of postoperative whole breast irradiation (WBI) after breast conservative treatment. Currently, many centers are applying the IORT following the strict selection criteria dictated by the working groups American Society for Radiation Oncology (ASTRO) and Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) and monitoring the oncological outcome together with radiation toxicity on breast tissue. The clinical experience of the Geneva University Hospital regarding the use of the Intrabeam system is evaluated and compared with current evidences.

Observations from Ground Zero at the World Trade Center in New York City, Part II: Theoretical and clinical considerations.

PubMed

Acosta, Judith K; Levenson, Richard L

2002-01-01

Part I of this series discussed our observations of Ground Zero of the World Trade Center (WTC) immediately after the attack on September 11, 2001, as well as the stress-response of police officers on site. This paper offers a variety of clinical techniques for emergency mental health practitioners and first responders for use with victims of critical incidents. The suggested interventions are based on the theory and clinical practice of Emergency Medical Hypnosis, Neuro-Linguistic Programming, and Ericksonian Psychotherapy. Specific examples of how they were applied with police personnel following the World Trade Center attack are provided along with specific clinical guidelines. These interventions are designed to augment and enhance standard CISM, mental health, and medical practice in the field.

The Effect of the Time of Injection of Intrathecal Analgesia on the Length of Early and Advanced Labor

DTIC Science & Technology

2000-01-03

drug combinations. Intrathecal Analgesia 36 Future Studies Recommendations for future studies include a prospective randomized clinical trial to examine...second stages of labor because of the variations in client population and in clinical practice. Friedman (1978) Intrathecal Analgesia 7 however, does...that the administration of morphine into the subarchnoid space of rats produced potent analgesia (Wang, 1977). These effects were then clinically applied

Guidelines for randomised controlled trials investigating Chinese herbal medicine.

PubMed

Flower, Andrew; Witt, Claudia; Liu, Jian Ping; Ulrich-Merzenich, Gudrun; Yu, He; Lewith, George

2012-04-10

ETHNOGRAPHIC RELEVANCE: Clinical trials investigating Chinese herbal medicine (CHM) have been frequently criticised for their lack of scientific rigour. As part of the GP-TCM project a team of experienced clinical researchers and CHM practitioners have developed clinical trial guidelines for CHM that combine an appreciation for traditional methods of practice with detailed and practical advice on research methodology. This paper presents an executive summary of this work. It introduces the practice of CHM and the key considerations that need to be addressed whilst researching this traditional medical system. These guidelines emphasise the importance of identifying best practice, and then developing and applying appropriate and rigorous research methodologies to investigate CHM as a whole system. It is hoped that this will encourage a thoughtful and meticulous process of investigation that will clarify the contribution that CHM can make to our future healthcare. Innovative new approaches are considered including the application of the new "omic" technologies and systems biology as a way of enhancing our understanding of traditional practice. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care.

PubMed

Quanbeck, Andrew; Brown, Randall T; E Zgierska, Aleksandra; A Johnson, Roberta; Robinson, James M; Jacobson, Nora

2016-01-27

Adoption of evidence-based practices takes place at a glacial place in healthcare. This research will pilot test an innovative implementation strategy - systems consultation -intended to speed the adoption of evidence-based practice in primary care. The strategy is based on tenets of systems engineering and has been extensively tested in addiction treatment. Three innovations have been included in the strategy - translation of a clinical practice guideline into a checklist-based implementation guide, the use of physician peer coaches ('systems consultants') to help clinics implement the guide, and a focus on reducing variation in practices across prescribers and clinics. The implementation strategy will be applied to improving opioid prescribing practices in primary care, which may help ultimately mitigate the increasing prevalence of opioid abuse and addiction. The pilot test will compare four intervention clinics to four control clinics in a matched-pairs design. A leading clinical guideline for opioid prescribing has been translated into a checklist-based implementation guide in a systematic process that involved experts who wrote the guideline in consultation with implementation experts and primary care physicians. Two physicians with expertise in family and addiction medicine are serving as the systems consultants. Each systems consultant will guide two intervention clinics, using two site visits and follow-up communication by phone and email, to implement the translated guideline. Mixed methods will be used to test the feasibility, acceptability, and preliminary effectiveness of the implementation strategy in an evaluation that meets standards for 'fully developed use' of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). The clinic will be the primary unit of analysis. The systems consultation implementation strategy is intended to generalize to the adoption of other clinical guidelines. This pilot test is intended to prepare for a large randomized clinical trial that will test the strategy against other implementation strategies, such as audit/feedback and academic detailing, used to close the gap between knowledge and practice. The systems consultation approach has the potential to shorten the famously long time it takes to implement evidence-based practices and clinical guidelines in healthcare.

Articulating nurse practitioner practice using King's theory of goal attainment.

PubMed

de Leon-Demare, Kathleen; MacDonald, Jane; Gregory, David M; Katz, Alan; Halas, Gayle

2015-11-01

To further understand the interactions between nurse practitioners (NPs) and patients, King's nursing theory of goal attainment was applied as the conceptual framework to describe the interactions between NPs and patients in the primary care setting. Six dyads of NPs and their patients were video- and audio-taped over three consecutive clinic visits. For the purposes of this arm of the study, the audio-taped interactions were transcribed and then coded using King's concepts in her theory of goal attainment. King's theory was applicable to describe NP practice. King's concepts and processes of nurse-patient interactions, such as disturbances, mutual goal setting, and transactions, were observed in NP-patient interactions. Disturbances during clinical encounters were essential in the progression toward goal attainment. Elements, such as social exchange, symptom reporting, role explanation, and information around clinical processes facilitated relationship building. NPs as practitioners need to be reflective of their own practice, embrace disturbances in the clinical encounter, and attend to these as opportunities for mutual goal setting. ©2015 American Association of Nurse Practitioners.

How doctors learn: the role of clinical problems across the medical school-to-practice continuum.

PubMed

Slotnick, H B

1996-01-01

The author proposes a theory of how physicians learn that uses clinical problem solving as its central feature. His theory, which integrates insights from Maslow, Schön, Norman, and others, claims that physicians-in-training and practicing physicians learn largely by deriving insights from clinical experience. These insights allow the learner to solve future problems and thereby address the learner's basic human needs for security, affiliation, and self-esteem. Ensuring that students gain such insights means that the proper roles of the teacher are (1) to select problems for students to solve and offer guidance on how to solve them, and (2) to serve as a role model of how to reflect on the problem, its solution, and the solution's effectiveness. Three principles guide instruction within its framework for learning: (1) learners, whether physicians-in-training or practicing physicians, seek to solve problems they recognize they have; (2) learners want to be involved in their own learning; and (3) instruction must both be time-efficient and also demonstrate the range of ways in which students can apply what they learn. The author concludes by applying the theory to an aspect of undergraduate education and to the general process of continuing medical education.

Rituals in nursing: intramuscular injections.

PubMed

Greenway, Kathleen

2014-12-01

To consider to what extent intramuscular injection technique can be described to remain entrenched in ritualistic practice and how evidence-based practice should be considered and applied to the nursing practice of this essential skill. The notion of rituals within nursing and the value or futile impact they afford to this essential nursing skill will be critically reviewed. Discursive paper. Literature review from 2002-2013 to review the current position of intramuscular injection injections. Within the literature review, it became clear that there are several actions within the administration of an intramuscular injection that could be perceived as ritualistic and require consideration for contemporary nursing practice. The essential nursing skill of intramuscular injection often appears to fit into the description of a ritualised practice. By providing evidence-based care, nurses will find themselves empowered to make informed decisions based on clinical need and using their clinical judgement. For key learning, it will outline with rationale how site selection, needle selection, insertion technique and aspiration can be cited as examples of routinised or ritualistic practice and why these should be rejected in favour of an evidence-based approach. The effect on some student nurses of experiencing differing practices between what is taught at university and what is often seen in clinical practice will also be discussed. © 2014 John Wiley & Sons Ltd.

Algorithmic tools for interpreting vital signs.

PubMed

Rathbun, Melina C; Ruth-Sahd, Lisa A

2009-07-01

Today's complex world of nursing practice challenges nurse educators to develop teaching methods that promote critical thinking skills and foster quick problem solving in the novice nurse. Traditional pedagogies previously used in the classroom and clinical setting are no longer adequate to prepare nursing students for entry into practice. In addition, educators have expressed frustration when encouraging students to apply newly learned theoretical content to direct the care of assigned patients in the clinical setting. This article presents algorithms as an innovative teaching strategy to guide novice student nurses in the interpretation and decision making related to vital sign assessment in an acute care setting.

Implementing clinical protocols in oncology: quality gaps and the learning curve phenomenon.

PubMed

Kedikoglou, Simos; Syrigos, Konstantinos; Skalkidis, Yannis; Ploiarchopoulou, Fani; Dessypris, Nick; Petridou, Eleni

2005-08-01

The quality improvement effort in clinical practice has focused mostly on 'performance quality', i.e. on the development of comprehensive, evidence-based guidelines. This study aimed to assess the 'conformance quality', i.e. the extent to which guidelines once developed are correctly and consistently applied. It also aimed to assess the existence of quality gaps in the treatment of certain patient segments as defined by age or gender and to investigate methods to improve overall conformance quality. A retrospective audit of clinical practice in a well-defined oncology setting was undertaken and the results compared to those obtained from prospectively applying an internally developed clinical protocol in the same setting and using specific tools to increase conformance quality. All indicators showed improvement after the implementation of the protocol that in many cases reached statistical significance, while in the entire cohort advanced age was associated (although not significantly) with sub-optimal delivery of care. A 'learning curve' phenomenon in the implementation of quality initiatives was detected, with all indicators improving substantially in the second part of the prospective study. Clinicians should pay separate attention to the implementation of chosen protocols and employ specific tools to increase conformance quality in patient care.

Wisdom in clinical reasoning and medical practice.

PubMed

Edmondson, Ricca; Pearce, Jane; Woerner, Markus H

2009-01-01

Exploring informal components of clinical reasoning, we argue that they need to be understood via the analysis of professional wisdom. Wise decisions are needed where action or insight is vital, but neither everyday nor expert knowledge provides solutions. Wisdom combines experiential, intellectual, ethical, emotional and practical capacities; we contend that it is also more strongly social than is usually appreciated. But many accounts of reasoning specifically rule out such features as irrational. Seeking to illuminate how wisdom operates, we therefore build on Aristotle's work on informal reasoning. His account of rhetorical communication shows how non-formal components can play active parts in reasoning, retaining, or even enhancing its reasonableness. We extend this account, applying it to forms of healthcare-related reasoning which are characterised by the need for wise decision-making. We then go on to explore some of what clinical wise reasoning may mean, concluding with a case taken from psychotherapeutic practice.

Clinical innovation for promoting family care in paediatric intensive care: demonstration, role modelling and reflective practice.

PubMed

Tomlinson, Patricia S; Thomlinson, Elizabeth; Peden-McAlpine, Cynthia; Kirschbaum, Mark

2002-04-01

To explore family caregiving problems in paediatric crisis care and methods that could be applied to move the abstraction of family care to development of specific family interventions. Family centred care has been accepted as the ideal philosophy for holistic health care of children, but methods for its implementation are not well established. In paediatric health crises, family care requires special sensitivity to family needs and a type of complex nursing care for which many practitioners are not sufficiently prepared. Developing family sensitive models of intervention and finding a strategy for transfer of this knowledge to clinical practice is an important challenge facing family nursing today. Social learning theory provides a rich background to explore these issues. Specific techniques of role modelling and reflective practice are suggested as effective approaches to teach family sensitive care in clinical settings where families are part of the care environment.

How to understand and conduct evidence-based medicine.

PubMed

Kang, Hyun

2016-10-01

Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions regarding the care of individual patients. This concept has gained popularity recently, and its applications have been steadily expanding. Nowadays, the term "evidence-based" is used in numerous situations and conditions, such as evidence-based medicine, evidence-based practice, evidence-based health care, evidence-based social work, evidence-based policy, and evidence-based education. However, many anesthesiologists and their colleagues have not previously been accustomed to utilizing EBM, and they have experienced difficulty in understanding and applying the techniques of EBM to their practice. In this article, the author discusses the brief history, definition, methods, and limitations of EBM. As EBM also involves making use of the best available information to answer questions in clinical practice, the author emphasizes the process of performing evidence-based medicine: generate the clinical question, find the best evidence, perform critical appraisal, apply the evidence, and then evaluate. Levels of evidence and strength of recommendation were also explained. The author expects that this article may be of assistance to readers in understanding, conducting, and evaluating EBM.

Conducting clinical post-conference in clinical teaching: a qualitative study.

PubMed

Hsu, Li-Ling

2007-08-01

The aim of this study was to explore nurse educators' perceptions regarding clinical postconferences. Additional aims included the exploration of interaction characteristics between students and faculty in clinical postconferences. Nursing students are challenged to think and learn in ways that will prepare them for practice in a complex health care environment. Clinical postconferences give students the opportunity to share knowledge gained through transformative learning and provide a forum for discussion and critical thinking. Faculty members must guide students as the latter participate in discussions, develop problem-solving skills and express feedings and attitudes in clinical conferences. The study used qualitative research methods, including participant observation and an open-ended questionnaire. Participant observers watched interaction activities between teachers and students in clinical postconferences. A total of 20 clinical postconferences, two conferences per teacher, were observed. The Non-Numerical Unstructured Data Indexing Searching and Theory-building qualitative software program was used in data analysis. Research findings indicated that, of the six taxonomy questions, lower-level questions (knowledge and comprehensive questions) were mostly asked by faculty members' postclinical conferences. The most frequently used guideline was task orientation, which is related to practice goals and was found in discussions of assignments, reading reports, discussions of clinical experiences, role plays, psychomotor skill practice, quizzes and student evaluations. It is an essential responsibility of nurse educators to employ postconferences to assist students in applying their knowledge in practical situations, in developing professional values and in enhancing their problem solving abilities.

The role of evidence based medicine in neurotrauma.

PubMed

Honeybul, S; Ho, K M

2015-04-01

The introduction of evidence based medicine de-emphasised clinical experience and so-called "background information" and stressed the importance of evidence gained from clinical research when making clinical decisions. For many years randomised controlled trials have been seen to be the only way to advance clinical practice, however, applying this methodology in the context of severe trauma can be problematic. In addition, it is increasingly recognised that considerable clinical experience is required in order to critically evaluate the quality of the evidence and the validity of the conclusions as presented. A contemporary example is seen when considering the role of decompressive craniectomy in the management of neurotrauma. Although there is a considerable amount of evidence available attesting to the efficacy of the procedure, considerable clinical expertise is required in order to properly interpret the results of these studies and the implications for clinical practice. Given these limitations the time may have come for a redesign of the traditional pyramid of evidence, to a model that re-emphasises the importance of "background information" such as pathophysiology and acknowledges the role of clinical experience such that the evidence can be critically evaluated in its appropriate context and the subsequent implications for clinical practice be clearly and objectively defined. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Constrained physical therapist practice: an ethical case analysis of recommending discharge placement from the acute care setting.

PubMed

Nalette, Ernest

2010-06-01

Constrained practice is routinely encountered by physical therapists and may limit the physical therapist's primary moral responsibility-which is to help the patient to become well again. Ethical practice under such conditions requires a certain moral character of the practitioner. The purposes of this article are: (1) to provide an ethical analysis of a typical patient case of constrained clinical practice, (2) to discuss the moral implications of constrained clinical practice, and (3) to identify key moral principles and virtues fostering ethical physical therapist practice. The case represents a common scenario of discharge planning in acute care health facilities in the northeastern United States. An applied ethics approach was used for case analysis. The decision following analysis of the dilemma was to provide the needed care to the patient as required by compassion, professional ethical standards, and organizational mission. Constrained clinical practice creates a moral dilemma for physical therapists. Being responsive to the patient's needs moves the physical therapist's practice toward the professional ideal of helping vulnerable patients become well again. Meeting the patient's needs is a professional requirement of the physical therapist as moral agent. Acting otherwise requires an alternative position be ethically justified based on systematic analysis of a particular case. Skepticism of status quo practices is required to modify conventional individual, organizational, and societal practices toward meeting the patient's best interest.

How do clinicians actually use the Diagnostic and Statistical Manual of Mental Disorders in clinical practice and why we need to know more.

PubMed

First, Michael B; Bhat, Venkat; Adler, David; Dixon, Lisa; Goldman, Beth; Koh, Steve; Levine, Bruce; Oslin, David; Siris, Sam

2014-12-01

The clinical use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is explicitly stated as a goal for both the DSM Fourth Edition and DSM Fifth Edition (DSM-5) revisions. Many uses assume a relatively faithful application of the DSM diagnostic definitions. However, studies demonstrate significant discrepancies between clinical psychiatric diagnoses with those made using structured interviews suggesting that clinicians do not systematically apply the diagnostic criteria. The limited information regarding how clinicians actually use the DSM raises important questions: a) How can the clinical use be improved without first having a baseline assessment? b) How can potentially significant shifts in practice patterns based on wording changes be assessed without knowing the extent to which the criteria are used as written? Given the American Psychiatric Association's plans for interim revisions to the DSM-5, the value of a detailed exploration of its actual use in clinical practice remains a significant ongoing concern and deserves further study including a number of survey and in vivo studies.

Mothering: Thinking Is Part of the Job Description: Application of Cognitive Views to Understanding Maladaptive Parenting and Doing Intervention and Prevention Work

ERIC Educational Resources Information Center

Azar, Sandra T.; Reitz, Elizabeth B.; Goslin, Megan C.

2008-01-01

Irving Sigel's work, particularly his two volumes and numerous papers on parental beliefs, has left a strong mark on theoretical developmental work, applied research, and clinical research and practice. This article focuses on the impact that a cognitive perspective on parenting has had on our understanding of maladaptive parenting and practice.…

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.

Preferred information sources for clinical decision making: critical care nurses' perceptions of information accessibility and usefulness.

PubMed

Marshall, Andrea P; West, Sandra H; Aitken, Leanne M

2011-12-01

Variability in clinical practice may result from the use of diverse information sources to guide clinical decisions. In routine clinical practice, nurses privilege information from colleagues over more formal information sources. It is not clear whether similar information-seeking behaviour is exhibited when critical care nurses make decisions about a specific clinical practice, where extensive practice variability exists alongside a developing research base. This study explored the preferred sources of information intensive care nurses used and their perceptions of the accessibility and usefulness of this information for making decisions in clinically uncertain situations specific to enteral feeding practice. An instrumental case study design, incorporating concurrent verbal protocols, Q methodology and focus groups, was used to determine intensive care nurses' perspectives of information use in the resolution of clinical uncertainty. A preference for information from colleagues to support clinical decisions was observed. People as information sources were considered most useful and most accessible in the clinical setting. Text and electronic information sources were seen as less accessible, mainly because of the time required to access the information within the documents. When faced with clinical uncertainty, obtaining information from colleagues allows information to be quickly accessed and applied within the context of a specific clinical presentation. Seeking information from others also provides opportunities for shared decision-making and potential validation of clinical judgment, although differing views may exacerbate clinical uncertainty. The social exchange of clinical information may meet the needs of nurses working in a complex, time-pressured environment but the extent of the evidence base for information passed through verbal communication is unclear. The perceived usefulness and accessibility of information is premised on the ease of use and access and thus the variability in information may be contributing to clinical uncertainty. Copyright ©2011 Sigma Theta Tau International.

[Prescribing monitoring in clinical practice: from enlightened empiricism to rational strategies].

PubMed

Buclin, Thierry; Herzig, Lilli

2013-05-15

Monitoring of a medical condition is the periodic measurement of one or several physiological or biological variables to detect a signal regarding its clinical progression or its response to treatment. We distinguish different medical situations between diagnostic, clinical and therapeutic process to apply monitoring. Many clinical, variables can be used for monitoring, once their intrinsic properties (normal range, critical difference, kinetics, reactivity) and external validity (pathophysiological importance, predictive power for clinical outcomes) are established. A formal conceptualization of monitoring is being developed and should support the rational development of monitoring strategies and their validation through appropriate clinical trials.

Form Follows Function: A Model for Clinical Supervision of Genetic Counseling Students.

PubMed

Wherley, Colleen; Veach, Patricia McCarthy; Martyr, Meredith A; LeRoy, Bonnie S

2015-10-01

Supervision plays a vital role in genetic counselor training, yet models describing genetic counseling supervision processes and outcomes are lacking. This paper describes a proposed supervision model intended to provide a framework to promote comprehensive and consistent clinical supervision training for genetic counseling students. Based on the principle "form follows function," the model reflects and reinforces McCarthy Veach et al.'s empirically derived model of genetic counseling practice - the "Reciprocal Engagement Model" (REM). The REM consists of mutually interactive educational, relational, and psychosocial components. The Reciprocal Engagement Model of Supervision (REM-S) has similar components and corresponding tenets, goals, and outcomes. The 5 REM-S tenets are: Learning and applying genetic information are key; Relationship is integral to genetic counseling supervision; Student autonomy must be supported; Students are capable; and Student emotions matter. The REM-S outcomes are: Student understands and applies information to independently provide effective services, develop professionally, and engage in self-reflective practice. The 16 REM-S goals are informed by the REM of genetic counseling practice and supported by prior literature. A review of models in medicine and psychology confirms the REM-S contains supervision elements common in healthcare fields, while remaining unique to genetic counseling. The REM-S shows promise for enhancing genetic counselor supervision training and practice and for promoting research on clinical supervision. The REM-S is presented in detail along with specific examples and training and research suggestions.

Mitigation of adverse interactions in pairs of clinical practice guidelines using constraint logic programming.

PubMed

Wilk, Szymon; Michalowski, Wojtek; Michalowski, Martin; Farion, Ken; Hing, Marisela Mainegra; Mohapatra, Subhra

2013-04-01

We propose a new method to mitigate (identify and address) adverse interactions (drug-drug or drug-disease) that occur when a patient with comorbid diseases is managed according to two concurrently applied clinical practice guidelines (CPGs). A lack of methods to facilitate the concurrent application of CPGs severely limits their use in clinical practice and the development of such methods is one of the grand challenges for clinical decision support. The proposed method responds to this challenge. We introduce and formally define logical models of CPGs and other related concepts, and develop the mitigation algorithm that operates on these concepts. In the algorithm we combine domain knowledge encoded as interaction and revision operators using the constraint logic programming (CLP) paradigm. The operators characterize adverse interactions and describe revisions to logical models required to address these interactions, while CLP allows us to efficiently solve the logical models - a solution represents a feasible therapy that may be safely applied to a patient. The mitigation algorithm accepts two CPGs and available (likely incomplete) patient information. It reports whether mitigation has been successful or not, and on success it gives a feasible therapy and points at identified interactions (if any) together with the revisions that address them. Thus, we consider the mitigation algorithm as an alerting tool to support a physician in the concurrent application of CPGs that can be implemented as a component of a clinical decision support system. We illustrate our method in the context of two clinical scenarios involving a patient with duodenal ulcer who experiences an episode of transient ischemic attack. Copyright © 2013 Elsevier Inc. All rights reserved.

Practical Problems with Medication Use that Older People Experience: A Qualitative Study

PubMed Central

Notenboom, Kim; Beers, Erna; van Riet-Nales, Diana A; Egberts, Toine C G; Leufkens, Hubert G M; Jansen, Paul A F; Bouvy, Marcel L

2014-01-01

Objectives To identify the practical problems that older people experience with the daily use of their medicines and their management strategies to address these problems and to determine the potential clinical relevance thereof. Design Qualitative study with semistructured face-to-face interviews. Setting A community pharmacy and a geriatric outpatient ward. Participants Community-dwelling people aged 70 and older (N = 59). Measurements Participants were interviewed at home. Two researchers coded the reported problems and management strategies independently according to a coding scheme. An expert panel classified the potential clinical relevance of every identified practical problem and associated management strategy using a 3-point scale. Results Two hundred eleven practical problems and 184 management strategies were identified. Ninety-five percent of the participants experienced one or more practical problems with the use of their medicines: problems reading and understanding the instructions for use, handling the outer packaging, handling the immediate packaging, completing preparation before use, and taking the medicine. For 10 participants, at least one of their problems, in combination with the applied management strategy, had potential clinical consequences and 11 cases (5% of the problems) had the potential to cause moderate or severe clinical deterioration. Conclusion Older people experience a number of practical problems using their medicines, and their strategies to manage these problems are sometimes suboptimal. These problems can lead to incorrect medication use with clinically relevant consequences. The findings pose a challenge for healthcare professionals, drug developers, and regulators to diminish these problems. PMID:25516030

Developing clinical leaders: the impact of an action learning mentoring programme for advanced practice nurses.

PubMed

Leggat, Sandra G; Balding, Cathy; Schiftan, Dan

2015-06-01

To determine whether a formal mentoring programme assists nurse practitioner candidates to develop competence in the clinical leadership competencies required in their advanced practice roles. Nurse practitioner candidates are required to show evidence of defined clinical leadership competencies when they apply for endorsement within the Australian health care system. Aiming to assist the candidates with the development or enhancement of these leadership skills, 18 nurse practitioner candidates participated in a mentoring programme that matched them with senior nurse mentors. A pre-postlongitudinal intervention study. Eighteen nurse practitioner candidates and 17 senior nurses participated in a voluntary mentoring programme that incorporated coaching and action learning over 18 months in 2012 and 2013. Participants completed a pen and paper questionnaire to document baseline measures of self-reported leadership practices prior to commencement of the programme and again at the end of the programme. The mentors and the nurse practitioner candidates qualitatively evaluated the programme as successful and quantitative data illustrated significant improvement in self-reported leadership practices among the nurse practitioner candidates. In particular, the nurse practitioner candidates reported greater competence in the transformational aspects of leadership, which is directly related to the nurse practitioner candidate clinical leadership standard. A formal, structured mentoring programme based on principles of action learning was successful in assisting Australian advanced practice nurses enhance their clinical leadership skills in preparation for formal endorsement as a nurse practitioner and for success in their advanced practice role. Mentoring can assist nurses to transition to new roles and develop knowledge and skills in clinical leadership essential for advanced practice roles. Nurse managers should make greater use of mentoring programmes to support nurses in their transition to new roles. © 2015 John Wiley & Sons Ltd.

Incorporating Hypnosis into Pediatric Clinical Encounters

PubMed Central

Pendergrast, Robert A.

2017-01-01

Increasing numbers of licensed health professionals who care for children have been trained in clinical hypnosis. The evidence base for the safety and efficacy of this therapeutic approach in a wide variety of conditions is also growing. Pediatricians and other health professionals who have received training may wish to apply these skills in appropriate clinical scenarios but still may be unsure of the practical matters of how to incorporate this skill-set into day to day practice. Moreover, the practical application of such skills will take very different forms depending on the practice setting, types of acute or chronic conditions, patient and family preferences, and the developmental stages of the child or teen. This article reviews the application of pediatric clinical hypnosis skills by describing the use of hypnotic language outside of formal trance induction, by describing natural trance states that occur in children and teens in healthcare settings, and by describing the process of planning a clinical hypnosis encounter. It is assumed that this article does not constitute training in hypnosis or qualify its readers for the application of such skills; rather, it may serve as a practical guide for those professionals who have been so trained, and may serve to inform other professionals what to expect when referring a patient for hypnotherapy. The reader is referred to specific training opportunities and organizations. PMID:28300761

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

Semi-spontaneous oral text production: measurements in clinical practice.

PubMed

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

2009-12-01

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 measurements for the analysis of semi-spontaneous oral text production by speakers with aphasia. Specifically, the measurements are related to the production of verbs and nouns, and the realization of different sentence types. The proposed measurements should be clinically relevant, easily applicable, and linguistically meaningful. The measurements have been applied to oral descriptions of the 'Cookie Theft' picture by eight monolingual Norwegian speakers, four with an anomic type of aphasia and four without any type of language impairment. Despite individual differences in both the clinical and the non-clinical group, most of the measurements seem to distinguish between speakers with and without aphasia.

The tacit dimension of clinical judgment.

PubMed Central

Goldman, G. M.

1990-01-01

Two distinct views of the nature of clinical judgment are identified and contrasted. The dominant view that clinical judgment is a fully explicit process is compared to the relatively neglected view that tacit knowledge plays a substantial role in the clinician's mental operations. The tacit dimension of medical thinking is explored at length. The discussion suggests severe limits when applying decision analysis, expert systems, and computer-aided cost-benefit review to medicine. The goals and practices of postgraduate medical education are also examined from this perspective, as are various other implications for the clinician. The paper concludes that it is valuable to explore the nature of medical thinking in order to improve clinical practice and education. Such explorations should, however, take cognizance of the often overlooked tacit dimension of clinical judgment. Possible constraints on the medical applicability of both formal expert systems and heavily didactic instructional programs are considered. PMID:2356625

[Application of three-dimensional printing technique in orthopaedics].

PubMed

Luo, Qiang; Lau, Tak Wing; Fang, Xinshuo; Leung, Frankie

2014-03-01

To review the current progress of three-dimensional (3-D) printing technique in the clinical practice, its limitations and prospects. The recent publications associated with the clinical application of 3-D printing technique in the field of surgery, especially in orthopaedics were extensively reviewed. Currently, 3-D printing technique has been applied in orthopaedic surgery to aid diagnosis, make operative plans, and produce personalized prosthesis or implants. 3-D printing technique is a promising technique in clinical application.

The Effect of the Time of Injection of Intrathecal Analgesia on the Length of Early and Advanced Labor

DTIC Science & Technology

1999-10-01

Recommendations for future studies include a prospective randomized clinical trial to examine the effect of the timing of intrathecal narcotic...population and in clinical practice. Friedman (1978) Intrathecal Analgesia 7 however, does provide averages and upper statistical limits for the first and...morphine into the subarchnoid space of rats produced potent analgesia (Wang, 1977). These effects were then clinically applied in man for the relief of

Fundamentals in Biostatistics for Investigation in Pediatric Dentistry: Part II -Biostatistical Methods.

PubMed

Pozos-Guillén, Amaury; Ruiz-Rodríguez, Socorro; Garrocho-Rangel, Arturo

The main purpose of the second part of this series was to provide the reader with some basic aspects of the most common biostatistical methods employed in health sciences, in order to better understand the validity, significance and reliability of the results from any article on Pediatric Dentistry. Currently, as mentioned in the first paper, Pediatric Dentists need basic biostatistical knowledge to be able to apply it when critically appraise a dental article during the Evidence-based Dentistry (EBD) process, or when participating in the development of a clinical study with dental pediatric patients. The EBD process provides a systematic approach of collecting, review and analyze current and relevant published evidence about oral health care in order to answer a particular clinical question; then this evidence should be applied in everyday practice. This second report describes the most commonly used statistical methods for analyzing and interpret collected data, and the methodological criteria to be considered when choosing the most appropriate tests for a specific study. These are available to Pediatric Dentistry practicants interested in reading or designing original clinical or epidemiological studies.

[Research of bleeding volume and method in blood-letting acupuncture therapy based on data mining].

PubMed

Liu, Xin; Jia, Chun-Sheng; Wang, Jian-Ling; Du, Yu-Zhu; Zhang, Xiao-Xu; Shi, Jing; Li, Xiao-Feng; Sun, Yan-Hui; Zhang, Shen; Zhang, Xuan-Ping; Gang, Wei-Juan

2014-03-01

Through computer-based technology and data mining method, with treatment in cases of bloodletting acupuncture therapy in collected literature as sample data, the association rule in data mining was applied. According to self-built database platform, the data was input, arranged and summarized, and eventually required data was acquired to perform the data mining of bleeding volume and method in blood-letting acupuncture therapy, which summarized its application rules and clinical values to provide better guide for clinical practice. There were 9 kinds of blood-letting tools in the literature, in which the frequency of three-edge needle was the highest, accounting for 84.4% (1239/1468). The bleeding volume was classified into six levels, in which less volume (less than 0.1 mL) had the highest frequency (401 times). According to the results of the data mining, blood-letting acupuncture therapy was widely applied in clinical practice of acupuncture, in which use of three-edge needle and less volume (less than 0.1 mL) of blood were the most common, however, there was no central tendency in general.

The full spectrum of ethical issues in dementia care: systematic qualitative review.

PubMed

Strech, Daniel; Mertz, Marcel; Knüppel, Hannes; Neitzke, Gerald; Schmidhuber, Martina

2013-06-01

Integrating ethical issues in dementia-specific training material, clinical guidelines and national strategy plans requires an unbiased awareness of all the relevant ethical issues. To determine systematically and transparently the full spectrum of ethical issues in clinical dementia care. We conducted a systematic review in Medline (restricted to English and German literature published between 2000 and 2011) and Google books (with no restrictions). We applied qualitative text analysis and normative analysis to categorise the spectrum of ethical issues in clinical dementia care. The literature review retrieved 92 references that together mentioned a spectrum of 56 ethical issues in clinical dementia care. The spectrum was structured into seven major categories that consist of first- and second-order categories for ethical issues. The systematically derived spectrum of ethical issues in clinical dementia care presented in this paper can be used as training material for healthcare professionals, students and the public for raising awareness and understanding of the complexity of ethical issues in dementia care. It can also be used to identify ethical issues that should be addressed in dementia-specific training programmes, national strategy plans and clinical practice guidelines. Further research should evaluate whether this new genre of systematic reviews can be applied to the identification of ethical issues in other cognitive and somatic diseases. Also, the practical challenges in addressing ethical issues in training material, guidelines and policies need to be evaluated.

Fostering clinical engagement and medical leadership and aligning cultural values: an evaluation of a general practice specialty trainee integrated training placement in a primary care trust.

PubMed

Ruston, Annmarie; Tavabie, Abdol

2010-01-01

To report on the extent to which a general practice specialty trainee integrated training placement (ITP) developed the leadership skills and knowledge of general practice specialty trainees (GPSTRs) and on the potential of the ITP to improve clinical engagement. A case study method was used in a Kent primary care trust (PCT). Sources of data included face-to-face and telephone interviews (three GPSTRs, three PCT clinical supervisors, three general practitioner (GP) clinical supervisors and three Deanery/PCT managers), reflective diaries, documentary sources and observation. Interview data were transcribed and analysed using the constant comparative method. All respondents were positive about the value and success of the ITP in developing the leadership skills of the GPSTRs covering three dimensions: leadership of self, leadership of teams and leadership of organisations within systems. The ITP had enabled GP trainees to understand the context for change, to develop skills to set the direction for change and to collect and apply evidence to decision making. The ITP was described as an effective means of breaking down cultural barriers between general practice and the PCT and as having the potential for improving clinical engagement. The ITP provided a model to enable the effective exchange of knowledge and understanding of differing cultures between GPSTRs, general practice and the PCT. It provided a sound basis for effective, dispersed clinical engagement and leadership.

Translating research into clinical practice: integrating robotics into neurorehabilitation for stroke survivors.

PubMed

Backus, Deborah; Winchester, Patricia; Tefertiller, Candace

2010-01-01

Technological advances continue to infuse the field of neurorehabilitation with both excitement and apprehension. A challenge for clinicians is to determine which of the growing number of devices or interventions available should be incorporated into their clinical practice, and when and with whom they should be offered, in order to best assist their patients in attaining the highest level of function and quality of life. Robotics is one area of technology that has seen robust growth in rehabilitation applications, so much so that the presence of robotic devices in rehabilitation centers has become an expectation among patients, their caregivers, and therapists. Although rehabilitation robotic devices afford the opportunity to provide high doses of repetitive movement in a reliable and controllable manner, the role they play in the continuum of clinical care remains uncertain. The focus of this article is on translating the empirical evidence related to the application of rehabilitation robotics for improving lower limb and walking function in a manner that the clinician, or any stakeholder, will be able to incorporate relevant findings into clinical practice. A process is outlined and applied to a recent review of the literature related to the use of robotics for the treatment of lower limb and walking function in persons with stroke. This process provides the reader with a tool that can be applied to the translation and implementation of evidence related to any intervention for any client with neurological injury or disease.

The FAMULATUR PLUS as an innovative approach for teaching physical examination skills.

PubMed

Jerg, Achim; Öchsner, Wolfgang; Wander, Henriette; Traue, Harald C; Jerg-Bretzke, Lucia

2016-01-01

The FAMULATUR PLUS is an innovative approach to teaching physical examination skills. The concept is aimed at medical students during the clinical part of their studies and includes a clinical traineeship (English for "Famulatur") extended to include various courses ("PLUS"). The courses are divided into clinical examination courses and problembased-learning (PBL) seminars. The concept's special feature is the full integration of these courses into a 30-day hospital traineeship. The aim is to facilitate the transfer of knowledge from the courses into daily practice. Each week of the FAMULATUR PLUS is structured in line with the courses and focuses on a particular part of the body (e.g., abdomen). A physical examination course under the supervision of a physician is offered at the beginning of the week. Here, medical students learn the relevant examination techniques by practicing on each other (partner exercises). Subsequently, the techniques taught are applied independently during everyday work on the ward, corrected by the supervisor, if necessary, and thereby reinforced. The final POL seminar takes place towards the end of the week. Possible differential diagnoses are developed based on a clinical case study. The goal is to check these by taking a fictitious medical history and performing a physical examination, as well as to make a preliminary diagnosis. Finally, during the PBL seminar, medical students will be shown how physical examination techniques can be efficiently applied in the diagnosis of common cardinal symptoms (e.g., abdominal pain). The initial implementation of the FAMULATUR PLUS proved the practical feasibility of the concept. In addition, the accompanying evaluation showed that the participants of the pilot project improved with regard to their practical physical examination skills.

The FAMULATUR PLUS as an innovative approach for teaching physical examination skills

PubMed Central

Jerg, Achim; Öchsner, Wolfgang; Wander, Henriette; Traue, Harald C.; Jerg-Bretzke, Lucia

2016-01-01

The FAMULATUR PLUS is an innovative approach to teaching physical examination skills. The concept is aimed at medical students during the clinical part of their studies and includes a clinical traineeship (English for “Famulatur”) extended to include various courses (“PLUS”). The courses are divided into clinical examination courses and problembased-learning (PBL) seminars. The concept’s special feature is the full integration of these courses into a 30-day hospital traineeship. The aim is to facilitate the transfer of knowledge from the courses into daily practice. Each week of the FAMULATUR PLUS is structured in line with the courses and focuses on a particular part of the body (e.g., abdomen). A physical examination course under the supervision of a physician is offered at the beginning of the week. Here, medical students learn the relevant examination techniques by practicing on each other (partner exercises). Subsequently, the techniques taught are applied independently during everyday work on the ward, corrected by the supervisor, if necessary, and thereby reinforced. The final POL seminar takes place towards the end of the week. Possible differential diagnoses are developed based on a clinical case study. The goal is to check these by taking a fictitious medical history and performing a physical examination, as well as to make a preliminary diagnosis. Finally, during the PBL seminar, medical students will be shown how physical examination techniques can be efficiently applied in the diagnosis of common cardinal symptoms (e.g., abdominal pain). The initial implementation of the FAMULATUR PLUS proved the practical feasibility of the concept. In addition, the accompanying evaluation showed that the participants of the pilot project improved with regard to their practical physical examination skills. PMID:26958652

The attitude of Belgian social insurance physicians towards evidence-based practice and clinical practice guidelines.

PubMed

Heselmans, Annemie; Donceel, Peter; Aertgeerts, Bert; Van de Velde, Stijn; Ramaekers, Dirk

2009-09-09

Evidence-based medicine has broadened its scope and is starting to reach insurance medicine. Although still in its initial stages, physicians in the area of insurance medicine should keep up-to-date with the evidence on various diseases in order to correctly assess disability and to give appropriate advice about health care reimbursement. In order to explore future opportunities of evidence-based medicine to improve daily insurance medicine, there is a need for qualitative studies to better understand insurance physicians' perceptions of EBM. The present study was designed to identify the attitude of insurance physicians towards evidence-based medicine and clinical practice guidelines, and to determine their ability to access, retrieve and appraise the health evidence and the barriers for applying evidence to practice. A cross-sectional survey study was carried out among all Dutch-speaking insurance physicians employed at one of the six Belgian social insurance sickness funds and at the National Institute of Disability and Health care Insurance (n = 224). Chi-square tests were used to compare nominal and ordinal variables. Student's t-tests, ANOVA, Mann-Whitney and Kruskal-Wallis were used to compare means of continuous variables for different groups. The response rate was 48.7%. The majority of respondents were positive towards evidence-based medicine and clinical practice guidelines. Their knowledge of EBM was rather poor. Perceived barriers for applying evidence to practice were mainly time and lack of EBM skills. Although the majority of physicians were positive towards EBM and welcomed more guidelines, the use of evidence and clinical practice guidelines in insurance medicine is low at present. It is in the first place important to eradicate the perceived inertia which limits the use of EBM and to further investigate the EBM principles in the context of insurance medicine. Available high-quality evidence-based resources (at the moment mainly originating from other medical fields) need to be structured in a way that is useful for insurance physicians and global access to this information needs to be ensured.

The attitude of Belgian social insurance physicians towards evidence-based practice and clinical practice guidelines

PubMed Central

Heselmans, Annemie; Donceel, Peter; Aertgeerts, Bert; Van de Velde, Stijn; Ramaekers, Dirk

2009-01-01

Background Evidence-based medicine has broadened its scope and is starting to reach insurance medicine. Although still in its initial stages, physicians in the area of insurance medicine should keep up-to-date with the evidence on various diseases in order to correctly assess disability and to give appropriate advice about health care reimbursement. In order to explore future opportunities of evidence-based medicine to improve daily insurance medicine, there is a need for qualitative studies to better understand insurance physicians' perceptions of EBM. The present study was designed to identify the attitude of insurance physicians towards evidence-based medicine and clinical practice guidelines, and to determine their ability to access, retrieve and appraise the health evidence and the barriers for applying evidence to practice. Methods A cross-sectional survey study was carried out among all Dutch-speaking insurance physicians employed at one of the six Belgian social insurance sickness funds and at the National Institute of Disability and Health care Insurance (n = 224). Chi-square tests were used to compare nominal and ordinal variables. Student's t-tests, ANOVA, Mann-Whitney and Kruskal-Wallis were used to compare means of continuous variables for different groups. Results The response rate was 48.7%. The majority of respondents were positive towards evidence-based medicine and clinical practice guidelines. Their knowledge of EBM was rather poor. Perceived barriers for applying evidence to practice were mainly time and lack of EBM skills. Conclusion Although the majority of physicians were positive towards EBM and welcomed more guidelines, the use of evidence and clinical practice guidelines in insurance medicine is low at present. It is in the first place important to eradicate the perceived inertia which limits the use of EBM and to further investigate the EBM principles in the context of insurance medicine. Available high-quality evidence-based resources (at the moment mainly originating from other medical fields) need to be structured in a way that is useful for insurance physicians and global access to this information needs to be ensured. PMID:19740436

Can active learning principles be applied to the bioscience assessments of nursing students? A review of the literature.

PubMed

Bakon, Shannon; Craft, Judy; Christensen, Martin; Wirihana, Lisa

2016-02-01

To explore if active learning principles be applied to nursing bioscience assessments and will this influence student perception of confidence in applying theory to practice? A review of the literature utilising searches of various databases including CINAHL, PUBMED, Google Scholar and Mosby's Journal Index. The literature search identified research from twenty-six original articles, two electronic books, one published book and one conference proceedings paper. Bioscience has been identified as an area that nurses struggle to learn in tertiary institutions and then apply to clinical practice. A number of problems have been identified and explored that may contribute to this poor understanding and retention. University academics need to be knowledgeable of innovative teaching and assessing modalities that focus on enhancing student learning and address the integration issues associated with the theory practice gap. Increased bioscience education is associated with improved patient outcomes therefore by addressing this "bioscience problem" and improving the integration of bioscience in clinical practice there will subsequently be an improvement in health care outcomes. From the literature several themes were identified. First there are many problems with teaching nursing students bioscience education. These include class sizes, motivation, concentration, delivery mode, lecturer perspectives, student's previous knowledge, anxiety, and a lack of confidence. Among these influences the type of assessment employed by the educator has not been explored or identified as a contributor to student learning specifically in nursing bioscience instruction. Second that educating could be achieved more effectively if active learning principles were applied and the needs and expectations of the student were met. Lastly, assessment influences student retention and the student experience and as such assessment should be congruent with the subject content, align with the learning objectives and be used as a stimulus tool for learning. Copyright © 2015 Elsevier Ltd. All rights reserved.

Evidence-based practice instruction by faculty members and librarians in North American optometry and ophthalmology programs

PubMed Central

Hrynchak, Patricia K.; Spafford, Marlee M.

2014-01-01

North American optometry and ophthalmology faculty members and vision science librarians were surveyed online (14% response rate) about teaching evidence-based practice (EBP). Similar to studies of other health care programs, all five EBP steps (Ask, Acquire, Appraise, Apply, Assess) were taught to varying degrees. Optometry and ophthalmology EBP educators may want to place further emphasis on (1) the Apply and Assess steps, (2) faculty- and student-generated questions and self-assessment in clinical settings, (3) online teaching strategies, (4) programmatic integration of EBP learning objectives, and (5) collaboration between faculty members and librarians. PMID:25031564

Format guidelines to make them vivid, intuitive, and visual: use simple formatting rules to optimize usability and accessibility of clinical practice guidelines.

PubMed

Versloot, Judith; Grudniewicz, Agnes; Chatterjee, Ananda; Hayden, Leigh; Kastner, Monika; Bhattacharyya, Onil

2015-06-01

We present simple formatting rules derived from an extensive literature review that can improve the format of clinical practice guidelines (CPGs), and potentially increase the likelihood of being used. We recently conducted a review of the literature from medicine, psychology, design, and human factors engineering on characteristics of guidelines that are associated with their use in practice, covering both the creation and communication of content. The formatting rules described in this article are derived from that review. The formatting rules are grouped into three categories that can be easily applied to CPGs: first, Vivid: make it stand out; second, Intuitive: match it to the audience's expectations, and third, Visual: use alternatives to text. We highlight rules supported by our broad literature review and provide specific 'how to' recommendations for individuals and groups developing evidence-based materials for clinicians. The way text documents are formatted influences their accessibility and usability. Optimizing the formatting of CPGs is a relatively inexpensive intervention and can be used to facilitate the dissemination of evidence in healthcare. Applying simple formatting principles to make documents more vivid, intuitive, and visual is a practical approach that has the potential to influence the usability of guidelines and to influence the extent to which guidelines are read, remembered, and used in practice.

The Prevention of Hemorrhagic Stroke

PubMed Central

Raymond, J.; Mohr, JP; the TEAM-ARUBA collaborative groups

2008-01-01

Summary There is currently no evidence that preventive treatment of unruptured aneurysms or AVMs is beneficial and randomized trials have been proposed to address this clinical uncertainty. Participation in a trial may necessitate a shift of point of view compared to a certain habitual clinical mentality. A review of the ethical and rational principles governing the design and realization of a trial may help integrate clinical research into expert clinical practices. The treatment of unruptured aneurysms and AVMs remains controversial, and data from observational studies cannot provide a normative basis for clinical decisions. Prevention targets healthy individuals and hence has an obligation of results. There is no opposition between the search for objective facts using scientific methods and the ethics of medical practice since a good practice cannot forbid physicians the means to define what could be beneficial to patients. Perhaps the most difficult task is to recognize the uncertainty that is crucial to allow resorting to trial methodology. The reasoning that is used in research and analysis differs from the casuistic methods typical of clinical work, but clinical judgement remains the dominant factor that decides both who enters the trial and to whom the results of the trial will apply. Randomization is still perceived as a difficult and strange method to integrate into normal practice, but in the face of uncertainty it assures the best chances for the best outcome to each participant. Some tension exists between scientific methods and normal practice, but they need to coexist if we are to progress at the same time we care for patients. PMID:20557736

A study of the effect of dyad practice versus that of individual practice on simulation-based complex skills learning and of students' perceptions of how and why dyad practice contributes to learning.

PubMed

Räder, Sune B E W; Henriksen, Ann-Helen; Butrymovich, Vitalij; Sander, Mikael; Jørgensen, Erik; Lönn, Lars; Ringsted, Charlotte V

2014-09-01

The aims of this study were (1) to explore the effectiveness of dyad practice compared with individual practice on a simulator for learning a complex clinical skill and (2) to explore medical students' perceptions of how and why dyad practice on a simulator contributes to learning a complex skill. In 2011, the authors randomly assigned 84 medical students to either the dyad or the individual practice group to learn coronary angiography skills using instruction videos and a simulator. Two weeks later, participants each performed two video-recorded coronary angiographies on the simulator. Two raters used a rating scale to assess the participants' video-recorded performance. The authors then interviewed the participants in the dyad practice group. Seventy-two (86%) participants completed the study. The authors found no significant difference between the performance scores of the two groups (mean±standard deviation, 68%±13% for individual versus 63%±16% for dyad practice; P=.18). Dyad practice participants noted that several key factors contributed to their learning: being equal-level novices, the quality of the cooperation between partners, observational learning and overt communication, social aspects and motivation, and meta-cognition. Dyad practice is more efficient and thus more cost-effective than individual practice and can be used for costly virtual reality simulator training. However, dyad practice may not apply to clinical training involving real patients because learning from errors and overt communication, both keys to dyad practice, do not transfer to clinical practice.

Advantages of the Dental Practice-Based Research Network Initiative and Its Role in Dental Education

PubMed Central

Curro, Frederick A.; Grill, Ashley C.; Thompson, Van P.; Craig, Ronald G.; Vena, Don; Keenan, Analia V.; Naftolin, Frederick

2012-01-01

Practice-based research networks (PBRNs) provide a novel venue in which providers can increase their knowledge base and improve delivery of care through participation in clinical studies. This article describes some aspects of our experience with a National Institute of Dental and Craniofacial Research-supported PBRN and discusses the role it can play in dental education. PBRNs create a structured pathway for providers to advance their professional development by participating in the process of collecting data through clinical research. This process allows practitioners to contribute to the goals of evidence-based dentistry by helping to provide a foundation of evidence on which to base clinical decisions as opposed to relying on anecdotal evidence. PBRNs strengthen the professional knowledge base by applying the principles of good clinical practice, creating a resource for future dental faculty, training practitioners on best practices, and increasing the responsibility, accountability, and scope of care. PBRNs can be the future pivotal instruments of change in dental education, the use of electronic health record systems, diagnostic codes, and the role of comparative effectiveness research, which can create an unprecedented opportunity for the dental profession to advance and be integrated into the health care system. PMID:21828299

Advantages of the dental practice-based research network initiative and its role in dental education.

PubMed

Curro, Frederick A; Grill, Ashley C; Thompson, Van P; Craig, Ronald G; Vena, Don; Keenan, Analia V; Naftolin, Frederick

2011-08-01

Practice-based research networks (PBRNs) provide a novel venue in which providers can increase their knowledge base and improve delivery of care through participation in clinical studies. This article describes some aspects of our experience with a National Institute of Dental and Craniofacial Research-supported PBRN and discusses the role it can play in dental education. PBRNs create a structured pathway for providers to advance their professional development by participating in the process of collecting data through clinical research. This process allows practitioners to contribute to the goals of evidence-based dentistry by helping to provide a foundation of evidence on which to base clinical decisions as opposed to relying on anecdotal evidence. PBRNs strengthen the professional knowledge base by applying the principles of good clinical practice, creating a resource for future dental faculty, training practitioners on best practices, and increasing the responsibility, accountability, and scope of care. PBRNs can be the future pivotal instruments of change in dental education, the use of electronic health record systems, diagnostic codes, and the role of comparative effectiveness research, which can create an unprecedented opportunity for the dental profession to advance and be integrated into the health care system.

East meets West: applying Eastern spirituality in clinical practice.

PubMed

Chan, Cecilia L W; Ng, S M; Ho, Rainbow T H; Chow, Amy Y M

2006-07-01

The paper discusses the application of the Eastern body-mind-spirit approach in healthcare practice. Traumas, sufferings and losses may induce immense distress in patients and their families, as well as apathy and exhaustion in healthcare workers. Over-specialization and compartmentalization of services may provide a convenient shelter for healthcare workers to be detached and to simply focus on a narrowly defined scope of intervention. However, the existential problems are still there. Based upon eastern philosophies and holistic health practices, we propose the body-mind-spirit approach in healthcare settings. This is a review paper summarizing the application of the approach on various clinical populations. The approach has been trialled with promising results in a number of health conditions and psychosocial predicaments. Spirituality is not restricted to any religious practices, nor is it narrowed to the pursuit of knowledge at a high level of abstraction. The interconnectedness of the body, mind and spirit presupposes that the practice of spirituality is multidimensional and multi-levelled. Using the body-mind-spirit framework flexibly we can engage more clients while facilitating the important process of exploration and change. The key components include getting in touch with the inner self, coming back to our senses, connecting our body and mind and rebalancing our relationship with the natural and social environment. The ultimate goal is to move out of meaninglessness and to reach a state of mature spirituality of tranquillity and transcendence. The practice of spirituality can be easily applied to daily life.

Clinical nurse leaders' and academics' perspectives in clinical assessment of final-year nursing students: A qualitative study.

PubMed

Wu, Xi Vivien; Enskär, Karin; Pua, Lay Hoon; Heng, Doreen Gek Noi; Wang, Wenru

2017-09-01

The nature of nursing practice is diverse; therefore, clinical assessment is a complex process. This study explores the perceptions of clinical nurse leaders and academics on clinical assessment for undergraduate nursing education during transition to practice. An explorative qualitative approach was applied. Eight nurse managers, six clinical nurse educators, and eight academics from two tertiary hospitals and a university in Singapore participated in four focus group discussions. Thematic analysis was conducted. Four overriding themes were revealed: the need for a valid and reliable clinical assessment tool, preceptors' competency in clinical assessment, challenges encountered by the students in clinical assessment, and the need for close academic and clinical collaboration to support preceptors and students. Closer academic-clinical partnership is recommended to review the clinical education curriculum. Clinical and educational institutions need to work closely to design a learning program to enhance preceptors' competence in clinical pedagogy and assessment. Furthermore, a stress management program could build students' resiliency in coping with unfamiliar clinical environments. Ongoing support needs to be provided for both preceptors and students to enrich the preceptorship and learning experiences. © 2017 John Wiley & Sons Australia, Ltd.

Expanding the use of empiricism in nursing: can we bridge the gap between knowledge and clinical practice?

PubMed

Giuliano, Karen K

2003-04-01

The philosophy of Aristotle and its impact on the process of empirical scientific inquiry has been substantial. The influence of the clarity and orderliness of his thinking, when applied to the acquisition of knowledge in nursing, can not be overstated. Traditional empirical approaches have and will continue to have an important influence on the development of nursing knowledge through nursing research. However, as nursing is primarily a practice discipline, the transition from empirical and syllogistic reasoning is problematic. Other types of inquiry are essential in the application of nursing knowledge obtained by empirical scientific approaches and to understand how that knowledge can best be used in the care of patients. This paper reviews the strengths and limitations of syllogistic reasoning by applying it to a recently published study on temperature measurement in nursing. It then discusses possible ways that the empirical knowledge gained from that study and confirmed in its reasoning by logical analysis could be used in the daily care of critically ill patients. It concludes by highlighting the utility of broader approaches to knowledge development, including interpretative approaches and contemporary empiricism, as a way to bridge the gap between factual empirical knowledge and the practical application of that knowledge in everyday clinical nursing practice.

Ask the right question: a critical step for practicing evidence-based laboratory medicine.

PubMed

Price, Christopher P; Christenson, Robert H

2013-07-01

The purpose of laboratory medicine is to facilitate better decision making in clinical practice and healthcare delivery. Decision making implies an unresolved issue, problem or unmet need. The most important criterion for any investigation to be of value in clinical practice is that it addresses an unmet need. The different ways in which laboratory investigations are utilized in patient care can be represented in the form of questions. It is important that these questions are articulated to highlight the variables that will impact on the effectiveness of the investigation in the scenario being considered. These variables include the characteristics of the patient (or population) and clinical setting, the nature of the decision and action taken on receipt of the test result and the expected outcome. Asking a question is the first step of the evidence-based laboratory medicine (EBLM) cycle, the other steps being acquiring the evidence, critically appraising the evidence, applying the evidence and auditing use of the evidence. Getting the question right determines the quality of the whole process, thus, defines the quality in practice of laboratory medicine. Whilst the main focus of the EBLM cycle is to provide a strong evidence base for use in clinical practice, it is clear that the five steps are equally applicable in commissioning, delivery and audit (performance management) of services. Asking the right question is crucial to improving the quality of evidence, and practice, in laboratory medicine, and should be used in routine laboratory medicine practice and management throughout healthcare.

THE MAQC PROJECT: ESTABLISHING QC METRICS AND THRESHOLDS FOR MICROARRAY QUALITY CONTROL

EPA Science Inventory

Microarrays represent a core technology in pharmacogenomics and toxicogenomics; however, before this technology can successfully and reliably be applied in clinical practice and regulatory decision-making, standards and quality measures need to be developed. The Microarray Qualit...

MO-F-304-01: Applying PDSA to a Practical Clinical Problem: Variation in Procedural Doses Among Interventional Radiologists

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jones, A.

With the current Maintenance of Certification (MOC) requirement for a practice quality improvement (PQI) project every 3 years, we all (well, most of us) find ourselves searching for projects that are both manageable and likely to have a positive impact on our clinical practice. In this session we will walk through the use of the Plan, Do, Study, Act (PDSA) cycle to address a common finding in practices where fluoroscopically guided interventions (FGI) are performed: variation in procedural doses among physicians. We will also examine strategies to secure physician support using carrots, not sticks. Learning Objectives: Review the PDSA cyclemore » and its application to PQI. Discuss strategies for action in the example presented. Examine strategies for successful group PQI projects. A. Kyle Jones: Owner, FluoroSafety Joseph R. Steele: Consultant, FluoroSafety.« less

Discovering the nature of advanced nursing practice in high dependency care: a critical care nurse consultant's experience.

PubMed

Fairley, Debra

2005-06-01

This paper describes how a critical care nurse consultant's clinical role has evolved within a surgical high dependency unit (SHDU) in a large teaching hospitals trust. In order to provide some background to role development, an overview of the research exploring the nature of advanced nursing practice in the context of critical care will be presented. From the outset, advanced nursing practice was not perceived as the acquisition and application of technical procedures usually undertaken by doctors, but possibly an integration of medicine and nursing where holistic nursing assessment is combined with symptom-focused physical examination. A reflective account of practical problems encountered relating to role integration, professional autonomy, legal and consent issues, non-medical prescribing, and role evaluation will be presented. A model of working that can be applied to high dependency units, integrating the role of the advanced nurse practitioner within the clinical team, will be described.

Barriers in implementing evidence-informed health decisions in rural rehabilitation settings: a mixed methods pilot study.

PubMed

Prakash, V; Hariohm, K; Balaganapathy, M

2014-08-01

Literature on the barriers to implementing research findings into physiotherapy practice are often urban centric, using self report based on the hypothetical patient scenario. The objective of this study was to investigate the occurrence of barriers, encountered by evidence informed practice-trained physiotherapists in the management of "real world" patients in rural rehabilitation settings. A mixed-methods research design was used. Physiotherapists working in rural outpatient rehabilitation settings participated in the study. In the first phase, we asked all participants (N = 5) to maintain a log book for a 4-week period to record questions that arose during their routine clinical encounters and asked them also to follow first four of the five steps of evidence-informed practice (ask, access, appraise and apply). In the second phase (after 4 weeks), we conducted a semistructured, direct interviews with the participants exploring their experiences involved in the process of implementing evidence-informed clinical decisions made during the study period. At the end of 4 weeks, 30 questions were recorded. For 17 questions, the participants found evidence but applied that evidence into their practice only in 9 instances. Being generalist practitioners, lack of outcomes specific to the patients were reported as barriers more so than time constraints in implementing evidence-informed practice. Practice setting, lack of patient-centered research and evidence-informed practice competency of physiotherapists can be significant barriers to implementing evidence-informed health decisions in rural rehabilitation setting. © 2014 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

Clinical Physiologic Research Instrumentation: An Approach Using Modular Elements and Distributed Processing

PubMed Central

Hagen, R. W.; Ambos, H. D.; Browder, M. W.; Roloff, W. R.; Thomas, L. J.

1979-01-01

The Clinical Physiologic Research System (CPRS) developed from our experience in applying computers to medical instrumentation problems. This experience revealed a set of applications with a commonality in data acquisition, analysis, input/output, and control needs that could be met by a portable system. The CPRS demonstrates a practical methodology for integrating commercial instruments with distributed modular elements of local design in order to make facile responses to changing instrumentation needs in clinical environments. ImagesFigure 3

Critical Appraisal Skills Among Canadian Obstetrics and Gynaecology Residents: How Do They Fare?

PubMed

Bougie, Olga; Posner, Glenn; Black, Amanda Y

2015-07-01

Evidence-based medicine has become the standard of care in clinical practice. In this study, our objectives were to (1) determine the type of epidemiology and/or biostatistical training being given in Canadian obstetrics and gynaecology post-graduate programs, (2) determine obstetrics and gynaecology residents' level of confidence with critical appraisal, and (3) assess knowledge of fundamental biostatistical and epidemiological principles among Canadian obstetrics and gynaecology trainees. During a national standardized in-training examination, all Canadian obstetrics and gynaecology residents were invited to complete an anonymous cross-sectional survey to determine their levels of confidence with critical appraisal. Fifteen critical appraisal questions were integrated into the standardized examination to assess critical appraisal skills objectively. Primary outcomes were the residents' level of confidence interpreting biostatistical results and applying research findings to clinical practice, their desire for more biostatistics/epidemiological training in residency, and their performance on knowledge questions. A total of 301 of 355 residents completed the survey (response rate=84.8%). Most (76.7%) had little/no confidence interpreting research statistics. Confidence was significantly higher in those with increased seniority (OR=1.93), in those who had taken a previous epidemiology/statistics course (OR=2.65), and in those who had prior publications (OR=1.82). Many (68%) had little/no confidence applying research findings to clinical practice. Confidence increased significantly with increasing training year (P<0.001) and with formal epidemiology training during residency (OR=2.01). The mean score of the 355 residents on the knowledge assessment questions was 69.8%. Increasing seniority was associated with improved overall test performance (P=0.02). Poorer performance topics included analytical study method (9.9%), study design (36.9%), and sample size (42.0%). Most (84.4%) wanted more epidemiology teaching. Canadian obstetrics and gynaecology residents may have the biostatistical and epidemiological knowledge to interpret results published in the literature, but lack confidence applying these skills in clinical settings. Most residents want additional training in these areas, and residency programs should include training in formal curriculums to improve their confidence and prepare them for a lifelong practice of evidence-based medicine.

A work-based learning approach for clinical support workers on mental health inpatient wards.

PubMed

Kemp, Philip; Gilding, Moorene; Seewooruttun, Khooseal; Walsh, Hannah

2016-09-14

Background With a rise in the number of unqualified staff providing health and social care, and reports raising concerns about the quality of care provided, there is a need to address the learning needs of clinical support workers. This article describes a qualitative evaluation of a service improvement project that involved a work-based learning approach for clinical support workers on mental health inpatient wards. Aim To investigate and identify insights in relation to the content and process of learning using a work-based learning approach for clinical support workers. Method This was a qualitative evaluation of a service improvement project involving 25 clinical support workers at the seven mental health inpatient units in South London and Maudsley NHS Foundation Trust. Three clinical skills tutors were appointed to develop, implement and evaluate the work-based learning approach. Four sources of data were used to evaluate this approach, including reflective journals, qualitative responses to questionnaires, three focus groups involving the clinical support workers and a group interview involving the clinical skills tutors. Data were analysed using thematic analysis. Findings The work-based learning approach was highly valued by the clinical support workers and enhanced learning in practice. Face-to-face learning in practice helped the clinical support workers to develop practice skills and reflective learning skills. Insights relating to the role of clinical support workers were also identified, including the benefits of face-to-face supervision in practice, particularly in relation to the interpersonal aspects of care. Conclusion A work-based learning approach has the potential to enhance care delivery by meeting the learning needs of clinical support workers and enabling them to apply learning to practice. Care providers should consider how the work-based learning approach can be used on a systematic, organisation-wide basis in the context of budgetary restrictions.

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. Copyright © 2013 Elsevier España, S.L. All rights reserved.

The case of juvenile polygraphy as a clinical ethics dilemma.

PubMed

Chaffin, Mark

2011-09-01

Polygraph interrogations are used by half of all surveyed juvenile sex offender (JSO) treatment programs in the United States. This is a distinctive and controversial practice that is rarely if ever used with other juvenile delinquent populations, and that is rarely used or is banned from JSO treatment programs in other countries. Clinical polygraphy is an ethically sensitive issue because it involves mental health therapists in involuntary coercive interrogations of minors. This article reviews core mental health professional ethics principles for juveniles. JSO polygraphy is used as an illustrative issue for applying human rights principles to a practice in light of its benefits, risks, and available alternatives.

Integrating Science and Engineering to Implement Evidence-Based Practices in Health Care Settings

PubMed Central

Wu, Shinyi; Duan, Naihua; Wisdom, Jennifer P.; Kravitz, Richard L.; Owen, Richard R.; Sullivan, Greer; Wu, Albert W.; Di Capua, Paul; Hoagwood, Kimberly Eaton

2015-01-01

Integrating two distinct and complementary paradigms, science and engineering, may produce more effective outcomes for the implementation of evidence-based practices in health care settings. Science formalizes and tests innovations, whereas engineering customizes and optimizes how the innovation is applied tailoring to accommodate local conditions. Together they may accelerate the creation of an evidence-based healthcare system that works effectively in specific health care settings. We give examples of applying engineering methods for better quality, more efficient, and safer implementation of clinical practices, medical devices, and health services systems. A specific example was applying systems engineering design that orchestrated people, process, data, decision-making, and communication through a technology application to implement evidence-based depression care among low-income patients with diabetes. We recommend that leading journals recognize the fundamental role of engineering in implementation research, to improve understanding of design elements that create a better fit between program elements and local context. PMID:25217100

Innovative physical therapy practice: a qualitative verification of factors that support diffusion of innovation in outpatient physical therapy practice

PubMed Central

Sabus, Carla; Spake, Ellen

2016-01-01

Background and purpose New ideas, methods, and technologies spread through cultures through typical patterns described by diffusion of innovation (DOI) theory. Professional cultures, including the physical therapy profession, have distinctive features and traditions that determine the adoption of practice innovation. The Consolidated Framework for Implementation Research (CFIR) proposes a framework of innovation implementation specific to health care services. While the CFIR has been applied to medical and nursing practice, it has not been extended to rehabilitation professions. The purpose of this qualitative study was to verify the CFIR factors in outpatient physical therapy practice. Design Through a nomination process of area rehabilitation managers and area directors of clinical education, 2 exemplar, outpatient, privately owned physical therapy clinics were identified as innovation practices. A total of 18 physical therapists (PTs), including 3 owners and a manager, participated in the study. Methods The 2 clinics served as case studies within a qualitative approach of directed content analysis. Data were collected through observation, spontaneous, unstructured questioning, workflow analysis, structured focus group sessions, and artifact analysis including clinical documents. Focus group data were transcribed. All the data were analyzed and coded among 4 investigators. Results Through data analysis and alignment with literature in DOI theory in health care practice, the factors that determine innovation adoption were verified. The phenomena of implementation in PT practice are largely consistent with models of implementation in health care service. Within the outpatient practices studied, patient-centered care and collaborative learning were foundational elements to diffusion of an innovation. Conclusion Innovation in outpatient physical therapy practice can be understood as a social process situated within the culture of the physical therapy professional that follows predictable patterns that strongly align with DOI theory and the CFIR. PMID:29355199

Innovative physical therapy practice: a qualitative verification of factors that support diffusion of innovation in outpatient physical therapy practice.

PubMed

Sabus, Carla; Spake, Ellen

2016-01-01

New ideas, methods, and technologies spread through cultures through typical patterns described by diffusion of innovation (DOI) theory. Professional cultures, including the physical therapy profession, have distinctive features and traditions that determine the adoption of practice innovation. The Consolidated Framework for Implementation Research (CFIR) proposes a framework of innovation implementation specific to health care services. While the CFIR has been applied to medical and nursing practice, it has not been extended to rehabilitation professions. The purpose of this qualitative study was to verify the CFIR factors in outpatient physical therapy practice. Through a nomination process of area rehabilitation managers and area directors of clinical education, 2 exemplar, outpatient, privately owned physical therapy clinics were identified as innovation practices. A total of 18 physical therapists (PTs), including 3 owners and a manager, participated in the study. The 2 clinics served as case studies within a qualitative approach of directed content analysis. Data were collected through observation, spontaneous, unstructured questioning, workflow analysis, structured focus group sessions, and artifact analysis including clinical documents. Focus group data were transcribed. All the data were analyzed and coded among 4 investigators. Through data analysis and alignment with literature in DOI theory in health care practice, the factors that determine innovation adoption were verified. The phenomena of implementation in PT practice are largely consistent with models of implementation in health care service. Within the outpatient practices studied, patient-centered care and collaborative learning were foundational elements to diffusion of an innovation. Innovation in outpatient physical therapy practice can be understood as a social process situated within the culture of the physical therapy professional that follows predictable patterns that strongly align with DOI theory and the CFIR.

Enhancing Critical Thinking Via a Clinical Scholar Approach.

PubMed

Simpson, Vicki; McComb, Sara A; Kirkpatrick, Jane M

2017-11-01

Safety, quality improvement, and a systems perspective are vital for nurses to provide quality evidence-based care. Responding to the call to prepare nurses with these perspectives, one school of nursing used a clinical scholar approach, enhanced by systems engineering to more intentionally develop the ability to clinically reason and apply evidence-based practice. A two-group, repeated-measures control trial was used to determine the effects of systems engineering content and support on nursing students' clinical judgment and critical thinking skills. Findings indicated this approach had a positive effects on student's clinical judgment and clinical reasoning skills. This approach helped students view health care issues from a broader perspective and use evidence to guide solution development, enhancing the focus on evidence-based practice, and quality improvement. Intentional integration of an evidence-based, systems perspective by nursing faculty supports development of nurses who can function safely and effectively in the current health care system. [J Nurs Educ. 2017;56(11):679-682.]. Copyright 2017, SLACK Incorporated.

Do we need autoimmune disease units in hospitals?

PubMed

Vasconcelos, Carlos

2009-09-01

Autoimmune diseases are increasing worldwide, and associated morbidity, mortality, and health care costs are high. Biological therapies, however, have brought physicians an extraordinary opportunity to change natural disease history, although these therapies can also have high associated iatrogenic costs. These factors point to the necessity of having physicians that are dedicated to autoimmunology. The question regarding the creation of a new specialty, the autoimmunologist, should be addressed after an inquiry into the current practice in this field of medicine. This includes many classical specialties, such as internal medicine, rheumatology, and neurology, as well as clinical immunology. In clinical immunology, not counting the specialists in allergology and clinical immunology that mainly work only with allergies, heterogeneity is high in clinical practice, as the European Union of Medical Specialists documented some years ago. I am, at least for now, in favor of the creation of a transversal competency to which the different physicians working in the area could apply to in order to standardize the clinical practice in autoimmunology. It will be necessary to define a core curriculum, and in the end we shall have classical specialists and clinical immunologists with or without the competency of autoimmunology. Of utmost importance is that this new field of medicine should not be translated, as in the past happened with other areas, by walls between medical specialties. Instead it should help standardize and harmonize clinical practice. The time for autoimmunology is now, and, indeed, hospitals must have autoimmune disease units.

Challenges in translating endpoints from trials to observational cohort studies in oncology

PubMed Central

Ording, Anne Gulbech; Cronin-Fenton, Deirdre; Ehrenstein, Vera; Lash, Timothy L; Acquavella, John; Rørth, Mikael; Sørensen, Henrik Toft

2016-01-01

Clinical trials are considered the gold standard for examining drug efficacy and for approval of new drugs. Medical databases and population surveillance registries are valuable resources for post-approval observational research, which are increasingly used in studies of benefits and risk of new cancer drugs. Here, we address the challenges in translating endpoints from oncology trials to observational studies. Registry-based cohort studies can investigate real-world safety issues – including previously unrecognized concerns – by examining rare endpoints or multiple endpoints at once. In contrast to clinical trials, observational cohort studies typically do not exclude real-world patients from clinical practice, such as old and frail patients with comorbidity. The observational cohort study complements the clinical trial by examining the effectiveness of interventions applied in clinical practice and by providing evidence on long-term clinical outcomes, which are often not feasible to study in a clinical trial. Various endpoints can be included in clinical trials, such as hard endpoints, soft endpoints, surrogate endpoints, and patient-reported endpoints. Each endpoint has it strengths and limitations for use in research studies. Endpoints used in oncology trials are often not applicable in observational cohort studies which are limited by the setting of standard clinical practice and by non-standardized endpoint determination. Observational studies can be more helpful moving research forward if they restrict focus to appropriate and valid endpoints. PMID:27354827

Interventional Radiology Clinical Practice Guideline Recommendations for Neurovascular Disorders Are Not Based on High-Quality Systematic Reviews.

PubMed

Chong, A B; Taylor, M; Schubert, G; Vassar, M

2017-04-01

In recent years, clinical practice guidelines have been criticized for biased interpretations of research evidence, and interventional radiology is no exception. Our aim was to evaluate the methodologic quality and transparency of reporting in systematic reviews used as evidence in interventional radiology clinical practice guidelines for neurovascular disorders from the Society of Interventional Radiology. Our sources were 9 neurovascular disorder clinical practice guidelines from the Society of Interventional Radiology. We selected 65 systematic reviews and meta-analyses. A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) tools were used to assess the methodologic quality and reporting transparency of systematic reviews. Radial plots were created on the basis of average scores for PRISMA and AMSTAR items. On the basis of AMSTAR scores, 3 (4.62%) reviews were high-quality, 28 reviews (43.08%) were moderate-quality, and 34 reviews (52.31%) were low-quality, with an average quality score of 3.66 (34.32%; minimum, 0%; maximum, 81.82%). The average PRISMA score was 18.18 (69.41%). We were unable to obtain previous versions for 8 reviews, 7 of which were from the Cochrane Database of Systematic Reviews. The methodologic quality of systematic reviews needs to be improved. Although reporting clarity was much better than the methodologic quality, it still has room for improvement. The methodologic quality and transparency of reporting did not vary much among clinical practice guidelines. This study can also be applied to other medical specialties to examine the quality of studies used as evidence in their own clinical practice guidelines. © 2017 by American Journal of Neuroradiology.

Evidence based general practice: a retrospective study of interventions in one training practice.

PubMed Central

Gill, P.; Dowell, A. C.; Neal, R. D.; Smith, N.; Heywood, P.; Wilson, A. E.

1996-01-01

OBJECTIVES--To estimate the proportion of interventions in general practice that are based on evidence from clinical trials and to assess the appropriateness of such an evaluation. DESIGN--Retrospective review of case notes. SETTING--One suburban training general practice. SUBJECTS--122 consecutive doctor-patient consultations over two days. MAIN OUTCOME MEASURES--Proportions of interventions based on randomised controlled trials (from literature search with Medline, pharmaceutical databases, and standard textbooks), on convincing non-experimental evidence, and without substantial evidence. RESULTS--21 of the 122 consultations recorded were excluded due to insufficient data; 31 of the interventions were based on randomised controlled trial evidence and 51 based on convincing non-experimental evidence. Hence 82/101 (81%) of interventions were based on evidence meeting our criteria. CONCLUSIONS--Most interventions within general practice are based on evidence from clinical trials, but the methods used in such trials may not be the most appropriate to apply to this setting. PMID:8608291

Beyond Positivism: Understanding and addressing childhood obesity disparities through a Critical Theory perspective

PubMed Central

Schroeder, Krista; Kulage, Kristine M.; Lucero, Robert

2016-01-01

Purpose We apply Critical Theory to examine menu labeling with the aim of uncovering important implications for nursing practice, research, and policy. Conclusions Our critical analysis uncovers barriers to menu labeling's effectiveness, particularly for vulnerable populations. Nurses must work to minimize the impact of these barriers and optimize the effectiveness of menu labeling, in order to strengthen the fight against obesity. Practice implications We suggest changes, guided by this critical analysis,that can be implemented by nurses working in clinical practice, research, and policy. PMID:26112774

The Zero Suicide Model: Applying Evidence-Based Suicide Prevention Practices to Clinical Care

PubMed Central

Brodsky, Beth S.; Spruch-Feiner, Aliza; Stanley, Barbara

2018-01-01

Suicide is reaching epidemic proportions, with over 44,000 deaths by suicide in the US, and 800,000 worldwide in 2015. This, despite research and development of evidence-based interventions that target suicidal behavior directly. Suicide prevention efforts need a comprehensive approach, and research must lead to effective implementation across public and mental health systems. A 10-year systematic review of evidence-based findings in suicide prevention summarized the areas necessary for translating research into practice. These include risk assessment, means restriction, evidence-based treatments, population screening combined with chain of care, monitoring, and follow-up. In this article, we review how suicide prevention research informs implementation in clinical settings where those most at risk present for care. Evidence-based and best practices address the fluctuating nature of suicide risk, which requires ongoing risk assessment, direct intervention and monitoring. In the US, the National Action Alliance for Suicide Prevention has put forth the Zero Suicide (ZS) Model, a framework to coordinate a multilevel approach to implementing evidence-based practices. We present the Assess, Intervene and Monitor for Suicide Prevention model (AIM-SP) as a guide for implementation of ZS evidence-based and best practices in clinical settings. Ten basic steps for clinical management model will be described and illustrated through case vignette. These steps are designed to be easily incorporated into standard clinical practice to enhance suicide risk assessment, brief interventions to increase safety and teach coping strategies and to improve ongoing contact and monitoring of high-risk individuals during transitions in care and high risk periods. PMID:29527178

Liver fibrosis in human immunodeficiency virus/hepatitis C virus coinfection: Diagnostic methods and clinical impact

PubMed Central

Sagnelli, Caterina; Martini, Salvatore; Pisaturo, Mariantonietta; Pasquale, Giuseppe; Macera, Margherita; Zampino, Rosa; Coppola, Nicola; Sagnelli, Evangelista

2015-01-01

Several non-invasive surrogate methods have recently challenged the main role of liver biopsy in assessing liver fibrosis in hepatitis C virus (HCV)-monoinfected and human immunodeficiency virus (HIV)/HCV-coinfected patients, applied to avoid the well-known side effects of liver puncture. Serological tests involve the determination of biochemical markers of synthesis or degradation of fibrosis, tests not readily available in clinical practice, or combinations of routine tests used in chronic hepatitis and HIV/HCV coinfection. Several radiologic techniques have also been proposed, some of which commonly used in clinical practice. The studies performed to compare the prognostic value of non-invasive surrogate methods with that of the degree of liver fibrosis assessed on liver tissue have not as yet provided conclusive results. Each surrogate technique has shown some limitations, including the risk of over- or under-estimating the extent of liver fibrosis. The current knowledge on liver fibrosis in HIV/HCV-coinfected patients will be summarized in this review article, which is addressed in particular to physicians involved in this setting in their clinical practice. PMID:26523204

mHealth: Mobile Technologies to Virtually Bring the Patient Into an Oncology Practice.

PubMed

Pennell, Nathan A; Dicker, Adam P; Tran, Christine; Jim, Heather S L; Schwartz, David L; Stepanski, Edward J

2017-01-01

Accompanied by the change in the traditional medical landscape, advances in wireless technology have led to the development of telehealth or mobile health (mHealth), which offers an unparalleled opportunity for health care providers to continually deliver high-quality care. This revolutionary shift makes the patient the consumer of health care and empowers patients to be the driving force of management of their own health through mobile devices and wearable technology. This article presents an overview of technology as it pertains to clinical practice considerations. Telemedicine is changing the way clinical care is delivered without regard for proximity to the patient, whereas nonclinical telehealth applications affect distance education for consumers or clinicians, meetings, research, continuing medical education, and health care management. Technology has the potential to reduce administrative burdens and improve both efficiency and quality of care delivery in the clinic. Finally, the potential for telehealth approaches as cost-effective ways to improve adherence to treatment is explored. As telehealth advances, health care providers must understand the fundamental framework for applying telehealth strategies to incorporate into successful clinical practice.

[How can institutional structures make clinical research in France more operational?].

PubMed

Funck-Brentano, C; Brouard, R

The laws regulating the practice of clinical research in France, in particular the law of 20 December 1988, the so-called Huriet's law, constitute a major advance for medical progress. However, their implementation by administrative offices generates practical difficulties which impair the development of applied research in human beings. Beyond the laws themselves, it appears that our institutions are unprepared to optimize the conduct of such research. This round table sought to list the existing problems and to propose constructive solutions or objectives to be reached to optimize clinical research in France, with a view to improving French participation in international collaborative programmes, notably European ones. Evaluation of projects and practices, financial support and accounting, and some aspects of existing laws have been identified as the major sources of our difficulties. Harmonization and clarification of our procedures as well as improvement of training should be our primary objectives to achieve a higher level of medical, scientific, financial and administrative quality in the conduct of clinical research. Creation of a referential Web site, designed and updated by a central public organization, is an imperative step towards reaching these objectives.

Clinical practice guidelines in complementary and alternative medicine. An analysis of opportunities and obstacles. Practice and Policy Guidelines Panel, National Institutes of Health Office of Alternative Medicine.

PubMed

1997-01-01

An estimated 1 of 3 Americans uses some form of complementary and alternative medicine (CAM), such as acupuncture, homeopathy, or herbal medicine. In 1995, the National Institutes of Health Office of Alternative Medicine convened an expert panel to examine the role of clinical practice guidelines in CAM. The panel concluded that CAM practices currently are unsuitable for the development of evidence-based practice guidelines, in part because of the lack of relevant outcomes data from well-designed clinical trials. Moreover, the notions of standardization and appropriateness, inherent in guideline development, face challenging methodologic problems when applied to CAM, which considers many different treatment practices appropriate and encourages highly individualized care. Due to different belief systems and divergent theories about the nature of health and illness, CAM disciplines have fundamental differences in how they define target conditions, causes of disease, interventions, and outcome measures of effectiveness. These differences are even more striking when compared with those used by Western medicine. The panel made a series of recommendations on strategies to strengthen the evidence base for future guideline development in CAM and to meet better the current information needs of clinicians, patients, and guideline developers who seek information about CAM treatments.

A Clinical Nurse Leader (CNL) practice development model to support integration of the CNL role into microsystem care delivery.

PubMed

Kaack, Lorraine; Bender, Miriam; Finch, Michael; Borns, Linda; Grasham, Katherine; Avolio, Alice; Clausen, Shawna; Terese, Nadine A; Johnstone, Diane; Williams, Marjory

The Veterans Health Administration (VHA) Office of Nursing Services (ONS) was an early adopter of Clinical Nurse Leader (CNL) practice, generating some of the earliest pilot data of CNL practice effectiveness. In 2011 the VHA ONS CNL Implementation & Evaluation Service (CNL I&E) piloted a curriculum to facilitate CNL transition to effective practice at local VHA settings. In 2015, the CNL I&E and local VHA setting stakeholders collaborated to refine the program, based on lessons learned at the national and local level. The workgroup reviewed the literature to identify theoretical frameworks for CNL practice and practice development. The workgroup selected Benner et al.'s Novice-to-Expert model as the defining framework for CNL practice development, and Bender et al.'s CNL Practice Model as the defining framework for CNL practice integration. The selected frameworks were cross-walked against existing curriculum elements to identify and clarify additional practice development needs. The work generated key insights into: core stages of transition to effective practice; CNL progress and expectations for each stage; and organizational support structures necessary for CNL success at each stage. The refined CNL development model is a robust tool that can be applied to support consistent and effective integration of CNL practice into care delivery. Published by Elsevier Inc.

Critical thinking in clinical nurse education: application of Paul's model of critical thinking.

PubMed

Andrea Sullivan, E

2012-11-01

Nurse educators recognize that many nursing students have difficulty in making decisions in clinical practice. The ability to make effective, informed decisions in clinical practice requires that nursing students know and apply the processes of critical thinking. Critical thinking is a skill that develops over time and requires the conscious application of this process. There are a number of models in the nursing literature to assist students in the critical thinking process; however, these models tend to focus solely on decision making in hospital settings and are often complex to actualize. In this paper, Paul's Model of Critical Thinking is examined for its application to nursing education. I will demonstrate how the model can be used by clinical nurse educators to assist students to develop critical thinking skills in all health care settings in a way that makes critical thinking skills accessible to students. Copyright © 2012 Elsevier Ltd. All rights reserved.

Narrative thematic analysis of baccalaureate nursing students' reflections: critical thinking in the clinical education context.

PubMed

Naber, Jessica L; Hall, Joanne; Schadler, Craig Matthew

2014-09-01

This study sought to identify characteristics of clinically situated critical thinking in nursing students' reflections, originally part of a study guided by Richard Paul's model of critical thinking. Nurses are expected to apply critical thinking in all practice situations to improve health outcomes, including patient safety and satisfaction. In a previous study, Paul's model of critical thinking was used to develop questions for reflective writing assignments. Within that study, 30 nursing students completed six open-ended narratives of nurse-patient clinical encounters during an 8-week period. Improvements were seen in critical thinking scores after the intervention. This article reports the qualitative analysis of the content of six open-ended narratives. Six overarching themes were identified and combined into a tentative conceptual model. Faculty's understanding of the characteristics of critical thinking in the context of clinical education will help them to teach and evaluate students' progress and competencies for future practice.

The student-run free clinic: an ideal site to teach interprofessional education?

PubMed

Sick, Brian; Sheldon, Lisa; Ajer, Katy; Wang, Qi; Zhang, Lei

2014-09-01

Student-run free clinics (SRFCs) often include an interprofessional group of health professions students and preceptors working together toward the common goal of caring for underserved populations. Therefore, it would seem that these clinics would be an ideal place for students to participate in an interprofessional collaborative practice and for interprofessional education to occur. This article describes a prospective, observational cohort study of interprofessional attitudes and skills including communication and teamwork skills and attitudes about interprofessional learning, relationships and interactions of student volunteers in a SRFC compared to students who applied and were not accepted to the clinic and to students who never applied to the clinic. This study showed a decrease in attitudes and skills after the first year for all groups. Over the next two years, the total score on the survey for the accepted students was higher than the not accepted students. The students who were not accepted also became more similar to students who never applied. This suggests a protective effect against declining interprofessional attitudes and skills for the student volunteers in a SRFC. These findings are likely a function of the design of the clinical and educational experience in the clinic and of the length of contact the students have with other professions.

Selection and utilization of assessment instruments in substance abuse treatment trials: the National Drug Abuse Treatment Clinical Trials Network experience.

PubMed

Rosa, Carmen; Ghitza, Udi; Tai, Betty

2012-07-17

Based on recommendations from a US Institute of Medicine report, the National Institute on Drug Abuse established the National Drug Abuse Treatment Clinical Trials Network (CTN) in 1999, to accelerate the translation of science-based addiction treatment research into community-based practice, and to improve the quality of addiction treatment, using science as the vehicle. One of the CTN's primary tasks is to serve as a platform to forge bi-directional communications and collaborations between providers and scientists, to enhance the relevance of research, which generates empirical results that impact practice. Among many obstacles in moving research into real-world settings, this commentary mainly describes challenges and iterative experiences in regard to how the CTN develops its research protocols, with focus on how the CTN study teams select and utilize assessment instruments, which can reasonably balance the interests of both research scientists and practicing providers when applied in CTN trials. This commentary also discusses the process by which the CTN further selects a core set of common assessment instruments that may be applied across all trials, to allow easier cross-study analyses of comparable data.

The Interface of Clinical Decision-Making With Study Protocols for Knowledge Translation From a Walking Recovery Trial.

PubMed

Hershberg, Julie A; Rose, Dorian K; Tilson, Julie K; Brutsch, Bettina; Correa, Anita; Gallichio, Joann; McLeod, Molly; Moore, Craig; Wu, Sam; Duncan, Pamela W; Behrman, Andrea L

2017-01-01

Despite efforts to translate knowledge into clinical practice, barriers often arise in adapting the strict protocols of a randomized, controlled trial (RCT) to the individual patient. The Locomotor Experience Applied Post-Stroke (LEAPS) RCT demonstrated equal effectiveness of 2 intervention protocols for walking recovery poststroke; both protocols were more effective than usual care physical therapy. The purpose of this article was to provide knowledge-translation tools to facilitate implementation of the LEAPS RCT protocols into clinical practice. Participants from 2 of the trial's intervention arms: (1) early Locomotor Training Program (LTP) and (2) Home Exercise Program (HEP) were chosen for case presentation. The two cases illustrate how the protocols are used in synergy with individual patient presentations and clinical expertise. Decision algorithms and guidelines for progression represent the interface between implementation of an RCT standardized intervention protocol and clinical decision-making. In each case, the participant presents with a distinct clinical challenge that the therapist addresses by integrating the participant's unique presentation with the therapist's expertise while maintaining fidelity to the LEAPS protocol. Both participants progressed through an increasingly challenging intervention despite their own unique presentation. Decision algorithms and exercise progression for the LTP and HEP protocols facilitate translation of the RCT protocol to the real world of clinical practice. The two case examples to facilitate translation of the LEAPS RCT into clinical practice by enhancing understanding of the protocols, their progression, and their application to individual participants.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A147).

Hypnosis Training and Education: Experiences with a Norwegian One-Year Education Course in Clinical Hypnosis for Children and Adolescents.

PubMed

Lindheim, Maren Ø; Helgeland, Helene

2017-01-01

Although the efficacy of clinical hypnosis is well documented, its implementation in clinical practice is far from completed and there are few reports of systematic, professional training. This article gives a historical overview and description of a 1-year training program in clinical hypnosis which started in Norway in 2008 and has been held yearly since then. We describe the present education course with respect to aims, conceptual framework, structure, target groups, teaching themes, and experiences. The following factors have been considered of importance for the success of this program: The extent and duration of the course, the focus on demonstrations, experiential skill-building and exercises, and that the education is rooted in acknowledged clinical, academic, and educational environments. The participants' evaluations tell stories of mastery and positive experiences with hypnosis as a therapeutic tool in their clinical practice. However, many struggle to understand the various concepts of hypnosis, trance, and suggestions. Some find it hard to get started and challenging to integrate hypnosis in their clinical practice. Finally, some report scarce opportunities to apply their newly acquired skills at their work places and limited support by their leaders. The development of systematic, professional training programs as described in this article may be of importance for further implementation. However, this will also require that clinicians and leaders in universities and professional environments, and policymakers at higher levels, recognize clinical hypnosis as a valid and efficient choice of treatment. This must be reflected in dedicated efforts to ensure successful implementation in practice.

Spiritual Diversity and Living with Early-Stage Dementia.

PubMed

McGee, Jocelyn Shealy; Zhao, Holly Carlson; Myers, Dennis R; Seela Eaton, Hannah

2018-01-01

Attention to spiritual diversity is necessary for the provision of culturally informed clinical care for people with early-stage dementia and their family members. In this article, an evidence-based theoretical framework for conceptualizing spiritual diversity is described in detail (Pargament, 2011). The framework is then applied to two clinical case studies of people living with early-stage dementia to elucidate the multilayered components of spiritual diversity in this population. The case studies were selected from a larger mixed-methods study on spirituality, positive psychological factors, health, and well-being in people living with early-stage dementia and their family members. To our knowledge this is the first systematic attempt to apply a theoretical framework for understanding spiritual diversity in this population. Implications for clinical practice are provided.

Clinical experience using a 5-week treadmill training program with virtual reality to enhance gait in an ambulatory physical therapy service.

PubMed

Shema, Shirley Roth; Brozgol, Marina; Dorfman, Moran; Maidan, Inbal; Sharaby-Yeshayahu, Lior; Malik-Kozuch, Hila; Wachsler Yannai, Orly; Giladi, Nir; Hausdorff, Jeffrey M; Mirelman, Anat

2014-09-01

Current literature views safe gait as a complex task, relying on motor and cognitive resources. The use of virtual reality (VR) in gait training offers a multifactorial approach, showing positive effects on mobility, balance, and fall risk in elderly people and individuals with neurological disorders. This form of training has been described as a viable research tool; however, it has not been applied routinely in clinical practice. Recently, VR was used to develop an adjunct training method for use by physical therapists in an ambulatory clinical setting. The aim of this article is to describe the initial clinical experience of applying a 5-week VR clinical service to improve gait and mobility in people with a history of falls, poor mobility, or postural instability. A retrospective data analysis was conducted. The clinical records of the first 60 patients who completed the VR gait training program were examined. Training was provided 3 times per week for 5 weeks, with each session lasting approximately 1 hour and consisting of walking on a treadmill while negotiating virtual obstacles. Main outcome measures were compared across time and included the Timed "Up & Go" Test (TUG), the Two-Minute Walk Test (2MWT), and the Four Square Step Test (FSST). After 5 weeks of training, time to complete the TUG decreased by 10.3%, the distance walked during the 2MWT increased by 9.5%, and performance on the FSST improved by 13%. Limitations of the study include the use of a retrospective analysis with no control group and the lack of objective cognitive assessment. Treadmill training with VR appears to be an effective and practical tool that can be applied in an outpatient physical therapy clinic. This training apparently leads to improvements in gait, mobility, and postural control. It, perhaps, also may augment cognitive and functional aspects. © 2014 American Physical Therapy Association.

Implementing web-based ping-pong-type e-communication to enhance staff satisfaction, multidisciplinary cooperation, and clinical effectiveness: A SQUIRE-compliant quality-improving study.

PubMed

Yeh, Pei-Han; Hung, Shih-Kai; Lee, Moon-Sing; Chiou, Wen-Yen; Lai, Chun-Liang; Tsai, Wei-Ta; Hsieh, Hui-Ling; Shih, Yi-Ting; Chen, Liang-Cheng; Huang, Li-Wen; Lin, Yi-An; Lin, Po-Hao; Lin, Yung-Hsiang; Liu, Dai-Wei; Hsu, Feng-Chun; Tsai, Shiang-Jiun; Liu, Jia-Chi; Chung, En-Seu; Lin, Hon-Yi

2016-11-01

Frequent multidisciplinary communication is essential in conducting daily radiotherapy (RT) practice. However, traditional oral or paper-based communication has limitations. E-communication has been suggested, but its effects are still not well demarcated in the field of radiation oncology. In our web-based integrated information platform, we constructed a ping-pong-type e-communication function to transfer specific notations among multidisciplinary RT staffs. The purpose was to test whether applying this e-communication can increase effectiveness of multidisciplinary cooperation when compared with oral or paper-based practice. Staff satisfaction and clinical benefits were also demonstrated. A real-world quality-improving study was conducted in a large center of radiation oncology. Before and after applying multidisciplinary e-communication (from 2014 to 2015), clinical RT staffs were surveyed for their user experience and satisfaction (n = 23). For measuring clinical effectiveness, a secondary database of irradiated head and neck cancer patients was re-analyzed for comparing RT toxicities (n = 402). Applying ping-pong-type multidisciplinary reflective e-communication was the main intervention. For measuring staff satisfaction, eight domains were surveyed, such as timeliness, convenience, and completeness. For measuring clinical effectiveness of multidisciplinary cooperation, event rates of severe (i.e., grade 3-4) RT mucositis and dermatitis were recorded. Overall, when compared with oral communication only, e-communication demonstrated multiple benefits, particularly on notation-review convenience (2.00 ± 1.76 vs 9.19 ± 0.81; P < 0.0001).When compared with paper-based practice, e-communication showed statistically significant benefits on all eight domains, especially on notation-review convenience (5.05 ± 2.11 vs 9.19 ± 0.81; P < 0.0001) and convenience of feedback notation (4.81 ± 1.72 vs 8.76 ± 1.09; P < 0.0001).Moreover, staff satisfaction was gradually increased from oral (3.57 ± 1.94), paper-based (5.57 ± 2.06), to e-communication (8.76 ± 0.70; P < 0.0001). Secondary measurement confirmed these observations.Before and after facilitating multidisciplinary cooperation by using e-communication, severe (i.e., grade 3-4) mucositis and dermatitis were decreased from 21.7% to 10% then to 5.1%. Replacing oral or paper-based practice with e-communication is useful in facilitating RT multidisciplinary teamwork. Staff satisfaction and clinical effectiveness can be increased.

Practical Considerations for Clinical PET/MR Imaging.

PubMed

Galgano, Samuel; Viets, Zachary; Fowler, Kathryn; Gore, Lael; Thomas, John V; McNamara, Michelle; McConathy, Jonathan

2018-01-01

Clinical PET/MR imaging is currently performed at a number of centers around the world as part of routine standard of care. This article focuses on issues and considerations for a clinical PET/MR imaging program, focusing on routine standard-of-care studies. Although local factors influence how clinical PET/MR imaging is implemented, the approaches and considerations described here intend to apply to most clinical programs. PET/MR imaging provides many more options than PET/computed tomography with diagnostic advantages for certain clinical applications but with added complexity. A recurring theme is matching the PET/MR imaging protocol to the clinical application to balance diagnostic accuracy with efficiency. Copyright © 2017 Elsevier Inc. All rights reserved.

Practical Considerations for Clinical PET/MR Imaging.

PubMed

Galgano, Samuel; Viets, Zachary; Fowler, Kathryn; Gore, Lael; Thomas, John V; McNamara, Michelle; McConathy, Jonathan

2017-05-01

Clinical PET/MR imaging is currently performed at a number of centers around the world as part of routine standard of care. This article focuses on issues and considerations for a clinical PET/MR imaging program, focusing on routine standard-of-care studies. Although local factors influence how clinical PET/MR imaging is implemented, the approaches and considerations described here intend to apply to most clinical programs. PET/MR imaging provides many more options than PET/computed tomography with diagnostic advantages for certain clinical applications but with added complexity. A recurring theme is matching the PET/MR imaging protocol to the clinical application to balance diagnostic accuracy with efficiency. Copyright © 2016 Elsevier Inc. All rights reserved.

Physicians, Preventive Care, and Applied Nutrition: Selected Literature.

ERIC Educational Resources Information Center

Glanz, Karen; Golboy, Mary Neth

1992-01-01

Twenty-five articles on medical school curricula and physicians' knowledge, attitudes, and practices related to nutritional care, especially concerning heart disease and cholesterol control, were reviewed. It is concluded that nutrition education should occur in undergraduate clinical training and residency periods and that realistic nutrition…

Adult Learning Disorders: Contemporary Issues

ERIC Educational Resources Information Center

Wolf, Lorraine E., Ed.; Schreiber, Hope E., Ed.; Wasserstein, Jeanette, Ed.

2008-01-01

Recent advances in neuroimaging and genetics technologies have enhanced our understanding of neurodevelopmental disorders in adults. The authors in this volume not only discuss such advances as they apply to adults with learning disorders, but also address their translation into clinical practice. One cluster of chapters addresses developmental…

A Novel Approach to Improving Utilization of Laboratory Testing.

PubMed

Zhou, Yaolin; Procop, Gary W; Riley, Jacquelyn D

2018-02-01

- The incorporation of best practice guidelines into one's institution is a challenging goal of utilization management, and the successful adoption of such guidelines depends on institutional context. Laboratorians who have access to key clinical data are well positioned to understand existing local practices and promote more appropriate laboratory testing. - To apply a novel approach to utilization management by reviewing international clinical guidelines and current institutional practices to create a reliable mechanism to improve detection and reduce unnecessary tests in our patient population. - We targeted a frequently ordered genetic test for HFE-related hereditary hemochromatosis, a disorder of low penetrance. After reviewing international practice guidelines, we evaluated 918 HFE tests and found that all patients with new diagnoses had transferrin saturation levels that were significantly higher than those of patients with nonrisk genotypes (72% versus 42%; P < .001). - Our "one-button" order that restricts HFE genetic tests to patients with transferrin saturation greater than 45% is consistent with published practice guidelines and detected 100% of new patients with HFE-related hereditary hemochromatosis. - Our proposed algorithm differs from previously published approaches in that it incorporates both clinical practice guidelines and local physician practices, yet requires no additional hands-on effort from pathologists or clinicians. This novel approach to utilization management embraces the role of pathologists as leaders in promoting high-quality patient care in local health care systems.

Justification of radiographic examinations: What are the key issues?

PubMed

Vom, Jason; Williams, Imelda

2017-09-01

Justification of radiographic examinations is the practice of evaluating requested radiological examinations to assess for clinical merit and appropriateness based on clinical notes and patient information. This implies that justification in radiography requires the evaluation of requested examinations, the justification of exposures being applied and determining whether patients fit the recommended criteria for the procedure. Medico-legal requirements by the professional registration body, the Medical Radiation Practice Board of Australia (MRPBA), identify justification as an advocated and obligatory practice for radiographers. Yet, justification remains an inconsistent practice implemented amongst Australian radiographers. This review aims to identify associated barriers inhibiting the consistent practice of justification and the hesitance by radiographers in practicing justification responsibilities. It also recommends a change in workplace culture which encourages radiographers to accept a more autonomous role that cultivates critical thinking, reflection and research-informed decision making as justification will ultimately benefit patients. © 2017 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.

An American and Dutch partnership for psychiatric mental health advance nursing practice: nurturing a relationship across the ocean.

PubMed

Maas, Lillian; Ezeobele, I Ezebuiro; Tetteroo, Marieke

2012-07-01

The purpose of this article is to discuss the challenges and rewards of developing and nurturing an international clinical psychiatric mental health advanced nursing practice exchange between the Netherlands and the United States. Since 1997, Rotterdam University of Applied Sciences in the Netherlands has been participating in international clinical experiences for their psychiatric mental health (PMH) advanced practice nursing students. The international experience is mandatory prior to graduation and is the first of its kind in Europe to mandate such a unique experience. This study sample included eight Dutch PMH advanced practice nursing students enrolled in a full-time master's in advanced nursing practice program. The descriptive study included reflective reports and one-on-one discussions over a 3-year period. With proper planning, an international nursing experience provides a unique opportunity for nurses to think beyond their own culture and healthcare system. Solving problems together through different perspectives creates opportunities for creative solutions. International partnerships within PMH advanced practice nursing promotes sharing of knowledge and solutions as patients and diseases have no border. © 2011 Wiley Periodicals, Inc.

Proper management of rheumatoid arthritis in Latin America. What the guidelines say?

PubMed

Brenol, Claiton V; Nava, Jorge Ivan Gamez; Soriano, Enrique R

2015-03-01

To analyze characteristics of clinical practice guidelines (CPGs) for the management of rheumatoid arthritis (RA) developed in Latin American (LA) countries and to describe the knowledge, use, and barriers for their implementation perceived among LA rheumatologists, a comprehensive literature search including Medline, PubMed, Cochrane Library, LILACS and Scielo was performed. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was applied for evaluation. A survey was sent to PANLAR members containing questions related to knowledge about guidelines, application of the recommendations, and difficulties in implementing CPGs. Eight guidelines were identified. Most guidelines were evidence based (62 %), but in only 37 % a systematic literature search was done. None of the guidelines included patients' views and preferences, and only few of them stated an updating procedure. Funding body independence and disclosure of conflicts of interest were rarely reported. The survey was answered by 214 rheumatologists from all Latin American countries. Most rheumatologist reported knowledge and use of clinical guidelines, mainly international ones. In general, rheumatologist felt that guidelines apply to only a minority of patients seen in daily clinical practice. Limited access expensive drugs, suggested by the guidelines, was the most frequent barrier to guidelines implementation that was reported. A good number of guidelines on the treatment of rheumatoid arthritis have been developed in Latin America. Most of them are lacking some of the components recognized for high-quality clinical guidelines development. In spite that most rheumatologist know and apply guidelines, access to drugs is still a very important barrier to their implementation in Latin America.

Fingolimod hydrochloride for the treatment of relapsing remitting multiple sclerosis.

PubMed

Thomas, Katja; Proschmann, Undine; Ziemssen, Tjalf

2017-10-01

Fingolimod was the first oral and the first in class disease modifying treatment in multiple sclerosis that acts as sphingosine-1-phospathe receptor agonist. Since approval in 2010 there is a growing experience with fingolimod use in clinical practice, but also next-generation sphingosin-1-receptor agonists in ongoing clinical trials. Growing evidence demonstrates additional effects beyond impact on lymphocyte circulation, highlighting further promising targets in multiple sclerosis therapy. Areas covered: Here we present a systematic review using PubMed database searching and expert opinion on fingolimod use in clinical practice. Long-term data of initial clinical trials and post-marketing evaluations including long-term efficacy, safety, tolerability and management especially within growing disease modifying treatment options and pre-treatment constellation in multiple sclerosis patients are critically discussed. Furthermore novel findings in mechanism of actions and prospective on additional use in progressive forms in multiple sclerosis are presented. Expert opinion: There is an extensive long-term experience on fingolimod use in clinical practice demonstrating the favorable benefit-risk of this drug. Using a defined risk management approach experienced MS clinicians should apply fingolimod after critical choice of patients and review of clinical aspects. Further studies are essential to discuss additional benefit in progressive forms in multiple sclerosis.

A Constructive Reframing of Student Roles and Systems Learning in Medical Education Using a Communities of Practice Lens.

PubMed

Gonzalo, Jed D; Thompson, Britta M; Haidet, Paul; Mann, Karen; Wolpaw, Daniel R

2017-12-01

Health systems are in the midst of a transformation that is being driven by a variety of forces. This has important implications for medical educators because clinical practice environments play a key role in learning and professional development, and evolving health systems are beginning to demand that providers have "systems-ready" knowledge, attitudes, and skills. Such implications provide a clear mandate for medical schools to modify their goals and prepare physicians to practice flexibly within teams and effectively contribute to the improvement of health care delivery. In this context, the concepts of value-added medical education, authentic student roles, and health systems science are emerging as increasingly important. In this Article, the authors use a lens informed by communities of practice theory to explore these three concepts, examining the implications that the communities of practice theory has in the constructive reframing of educational practices-particularly common student roles and experiences-and charting future directions for medical education that better align with the needs of the health care system. The authors apply several key features of the communities of practice theory to current experiential roles for students, then propose a new approach to students' clinical experiences-value-added clinical systems learning roles-that provides students with opportunities to make meaningful contributions to patient care while learning health systems science at the patient and population level. Finally, the authors discuss implications for professional role formation and anticipated challenges to the design and implementation of value-added clinical systems learning roles.

[Clinical economics: a concept to optimize healthcare services].

PubMed

Porzsolt, F; Bauer, K; Henne-Bruns, D

2012-03-01

Clinical economics strives to support healthcare decisions by economic considerations. Making economic decisions does not mean saving costs but rather comparing the gained added value with the burden which has to be accepted. The necessary rules are offered in various disciplines, such as economy, epidemiology and ethics. Medical doctors have recognized these rules but are not applying them in daily clinical practice. This lacking orientation leads to preventable errors. Examples of these errors are shown for diagnosis, screening, prognosis and therapy. As these errors can be prevented by application of clinical economic principles the possible consequences for optimization of healthcare are discussed.

How to confidently teach EBM on foot: development and evaluation of a web-based e-learning course.

PubMed

Weberschock, Tobias; Sorinola, Olanrewaju; Thangaratinam, Shakila; Oude Rengerink, Katrien; Arvanitis, Theodoros N; Khan, Khalid S

2013-10-01

Scarcity of well-trained clinical tutors is a key constraint in integrating teaching of evidence-based medicine (EBM) into clinical activities. We developed a web-based educational course for clinical trainers to confidently teach EBM principles in everyday practice. Its e-learning modules defined the learning objectives and incorporated video clips of practical and effective EBM teaching methods for exploiting educational opportunities in six different clinical settings. We evaluated the course with clinical tutors in different specialties across six European countries using a questionnaire to capture learning achievement against preset objectives. Among 56 tutors, 47 participants (84%) improved their scores from baseline. The mean pre-course score was 69.2 (SD=10.4), which increased to 77.3 (SD=11.7) postcourse (p<0.0001). The effect size was moderate with a Cohen's d of 0.73. An e-learning approach incorporating videos of applied EBM teaching and learning based on real clinical scenarios in the workplace can be useful in facilitating EBM teaching on foot. It can be integrated in the continuing professional development programmes for clinical trainers.

Using Data Augmentation to Facilitate Conduct of Phase I–II Clinical Trials with Delayed Outcomes

PubMed Central

Jin, Ick Hoon; Liu, Suyu; Thall, Peter F.; Yuan, Ying

2014-01-01

A practical impediment in adaptive clinical trials is that outcomes must be observed soon enough to apply decision rules to choose treatments for new patients. For example, if outcomes take up to six weeks to evaluate and the accrual rate is one patient per week, on average three new patients will be accrued while waiting to evaluate the outcomes of the previous three patients. The question is how to treat the new patients. This logistical problem persists throughout the trial. Various ad hoc practical solutions are used, none entirely satisfactory. We focus on this problem in phase I–II clinical trials that use binary toxicity and efficacy, defined in terms of event times, to choose doses adaptively for successive cohorts. We propose a general approach to this problem that treats late-onset outcomes as missing data, uses data augmentation to impute missing outcomes from posterior predictive distributions computed from partial follow-up times and complete outcome data, and applies the design’s decision rules using the completed data. We illustrate the method with two cancer trials conducted using a phase I–II design based on efficacy-toxicity trade-offs, including a computer stimulation study. PMID:25382884

Modern pain neuroscience in clinical practice: applied to post-cancer, paediatric and sports-related pain.

PubMed

Malfliet, Anneleen; Leysen, Laurence; Pas, Roselien; Kuppens, Kevin; Nijs, Jo; Van Wilgen, Paul; Huysmans, Eva; Goudman, Lisa; Ickmans, Kelly

In the last decade, evidence regarding chronic pain has developed exponentially. Numerous studies show that many chronic pain populations show specific neuroplastic changes in the peripheral and central nervous system. These changes are reflected in clinical manifestations, like a generalized hypersensitivity of the somatosensory system. Besides a hypersensitivity of bottom-up nociceptive transmission, there is also evidence for top-down facilitation of pain due to malfunctioning of the endogenous descending nociceptive modulatory systems. These and other aspects of modern pain neuroscience are starting to be applied within daily clinical practice. However, currently the application of this knowledge is mostly limited to the general adult population with musculoskeletal problems, while evidence is getting stronger that also in other chronic pain populations these neuroplastic processes may contribute to the occurrence and persistence of the pain problem. Therefore, this masterclass article aims at giving an overview of the current modern pain neuroscience knowledge and its potential application in post-cancer, paediatric and sports-related pain problems. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Implementation of additional prescribing authorization among oncology pharmacists in Alberta.

PubMed

Au, Bianca; Dersch-Mills, Deonne; Ghosh, Sunita; Jupp, Jennifer; Chambers, Carole; Cusano, Frances; Danilak, Melanie

2018-01-01

Purpose To describe the practice settings and prescribing practices of oncology pharmacists with additional prescribing authorization. Methods A descriptive, cross-sectional survey of all oncology pharmacists in Alberta was conducted using a web-based questionnaire over four weeks between March and April 2016. Pharmacists were identified from the Cancer Services Pharmacy Directory and leadership staff in Alberta Health Services. Descriptive statistics were used to describe the practice setting, prescribing practices, motivators to apply for additional prescribing authorization, and the facilitators and barriers of prescribing. Logistic regression was used to explore factors associated with having additional prescribing authorization. Results The overall response rate was 41% (71 of 175 pharmacists). Oncology pharmacists with additional prescribing authorization made up 38% of respondents. They primarily worked in urban, tertiary cancer centers, and practiced in ambulatory care. The top 3 clinical activities they participated in were medication reconciliation, medication counseling/education, and ambulatory patient assessment. Respondents thought additional prescribing authorization was most useful for ambulatory patient assessment and follow-up. Antiemetics were prescribed the most often. The median number of prescriptions written in an average week of clinical work was 5. Competence, self-confidence, and the potential impact on patient care/perceived impact on work environment were the strongest facilitators of prescribing. The strongest motivators to apply for additional prescribing authorization were relevancy to practice, the potential for increased efficiency, and advancing the profession. Conclusion The current majority of oncology pharmacist prescribing in Alberta occurs in ambulatory care with a large focus on antiemetic prescribing. Pharmacists found additional prescribing authorization most useful for ambulatory patient assessment and follow-up.

Developing clinically suitable measures of social cognition for children: initial findings from a normative sample.

PubMed

Saltzman-Benaiah, Jennifer; Lalonde, Christopher E

2007-03-01

Our understanding of children's social competence has increased tremendously over the past two decades. There is increasing evidence to suggest that social-cognitive impairments are not restricted to children on the autistic spectrum, but rather may be associated with a host of developmental and acquired neurological conditions including learning disabilities, attention deficit disorder, traumatic brain injury, and stroke. Although many investigators have begun to bridge the gap between clinical practice and research by applying experimental tasks to clinical populations, few tools are available for the clinical evaluation of social competence, particularly in children. This study marks a series of first steps in the development of measures suitable for the assessment of children between 6 and 12 years of age. The results of the study provide data for a number of experimental tasks that have been adapted with clinical practice in mind. A discussion of the developmental progressions and the relationships among the measures is also included.

Qualitative analysis of healthcare professionals' viewpoints on the role of ethics committees and hospitals in the resolution of clinical ethical dilemmas.

PubMed

Marcus, Brian S; Shank, Gary; Carlson, Jestin N; Venkat, Arvind

2015-03-01

Ethics consultation is a commonly applied mechanism to address clinical ethical dilemmas. However, there is little information on the viewpoints of health care providers towards the relevance of ethics committees and appropriate application of ethics consultation in clinical practice. We sought to use qualitative methodology to evaluate free-text responses to a case-based survey to identify thematically the views of health care professionals towards the role of ethics committees in resolving clinical ethical dilemmas. Using an iterative and reflexive model we identified themes that health care providers support a role for ethics committees and hospitals in resolving clinical ethical dilemmas, that the role should be one of mediation, rather than prescription, but that ultimately legal exposure was dispositive compared to ethical theory. The identified theme of legal fears suggests that the mediation role of ethics committees is viewed by health care professionals primarily as a practical means to avoid more worrisome medico-legal conflict.

Identifying Sources of Clinical Conflict: A Tool for Practice and Training in Bioethics Mediation.

PubMed

Bergman, Edward J

2015-01-01

Bioethics mediators manage a wide range of clinical conflict emanating from diverse sources. Parties to clinical conflict are often not fully aware of, nor willing to express, the true nature and scope of their conflict. As such, a significant task of the bioethics mediator is to help define that conflict. The ability to assess and apply the tools necessary for an effective mediation process can be facilitated by each mediator's creation of a personal compendium of sources that generate clinical conflict, to provide an orientation for the successful management of complex dilemmatic cases. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

The clinical application of research utilization: amphotericin B.

PubMed

Reedy, A M; Shivnan, J C; Hanson, J L; Haisfield, M E; Gregory, R E

1994-05-01

To describe the first application of the research utilization process by clinical nurses using the Stetler-Marram Model of Research Utilization to the practice of amphotericin B administration; to share the findings; and to discuss issues encountered in the process and their solutions. Published articles identified through computerized literature searches, published abstracts and books, personal communication with one author, and an informal survey of other cancer centers' amphotericin B infusion practices; research articles were selected for review if studies included settings and patient populations similar to those of the authors and if they used experimental designs. Studies were reviewed for scientific merit and clinical applicability according to the Stetler-Marram model; findings were used to develop a specific nursing protocol for infusion times of amphotericin B based on clinical criteria. The Stetler-Marram model helped staff nurses decide how to apply research findings to practice, although using it was difficult and required mentorship. A research base exists for amphotericin B administration time but not for test doses or premedications to prevent or minimize side effects. Staff nurses can use the Stetler-Marram model but need resources and support from individuals, committees, and administration. A specific protocol representing a practice change was implemented and may be applicable to other settings.

Interdisciplinary collaboration applied to clinical research: an example of remote monitoring in lung transplantation

PubMed Central

VanWormer, Arin; Robiner, William; Finkelstein, Stanley

2012-01-01

Collaboration across disciplines is vital in clinical practice. It is also needed to generate high-quality actionable research, yet few frameworks for interdisciplinary collaboration exit to promote effective communications among researchers with common boals, but varied backgrounds. A review of that has been learned about collaboration was undertaken to determine attributes of effective interdisciplinary collaboration and barriers to its realization in patients undergoing lung transplantation. PMID:22475710

Valuing both critical and creative thinking in clinical practice: narrowing the research-practice gap?

PubMed

Seymour, Beth; Kinn, Sue; Sutherland, Norrie

2003-05-01

Nurturing critical thinking skills in the classroom is considered an important educational activity. It is believed that critical thinking skills are transferable and that they can be applied in practice when appraising, evaluating and implementing research. That more nurses than ever before have been judged academically knowledgeable in research has not guaranteed the transfer of such knowledge to practice. This paper discusses some of the reasons for the failure to narrow the gap between research and practice. In particular we argue that, if nurses are encouraged to develop creative and generative thinking alongside their critical thinking skills, then the art of nursing will have fuller representation in education, research and practice. The successful development of critical thinking skills for academic purposes does not necessarily mean that these skills are used in practice in relation either to research or clinical decision-making. This suggests that the transferability of critical thinking skills is less than straightforward. Indeed, there has been little narrowing of the research-practice gap since students started to learn critical thinking for academic purposes. However, we propose that thinking skills can be encouraged in the context of practice and that regular educational events, such as journal clubs, can contribute to developing critical thinking in the practice environment. The research-practice gap will reduce only if research becomes part of practitioners' ideology, which includes the art and science of nursing. Critical and creative thinking are prerequisites to narrowing the disjuncture between research and practice, and we suggest that educators and practitioners explore structured ways of meeting together to appraise literature as a possible means of making use of their thinking and knowledge in clinical practice.

Revenue-based cost assignment: a potent but hidden threat to the survival of the multispecialty medical practice.

PubMed

Cooper, Robin; Kramer, Theresa R

2010-03-01

To demonstrate detrimental effects of revenue-based cost assignment (RBCA) in clinical practice and to compare that system with activity-based costing (ABC). Four cost-allocation methods including RBCA were applied to a comprehensive ophthalmology practice using typical accounting methods. Data were obtained by a survey of practitioners or practices and/or extracted from decision support and practice management systems. Inaccuracies and distortions in reported costs were enumerated. Accounting scenario analysis was used to predict resultant provider and managerial decisions. A sampling survey was used to analyze other specialties. ABC was applied to the practice. RBCA causes procedures with higher profitability to appear less profitable and those with lower profitability to appear more profitable. The distortion in reported costs, in medical settings, is often sufficient to incentivize providers with higher profitability to exit a practice and those with lower profitability to remain in it. The departure of providers causes the residual practice profits to decline. These detrimental effects occur in many subspecialties, which suggests a national effect on health care. ABC allocation can reduce cost distortions and eliminate detrimental effects. RBCA leads to fragmentation of health care and a reduction in the profitability of multispecialty practices. Its use may slow the updating of reimbursement and help eliminate low-profitability specialties.

Screening for important unwarranted variation in clinical practice: a triple-test of processes of care, costs and patient outcomes.

PubMed

Partington, Andrew; Chew, Derek P; Ben-Tovim, David; Horsfall, Matthew; Hakendorf, Paul; Karnon, Jonathan

2017-03-01

Objective Unwarranted variation in clinical practice is a target for quality improvement in health care, but there is no consensus on how to identify such variation or to assess the potential value of initiatives to improve quality in these areas. This study illustrates the use of a triple test, namely the comparative analysis of processes of care, costs and outcomes, to identify and assess the burden of unwarranted variation in clinical practice. Methods Routinely collected hospital and mortality data were linked for patients presenting with symptoms suggestive of acute coronary syndromes at the emergency departments of four public hospitals in South Australia. Multiple regression models analysed variation in re-admissions and mortality at 30 days and 12 months, patient costs and multiple process indicators. Results After casemix adjustment, an outlier hospital with statistically significantly poorer outcomes and higher costs was identified. Key process indicators included admission patterns, use of invasive diagnostic procedures and length of stay. Performance varied according to patients' presenting characteristics and time of presentation. Conclusions The joint analysis of processes, outcomes and costs as alternative measures of performance inform the importance of reducing variation in clinical practice, as well as identifying specific targets for quality improvement along clinical pathways. Such analyses could be undertaken across a wide range of clinical areas to inform the potential value and prioritisation of quality improvement initiatives. What is known about the topic? Variation in clinical practice is a long-standing issue that has been analysed from many different perspectives. It is neither possible nor desirable to address all forms of variation in clinical practice: the focus should be on identifying important unwarranted variation to inform actions to reduce variation and improve quality. What does this paper add? This paper proposes the comparative analysis of processes of care, costs and outcomes for patients with similar diagnoses presenting at alternative hospitals, using linked, routinely collected data. This triple test of performance indicators extracts maximum value from routine data to identify priority areas for quality improvement to reduce important and unwarranted variations in clinical practice. What are the implications for practitioners? The proposed analyses need to be applied to other clinical areas to demonstrate the general application of the methods. The outputs can then be validated through the application of quality improvement initiatives in clinical areas with identified important and unwarranted variation. Validated frameworks for the comparative analysis of clinical practice provide an efficient approach to valuing and prioritising actions to improve health service quality.

A Commentary on Hughes: The Tension between Pragmatics and Rigor.

ERIC Educational Resources Information Center

Doll, Beth

2000-01-01

Argues against Hughes' recommendation for a comprehensive clinical case planning process since it cannot displace consumers' need for psychological practice guidelines which can be applied autonomously. Challenges the notion that theory has been omitted from current research on empirically supported treatments. Concludes the problem facing…

A framework for analysis of research risks and benefits to participants in standard of care pragmatic clinical trials.

PubMed

Chen, Stephanie C; Kim, Scott Yh

2016-12-01

Standard of care pragmatic clinical trials that compare treatments already in use could improve care and reduce costs, but there is considerable debate about the research risks of standard of care pragmatic clinical trials and how to apply informed consent regulations to such trials. We sought to develop a framework integrating the insights from opposing sides of the debate. We developed a formal risk-benefit analysis framework for standard of care pragmatic clinical trials and then applied it to key provisions of the US federal regulations. Our formal framework for standard of care pragmatic clinical trial risk-benefit analysis takes into account three key considerations: the ex ante estimates of risks and benefits of the treatments to be compared in a standard of care pragmatic clinical trial, the allocation ratios of treatments inside and outside such a trial, and the significance of some participants receiving a different treatment inside a trial than outside the trial. The framework provides practical guidance on how the research ethics regulations on informed consent should be applied to standard of care pragmatic clinical trials. Our proposed formal model makes explicit the relationship between the concepts used by opposing sides of the debate about the research risks of standard of care pragmatic clinical trials and can be used to clarify the implications for informed consent. © The Author(s) 2016.

Why is there variation in the practice of evidence-based medicine in primary care? A qualitative study

PubMed Central

Hisham, Ranita; Ng, Chirk Jenn; Liew, Su May; Hamzah, Nurazira; Ho, Gah Juan

2016-01-01

Objective To explore the factors, including barriers and facilitators, influencing the practice of evidence-based medicine (EBM) across various primary care settings in Malaysia based on the doctors’ views and experiences. Research design The qualitative study was used to answer the research question. 37 primary care physicians participated in six focus group discussions and six individual in-depth interviews. A semistructured topic guide was used to facilitate both the interviews and focus groups, which were audio recorded, transcribed verbatim, checked and analysed using a thematic approach. Participants 37 primary care doctors including medical officers, family medicine specialists, primary care lecturers and general practitioners with different working experiences and in different settings. Setting The study was conducted across three primary care settings—an academic primary care practice, private and public health clinics in Klang Valley, Malaysia. Results The doctors in this study were aware of the importance of EBM but seldom practised it. Three main factors influenced the implementation of EBM in the doctors’ daily practice. First, there was a lack of knowledge and skills in searching for and applying evidence. Second, workplace culture influenced doctors’ practice of EBM. Third, some doctors considered EBM as a threat to good clinical practice. They were concerned that rigid application of evidence compromised personalised patient care and felt that EBM did not consider the importance of clinical experience. Conclusions Despite being aware of and having a positive attitude towards EBM, doctors in this study seldom practised EBM in their routine clinical practice. Besides commonly cited barriers such as having a heavy workload and lack of training, workplace ‘EBM culture’ had an important influence on the doctors’ behaviour. Strategies targeting barriers at the practice level should be considered when implementing EBM in primary care. PMID:26962037

Enhancing reflective practice through online learning: impact on clinical practice

PubMed Central

Sim, J; Radloff, A

2008-01-01

Purpose Traditionally, radiographers and radiation therapists function in a workplace environment that is protocol-driven with limited functional autonomy. The workplace promotes a culture of conformity and discourages practitioners from reflective and critical thinking, essential attributes for continuing learning and advancing workplace practices. As part of the first author’s doctoral study, a continuing professional development (CPD) educational framework was used to design and implement an online module for radiation therapists’ CPD activities. The study aimed to determine if it is possible to enhance healthcare practitioners’ reflective practice via online learning and to establish the impact of reflective learning on clinical practice. Materials and methods The objectives of the online module were to increase radiation therapists’ knowledge in planning for radiation therapy for the breast by assisting them engage in reflective practice. The cyclical process of action research was used to pilot the module twice with two groups of volunteer radiation therapists (twenty-six participants) from Australia, New Zealand and Canada. Results The online module was evaluated using Kirkpatrick’s four-level evaluation model. Evidence indicated that participants were empowered as a result of participation in the module. They began reflecting in the workplace while assuming a more proactive role and increased clinical responsibilities, engaged colleagues in collaborative reflections and adopted evidence-based approaches in advancing clinical practices. Conclusion The study shows that it is possible to assist practitioners engage in reflective practice using an online CPD educational framework. Participants were able to apply the reflective learning they had developed in their workplace. As a result of their learning, they felt empowered to continue to effect changes in their workplace beyond the cessation of the online module. PMID:21614319

Basing assessment and treatment of problem behavior on behavioral momentum theory: Analyses of behavioral persistence.

PubMed

Schieltz, Kelly M; Wacker, David P; Ringdahl, Joel E; Berg, Wendy K

2017-08-01

The connection, or bridge, between applied and basic behavior analysis has been long-established (Hake, 1982; Mace & Critchfield, 2010). In this article, we describe how clinical decisions can be based more directly on behavioral processes and how basing clinical procedures on behavioral processes can lead to improved clinical outcomes. As a case in point, we describe how applied behavior analyses of maintenance, and specifically the long-term maintenance of treatment effects related to problem behavior, can be adjusted and potentially enhanced by basing treatment on Behavioral Momentum Theory. We provide a brief review of the literature including descriptions of two translational studies that proposed changes in how differential reinforcement of alternative behavior treatments are conducted based on Behavioral Momentum Theory. We then describe current clinical examples of how these translations are continuing to impact the definitions, designs, analyses, and treatment procedures used in our clinical practice. Copyright © 2017 Elsevier B.V. All rights reserved.

The quest to standardize hemodialysis care.

PubMed

Hegbrant, Jörgen; Gentile, Giorgio; Strippoli, Giovanni F M

2011-01-01

A large global dialysis provider's core activities include providing dialysis care with excellent quality, ensuring a low variability across the clinic network and ensuring strong focus on patient safety. In this article, we summarize the pertinent components of the quality assurance and safety program of the Diaverum Renal Services Group. Concerning medical performance, the key components of a successful quality program are setting treatment targets; implementing evidence-based guidelines and clinical protocols; consistently, regularly, prospectively and accurately collecting data from all clinics in the network; processing collected data to provide feedback to clinics in a timely manner, incorporating information on interclinic and intercountry variations; and revising targets, guidelines and clinical protocols based on sound scientific data. The key activities for ensuring patient safety include a standardized approach to education, i.e. a uniform education program including control of theoretical knowledge and clinical competencies; implementation of clinical policies and procedures in the organization in order to reduce variability and potential defects in clinic practice; and auditing of clinical practice on a regular basis. By applying a standardized and systematic continuous quality improvement approach throughout the entire organization, it has been possible for Diaverum to progressively improve medical performance and ensure patient safety. Copyright © 2011 S. Karger AG, Basel.

Aggregated N-of-1 randomized controlled trials: modern data analytics applied to a clinically valid method of intervention effectiveness.

PubMed

Cushing, Christopher C; Walters, Ryan W; Hoffman, Lesa

2014-03-01

Aggregated N-of-1 randomized controlled trials (RCTs) combined with multilevel modeling represent a methodological advancement that may help bridge science and practice in pediatric psychology. The purpose of this article is to offer a primer for pediatric psychologists interested in conducting aggregated N-of-1 RCTs. An overview of N-of-1 RCT methodology is provided and 2 simulated data sets are analyzed to demonstrate the clinical and research potential of the methodology. The simulated data example demonstrates the utility of aggregated N-of-1 RCTs for understanding the clinical impact of an intervention for a given individual and the modeling of covariates to explain why an intervention worked for one patient and not another. Aggregated N-of-1 RCTs hold potential for improving the science and practice of pediatric psychology.

Barriers to implementing the "2008 Mexican Clinical Practice Guideline recommendations for the management of hip and knee osteoarthritis" in primary healthcare practice.

PubMed

Loyola-Sanchez, Adalberto; Richardson, Julie; Pelaez-Ballestas, Ingris; Sánchez, José Guadalupe; González, Martha Alicia; Sánchez-Cruz, Juan; Jiménez-Baez, María Valeria; Nolasco-Alonso, Nancy; Alvarado, Idolina; Rodríguez-Amado, Jacqueline; Alvarez-Nemegyei, José; Wilson, Mike G

2014-01-01

To evaluate the implementability of the "2008 Mexican Clinical Practice Guideline for the management of hip and knee osteoarthritis at the primary level of care" within primary healthcare of three Mexican regions using the Guideline Implementability Appraisal methodology version 2 (GLIA.v2). Six family physicians, representing the South, North, and Central Mexico, and one Mexican physiatrist evaluated the 45 recommendations stated by the Mexican guideline. The GLIA.v2 methodology includes the execution of qualitative and semi-quantitative techniques. Reviewers' agreement was between moderate to near complete in most cases. Sixty-nine percent of the recommendations were considered difficult to implement within clinical practice. Eight recommendations did not have an appropriate format. Only 6 recommendations were judged as able to be consistently applied to clinical practice. Barriers related to the context of one or more institutions/regions were identified in 25 recommendations. These barriers are related to health providers/patients' beliefs, processes of care within each institution, and availability of some treatments recommended by the guideline. The guideline presented problems of conciseness and clarity that negatively affect its application within the Mexican primary healthcare context. We identified individual, organizational and system characteristics, which are common to the 3 institutions/regions studied and constitute barriers for implementing the guideline to clinical practice. It is recommended that the 2008-Mexican-CPG-OA be thoroughly revised and restructured to improve the clarity of the actions implied by each recommendation. We propose some strategies to accomplish this and to overcome some of the identified regional/institutional barriers. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

[Between collegial conversation and controlled trials: hospital-based neurologists' sources of information and their practical knowledge in the treatment of stroke patients].

PubMed

Hasenbein, Uwe; Schulze, Axel; Frank, Bernd; Wallesch, Claus-Werner

2006-01-01

The application of evidence-based and standardized knowledge is an important basis for coordinated and effective clinical work. A multicenter study, which was conducted in 30 clinical neurology departments and included 99 junior and senior registrars, addressed aspects of practical knowledge of stroke treatment by open structured oral interviews which were analyzed with respect to interphysician and guideline conformity. In addition, the participants were asked to rate the usefulness of various informational sources and describe their informational sources used according to the aspects of practical knowledge addressed. The respective departmental directors were questioned about the sources of medical knowledge accessible in their clinic. In almost all hospitals, physicians had access to a library and the Internet. However, departments differed with respect to their information management (frequency and type of medical education, quality management, participation in research activities). In accordance with other studies, the knowledge sources reported most often were textbooks, journals and clinical studies. For most sources, the usefulness rankings largely corresponded to the rankings of user behavior. Both were only weak predictors for interphysician and guideline conformity. They are more closely related to the within-department homogeneity of practical knowledge than to interdepartmental and guideline conformity. Within-department homogeneity is enhanced by the use of recent, published and evidence-based sources and topical interaction with clinical colleagues. Guideline conformity was related to the use of databases and professional journals. A preference for colleagues from out-patient practices diminished both interphysician and guideline conformity. It seems there is still untapped potential for within-department knowledge management, such as medical education, implementation and use of guidelines and topical discussions, which may enhance the homogeneity and guideline conformity of the practical knowledge that clinicians apply.

Is medical perspective on clinical governance practices associated with clinical units' performance and mortality? A cross-sectional study through a record-linkage procedure.

PubMed

Sarchielli, Guido; De Plato, Giovanni; Cavalli, Mario; Albertini, Stefano; Nonni, Ilaria; Bencivenni, Lucia; Montali, Arianna; Ventura, Antonio; Montali, Francesca

2016-01-01

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. 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. 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). 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 governance tools application on its own clinical practice.

Exploring the contribution of the Clinical Librarian to facilitating evidence-based nursing.

PubMed

Tod, Angela M; Bond, Beverly; Leonard, Niamh; Gilsenan, Irene J; Palfreyman, Simon

2007-04-01

To examine the potential role of the Clinical Librarian in facilitating evidence-based practice of nurses in acute hospital settings and develop a model for the role. There is a growing policy and professional expectation that nurses will seek out and apply evidence in their clinical practice. Studies have demonstrated that nurses experience barriers in working with an evidence-based approach. The role of Clinical Librarian has been used in other countries and within medicine to overcome some of the barriers to evidence-based practice. There are limitations in the previous work in terms of rigour of evaluation, scope of the Clinical Librarian role and application to nursing in a UK setting. A qualitative consultation of 72 nurses in acute care settings. Six consultation group interviews of between 4-19 participants. Written records were recorded by the scribe. Content analysis was undertaken to identify the range and frequency of comments. Clinical questions currently go unanswered because of barriers of time, skills deficits and access to resources. Literature searching, skills training and evidence dissemination were the main areas of work the staff requested that a Clinical Librarian should undertake. It was anticipated that the Clinical Librarian could interact and work productively with nursing staff with a limited but regular presence on the ward. Interim communication could be via e-mail, phone and written suggestions and requests for work. It was seen to be vital that the Clinical Librarian worked in partnership with staff to build evidence-based practice capacity and ensure clinical relevance of the work. This study has generated the first model for the Clinical Librarian role with an emphasis on nursing. It is derived from the views of clinical nurses. Recommendations are made for the implementation and evaluation of such a role. The Clinical Librarian could be an invaluable support to promoting evidence-based nursing.

Addressing phenoconversion: the Achilles' heel of personalized medicine

PubMed Central

Shah, Rashmi R; Smith, Robert L

2015-01-01

Phenoconversion is a phenomenon that converts genotypic extensive metabolizers (EMs) into phenotypic poor metabolizers (PMs) of drugs, thereby modifying their clinical response to that of genotypic PMs. Phenoconversion, usually resulting from nongenetic extrinsic factors, has a significant impact on the analysis and interpretation of genotype-focused clinical outcome association studies and personalizing therapy in routine clinical practice. The high phenotypic variability or genotype–phenotype mismatch, frequently observed due to phenoconversion within the genotypic EM population, means that the real number of phenotypic PM subjects may be greater than predicted from their genotype alone, because many genotypic EMs would be phenotypically PMs. If the phenoconverted population with genotype–phenotype mismatch, most extensively studied for CYP2D6, is as large as the evidence suggests, there is a real risk that genotype-focused association studies, typically correlating only the genotype with clinical outcomes, may miss clinically strong pharmacogenetic associations, thus compromising any potential for advancing the prospects of personalized medicine. This review focuses primarily on co-medication-induced phenoconversion and discusses potential approaches to rectify some of the current shortcomings. It advocates routine phenotyping of subjects in genotype-focused association studies and proposes a new nomenclature to categorize study populations. Even with strong and reliable data associating patients' genotypes with clinical outcome(s), there are problems clinically in applying this knowledge into routine pharmacotherapy because of potential genotype–phenotype mismatch. Drug-induced phenoconversion during routine clinical practice remains a major public health issue. Therefore, the principal challenges facing personalized medicine, which need to be addressed, include identification of the following factors: (i) drugs that are susceptible to phenoconversion; (ii) co-medications that can cause phenoconversion; and (iii) dosage amendments that need to be applied during and following phenoconversion. PMID:24913012

Appropriateness of tumor marker request: a case of study

PubMed Central

Trevisiol, Chiara; Fabricio, Aline S. C.

2017-01-01

Appropriateness is crucial to provide efficient and high-quality health services at affordable costs. Laboratory medicine is a sector of special interest for the investigation of inappropriateness, due to the high rate of technological innovation and its pivotal role in many diseases and clinical settings. Some subjective aspects related to either the patient or physician seem to have a major role on inappropriateness rates. Given the psychological impact of cancer on both patients and physicians, tumor markers represent a case of study for appropriateness. The assessment of inappropriateness of laboratory tests has been focused mainly on ordering patterns. Appropriateness can barely be appraised by matching the requested test with the clinical problem because clinical information on the test requisition form is usually inadequate. Monitoring inappropriateness through individual clinical information may be feasible in inpatient (clinical data are available), while an indirect approach should be used for outpatients. To estimate inappropriateness in outpatients our group developed innovative models based on comparison between the actually ordered and expected requests of tumor marker, calculated according to recommendations of clinical practice guidelines (CPGs) applied to figures of cancer prevalence. The implementation of the model at national scale in Italy led to recognize a very high rate of overordering of tumor markers. The model was further focused by a dedicated algorithm to be adapted to different clinical conditions or organizational settings by applying performance indicators to cohort-wide structured information in electronic health records (EHRs). With this novel approach, we showed that inappropriateness is multifaceted even within the specific category of tumour markers. The model was effective in identifying both over- and underordering. Implementation of evidence based information and monitoring their impact on the clinical practice are parts of the same, multistage, process aimed at the progressive improvement of health care. PMID:28758100

[Applicability of "do not do recommendations" from the National Institute for Health and Care Excellence in a quaternary care hospital].

PubMed

Martin, S; Miñarro, R; Cano, P; Aranda, J M

2015-01-01

To qualitatively and quantitatively identify the level of agreement between the clinical staff of a quaternary care hospital and the National Institute for Health and Care Excellence (NICE) "do not do" recommendations, and to submit a strategic alternative for effective implementation. An ad hoc form was designed to evaluate level of clinical disagreement from the experience and knowledge of the clinical staff, as well as the applicability, usefulness, effectivity and efficiency of all the NICE "do not do" recommendations that had been published up to June 2012, checking their stability up to the July 2014 update. Description of the process of design and implementation of the strategic alternative to improve compliance is presented. The great majority (90%) of Clinical Unit directors agree with the NICE recommendations, with 64% finding them useful or very useful, 52% finding them applicable, and 32% and 34% thinking they are of high effectivity and efficiency, respectively. However, 20% of the efficient ones are not being applied. Moreover, knowledge discordances that might lead to clinical disagreements were detected. A strategic intervention, combining culture and incentives for good clinical practices, has been implemented. The improvement in the use of the good clinical practice recommendations is directly related to the agreement of its definition and evidence. An evaluation strategy of its application by the health professionals is essential to achieve an impact in avoidable costs. Moreover, to control for harmful effects of the economic impact on patient safety, it will be necessary to simultaneously evaluate clinical/health outcome indicators tightly linked to the applied recommendations. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

Assessing clinical practice of student nurses: Views of teachers, mentors and students.

PubMed

Helminen, Kristiina; Tossavainen, Kerttu; Turunen, Hannele

2014-08-01

Assessment received by students affects the way that they conduct their studies and shapes their interests in clinical placements. It is therefore important that mentors and teachers have high quality assessment strategies to ensure the competence of nursing students. The objective of this study is to describe the views and experiences of nursing students, nursing teachers, and mentors on the final assessment of nursing students in clinical practice. The study also investigates respondents' views on using a standardized national or European scheme for clinical assessment in the future. Descriptive survey design with a questionnaire. Implemented in five Finnish universities of applied sciences and in five partner hospitals. Nursing students (n=276), nursing teachers (n=108) and mentors (n=225). A questionnaire was used to collect data. Survey data were analyzed by using SPSS version 19. Descriptive statistics and cross tabulations were used to characterize the data. Nursing students felt that they had spent enough time with their mentors during their clinical practice period to ensure that the mentors could assess their behavior. Mentors also evaluated that they had spent enough time with the students. Students and mentors both indicated occasional difficulties with the language used in the competence assessment document. Most of the nursing students and mentors shared the view that it is always necessary for a teacher to be involved in the final assessment discussion. The study highlights the importance of assessment skills of mentors and the important role of the teachers. Findings from this study indicate that nursing students' clinical practice assessment already includes many good practices, but we still have some difficulties in ensuring effective measures of competence. Copyright © 2014. Published by Elsevier Ltd.

An estimate of the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada

PubMed Central

2014-01-01

Background Interest in the impact of burnout on physicians has been growing because of the possible burden this may have on health care systems. The objective of this study is to estimate the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada. Methods Using an economic model, the costs related to early retirement and reduction in clinical hours of physicians were compared for those who were experiencing burnout against a scenario in which they did not experience burnout. The January 2012 Canadian Medical Association Masterfile was used to determine the number of practicing physicians. Transition probabilities were estimated using 2007–2008 Canadian Physician Health Survey and 2007 National Physician Survey data. Adjustments were also applied to outcome estimates based on ratio of actual to planned retirement and reduction in clinical hours. Results The total cost of burnout for all physicians practicing in Canada is estimated to be $213.1 million ($185.2 million due to early retirement and $27.9 million due to reduced clinical hours). Family physicians accounted for 58.8% of the burnout costs, followed by surgeons for 24.6% and other specialists for 16.6%. Conclusion The cost of burnout associated with early retirement and reduction in clinical hours is substantial and a significant proportion of practicing physicians experience symptoms of burnout. As health systems struggle with human resource shortages and expanding waiting times, this estimate sheds light on the extent to which the burden could be potentially decreased through prevention and promotion activities to address burnout among physicians. PMID:24927847

Just allocation and team loyalty: a new virtue ethic for emergency medicine

PubMed Central

Girod, J; Beckman, A

2005-01-01

When traditional virtue ethics is applied to clinical medicine, it often claims as its goal the good of the individual patient, and focuses on the dyadic relationship between one physician and one patient. An alternative model of virtue ethics, more appropriate to the practice of emergency medicine, will be outlined by this paper. This alternative model is based on the assumption that the appropriate goal of the practice of emergency medicine is a team approach to the medical wellbeing of individual patients, constrained by the wellbeing of the patient population served by a particular emergency department. By defining boundaries and using the key virtues of justice and team loyalty, this model fits emergency practice well and gives care givers the conceptual clarity to apply this model to various conflicts both within the department and with those outside the department. PMID:16199595

Case Reports, Case Series - From Clinical Practice to Evidence-Based Medicine in Graduate Medical Education.

PubMed

Sayre, Jerry W; Toklu, Hale Z; Ye, Fan; Mazza, Joseph; Yale, Steven

2017-08-07

Case reports and case series or case study research are descriptive studies that are prepared for illustrating novel, unusual, or atypical features identified in patients in medical practice, and they potentially generate new research questions. They are empirical inquiries or investigations of a patient or a group of patients in a natural, real-world clinical setting. Case study research is a method that focuses on the contextual analysis of a number of events or conditions and their relationships. There is disagreement among physicians on the value of case studies in the medical literature, particularly for educators focused on teaching evidence-based medicine (EBM) for student learners in graduate medical education. Despite their limitations, case study research is a beneficial tool and learning experience in graduate medical education and among novice researchers. The preparation and presentation of case studies can help students and graduate medical education programs evaluate and apply the six American College of Graduate Medical Education (ACGME) competencies in the areas of medical knowledge, patient care, practice-based learning, professionalism, systems-based practice, and communication. A goal in graduate medical education should be to assist residents to expand their critical thinking, problem-solving, and decision-making skills. These attributes are required in the teaching and practice of EBM. In this aspect, case studies provide a platform for developing clinical skills and problem-based learning methods. Hence, graduate medical education programs should encourage, assist, and support residents in the publication of clinical case studies; and clinical teachers should encourage graduate students to publish case reports during their graduate medical education.

Articulation Rate in Preschool Children: A 3-Year Longitudinal Study

ERIC Educational Resources Information Center

Walker, Jean F.; Archibald, Lisa M. D.

2006-01-01

Background: Speaking rate has implications for both clinical practice and an understanding of normal and disordered communication processes. Fundamental information on speaking rate is required by the clinician for the appropriate management of those disorders with disturbances of rate or those in which rate modification strategies are applied.…

Psychiatric Psychopathology: A Practicum Approach.

ERIC Educational Resources Information Center

Keller, John W.; Piotrowski, Chris

This paper describes the University of West Florida graduate level, didactic/experiential course in psychopathology which has been offered since 1975 to introduce clinical psychology students to the applied and practical aspects of psychiatry. Elements of the basic practicum course are described: (1) each student is assigned to a psychiatrist on a…

Students' Evidence-Based Practice Intervention for Children with Oppositional Defiant Disorder

ERIC Educational Resources Information Center

Ronen, Tammie

2005-01-01

Objective: This project integrates clinical intervention as an integral part of social work studies for third-year students. Students applied a new manual-based intervention aiming to develop self-control skills among children exhibiting oppositional defiant disorder. Throughout, students were involved in assessment, intervention, and evaluation.…

What attributions do Australian high-performing general practices make for their success? Applying the clinical microsystems framework: a qualitative study

PubMed Central

Dunham, Annette H; Dunbar, James A; Johnson, Julie K; Fuller, Jeff; Morgan, Mark; Ford, Dale

2018-01-01

Objectives To identify the success attributions of high-performing Australian general practices and the enablers and barriers they envisage for practices wishing to emulate them. Design Qualitative study using semi-structured interviews and content analysis of the data. Responses were recorded, transcribed verbatim and coded according to success characteristics of high-performing clinical microsystems. Setting Primary healthcare with the participating general practices representing all Australian states and territories, and representing metropolitan and rural locations. Participants Twenty-two general practices identified as high performing via a number of success criteria. The 52 participants were 19 general practitioners, 18 practice managers and 15 practice nurses. Results Participants most frequently attributed success to the interdependence of the team members, patient-focused care and leadership of the practice. They most often signalled practice leadership, team interdependence and staff focus as enablers that other organisations would need to emulate their success. They most frequently identified barriers that might be encountered in the form of potential deficits or limitations in practice leadership, staff focus and mesosystem support. Conclusions Practice leaders need to empower their teams to take action through providing inclusive leadership that facilitates team interdependence. Mesosystem support for quality improvement in general practice should focus on enabling this leadership and team building, thereby ensuring improvement efforts are converted into effective healthcare provision. PMID:29643162

The epidemiology of a specialist neurorehabilitation clinic: implications for clinical practice and regional service development.

PubMed

Seeley, Helen; Pickard, John; Allanson, Judith; Hutchinson, Peter

2014-01-01

To examine the epidemiology of referrals to a specialist neurotrauma clinic and explore and highlight implications for clinical practice and service development for persons with head injury/traumatic brain injury (HI/TBI). A retrospective population-based cohort study of all referrals to a specialist neurotrauma clinic over a 9-year period. Data from a specialist head injury database (which included all persons presenting to hospital with traumatic brain injury) were analysed. In total, 1235 new patients of all ages, severities of injury, both admitted and non-admitted were referred. Referrals have increased due to successful integration with new service developments and resulting optimization of resources. Data gathered from the cohort gives increased understanding of the characteristics and numbers of patients requiring rehabilitation and adds to the evidence-base. Integration with new and complementary service developments has optimized the function/aims of the clinic and enhanced its role in terms of patient service and outcome and as a research resource. The model provides principles which may be applied to planning, organizing and providing follow-up/rehabilitation services for HI/TBI.

Simulated learning environment experience in nursing students for paediatric practice.

PubMed

Mendoza-Maldonado, Yessy; Barría-Pailaquilén, René Mauricio

The training of health professionals requires the acquisition of clinical skills in a safe and efficient manner, which is facilitated by a simulated learning environment (SLE). It is also an efficient alternative when there are limitations for clinical practice in certain areas. This paper shows the work undertaken in a Chilean university in implementing paediatric practice using SLE. Over eight days, the care experience of a hospitalized infant was studied applying the nursing process. The participation of a paediatrician, resident physician, nursing technician, and simulated user was included in addition to the use of a simulation mannequin and equipment. Simulation of care was integral and covered interaction with the child and family and was developed in groups of six students by a teacher. The different phases of the simulation methodology were developed from a pedagogical point of view. The possibility of implementing paediatric clinical practice in an efficient and safe way was confirmed. The experience in SLE was highly valued by the students, allowing them to develop different skills and abilities required for paediatric nursing through simulation. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Teaching evidence-based medicine using a problem-oriented approach.

PubMed

Hosny, Somaya; Ghaly, Mona S

2014-04-01

Faculty of Medicine, Suez Canal University is adopting an innovative curriculum. Evidence-based medicine (EBM) has been integrated into problem based learning (PBL) sessions as a responsive innovative paradigm for the practice and teaching of clinical medicine. To integrate EBM in the problem based sessions of the sixth-year students, and to assess students' and tutor satisfaction with this change. EBM training was conducted for sixth-year students (196) including four theoretical, and eight practical sessions. Sixteen EBM educational scenarios (problems) were formulated, according to sixth-year curriculum. Each problem was discussed in two sessions through steps of EBM, namely: formulating PICO questions, searching for and appraising evidence, applying the evidence to the clinical scenario and analysing the practice. Students and tutors satisfaction were evaluated using a 3-point ratings questionnaire. The majority of students and faculty expressed their satisfaction about integrating EBM with PBL and agreed that the problems were more stimulating. However, 33.6% of students indicated that available time was insufficient for searching literatures. Integrating EBM into PBL sessions tends to be more interesting and stimulating than traditional PBL sessions for final year students and helps them to practice and implement EBM in clinical context.

Clinical Natural Language Processing in 2015: Leveraging the Variety of Texts of Clinical Interest.

PubMed

Névéol, A; Zweigenbaum, P

2016-11-10

To summarize recent research and present a selection of the best papers published in 2015 in the field of clinical Natural Language Processing (NLP). A systematic review of the literature was performed by the two section editors of the IMIA Yearbook NLP section by searching bibliographic databases with a focus on NLP efforts applied to clinical texts or aimed at a clinical outcome. Section editors first selected a shortlist of candidate best papers that were then peer-reviewed by independent external reviewers. The clinical NLP best paper selection shows that clinical NLP is making use of a variety of texts of clinical interest to contribute to the analysis of clinical information and the building of a body of clinical knowledge. The full review process highlighted five papers analyzing patient-authored texts or seeking to connect and aggregate multiple sources of information. They provide a contribution to the development of methods, resources, applications, and sometimes a combination of these aspects. The field of clinical NLP continues to thrive through the contributions of both NLP researchers and healthcare professionals interested in applying NLP techniques to impact clinical practice. Foundational progress in the field makes it possible to leverage a larger variety of texts of clinical interest for healthcare purposes.

MRI and MRE for non-invasive quantitative assessment of hepatic steatosis and fibrosis in NAFLD and NASH: Clinical trials to clinical practice

PubMed Central

Dulai, Parambir S.; Sirlin, Claude B.; Loomba, Rohit

2016-01-01

Nonalcoholic fatty liver disease (NAFLD) represents one of the most common causes of chronic liver disease, and its prevalence is rising worldwide. The occurrence of nonalcoholic steatohepatitis (NASH) is associated with a substantial increase in disease related morbidity and mortality. Accordingly, there has been a surge of innovation surrounding drug development in an effort to off-set the natural progression and long-term risks of this disease. Disease assessment within clinical trials and clinical practice for NAFLD is currently done with liver biopsies. Liver biopsy-based assessments, however, remain imprecise and are not without cost or risk. This carries significant implications for the feasibility and costs of bringing therapeutic interventions to market. A need therefore arises for reliable and highly accurate surrogate end-points that can be used in phase 2 and 3 clinical trials to reduce trial size requirements and costs, while improving feasibility and ease of implementation in clinical practice. Significant advances have now been made in magnetic resonance technology, and magnetic resonance imaging (MRI) and elastrography (MRE) have been demonstrated to be highly accurate diagnostic tools for the detection of hepatic steatosis and fibrosis. In this review article, we will summarize the currently available evidence regarding the use of MRI and MRE among NAFLD patients, and the evolving role these surrogate biomarkers will play in the rapidly advancing arena of clinical trials in NASH and hepatic fibrosis. Furthermore, we will highlight how these tools can be readily applied to routine clinical practice, where the growing burden of NAFLD will need to be met with enhanced monitoring algorithms. PMID:27312947

Concluding comments: maximizing good patient care and minimizing potential liability when considering complementary and alternative medicine.

PubMed

Gilmour, Joan; Harrison, Christine; Vohra, Sunita

2011-11-01

Our goal for this supplemental issue of Pediatrics was to consider what practitioners, parents, patients, institutions, and policy-makers need to take into account to make good decisions about using complementary and alternative medicine (CAM) to treat children and to develop guidelines for appropriate use. We began by explaining underlying concepts and principles in ethical, legal, and clinical reasoning and then used case scenarios to explore how they apply and identify gaps that remain in practice and policy. In this concluding article, we review our major findings, summarize our recommendations, and suggest further research. We focus on several key areas: practitioner and patient/parent relationships; decision-making; dispute resolution; standards of practice; hospital/health facility policies; patient safety; education; and research. Ethical principles, standards, and rules applicable when making decisions about conventional care for children apply to decision-making about CAM as well. The same is true of legal reasoning. Although CAM use has seldom led to litigation, general legal principles relied on in cases involving conventional medical care provide the starting point for analysis. Similarly, with respect to clinical decision-making, clinicians are guided by clinical judgment and the best interests of their patient. Whether a therapy is CAM or conventional, clinicians must weigh the relative risks and benefits of therapeutic options and take into account their patient's values, beliefs, and preferences. Consequently, many of our observations apply to conventional and CAM care and to both adult and pediatric patients.

Statistics for clinical nursing practice: an introduction.

PubMed

Rickard, Claire M

2008-11-01

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

Assessing biocomputational modelling in transforming clinical guidelines for osteoporosis management.

PubMed

Thiel, Rainer; Viceconti, Marco; Stroetmann, Karl

2011-01-01

Biocomputational modelling as developed by the European Virtual Physiological Human (VPH) Initiative is the area of ICT most likely to revolutionise in the longer term the practice of medicine. Using the example of osteoporosis management, a socio-economic assessment framework is presented that captures how the transformation of clinical guidelines through VPH models can be evaluated. Applied to the Osteoporotic Virtual Physiological Human Project, a consequent benefit-cost analysis delivers promising results, both methodologically and substantially.

Head & neck optical diagnostics: vision of the future of surgery

PubMed Central

Upile, Tahwinder; Jerjes, Waseem; Sterenborg, Henricus JCM; El-Naggar, Adel K; Sandison, Ann; Witjes, Max JH; Biel, Merrill A; Bigio, Irving; Wong, Brian JF; Gillenwater, Ann; MacRobert, Alexander J; Robinson, Dominic J; Betz, Christian S; Stepp, Herbert; Bolotine, Lina; McKenzie, Gordon; Mosse, Charles Alexander; Barr, Hugh; Chen, Zhongping; Berg, Kristian; D'Cruz, Anil K; Stone, Nicholas; Kendall, Catherine; Fisher, Sheila; Leunig, Andreas; Olivo, Malini; Richards-Kortum, Rebecca; Soo, Khee Chee; Bagnato, Vanderlei; Choo-Smith, Lin-Ping; Svanberg, Katarina; Tan, I Bing; Wilson, Brian C; Wolfsen, Herbert; Yodh, Arjun G; Hopper, Colin

2009-01-01

Review paper and Proceedings of the Inaugural Meeting of the Head and Neck Optical Diagnostics Society (HNODS) on March 14th 2009 at University College London. The aim of our research must be to provide breakthrough translational research which can be applied clinically in the immediate rather than the near future. We are fortunate that this is indeed a possibility and may fundamentally change current clinical and surgical practice to improve our patients' lives. PMID:19594907

Nurses’ Wisdom in Action in the Emergency Department

PubMed Central

Matney, Susan A.; Staggers, Nancy; Clark, Lauren

2016-01-01

Nurses seek to understand better what practicing with wisdom means and how to apply wisdom to practice; however, the experience of wisdom in nursing has not been well defined or researched. This study was designed to understand how emergency department (ED) nurses construct the meaning of wisdom within the culture of clinical nursing practice. Using Charmaz’s constructivist grounded theory methodology, we developed a preliminary theory capturing the experience of wisdom in practice. The core theoretical model focuses on two juxtaposed processes, technical and affective, and is grounded in expertise. Significant findings were the recognition of affective categories, such as emotional intelligence, required to practice using wisdom. Results reinforce and extend the current wisdom literature and provide a new perspective on wisdom in practice in a nursing context. PMID:28462339

The U.N. Convention on the Rights of the Child: Relevance and Application to Pediatric Clinical Bioethics.

PubMed

Lansdown, Gerison; Lundy, Laura; Goldhagen, Jeffrey

2016-01-01

This article provides an overview of the relevance and import of the U.N. Convention on the Rights of the Child (CRC) to child health practice and pediatric bioethics. We discuss the four general principles of the CRC that apply to the implementation of all rights contained in the document, the right to health articulated in Article 24, and the important position ascribed to parents in fulfilling the rights of their children. We then examine how the CRC is implemented and monitored in law and practice. The CRC and associated principles of child rights provide strategies for rights-based approaches to clinical practice and health systems, as well as to policy design, professional training, and health services research. In light of the relevance of the CRC and principles of child rights to children's health and child health practice, it follows that there is an intersection between child rights and pediatric bioethics. Pediatric bioethicists and child rights advocates should work together to define this intersection in all domains of pediatric practice.

Mindfulness-Based Stress Reduction in Advanced Nursing Practice: A Nonpharmacologic Approach to Health Promotion, Chronic Disease Management, and Symptom Control.

PubMed

Williams, Hants; Simmons, Leigh Ann; Tanabe, Paula

2015-09-01

The aim of this article is to discuss how advanced practice nurses (APNs) can incorporate mindfulness-based stress reduction (MBSR) as a nonpharmacologic clinical tool in their practice. Over the last 30 years, patients and providers have increasingly used complementary and holistic therapies for the nonpharmacologic management of acute and chronic diseases. Mindfulness-based interventions, specifically MBSR, have been tested and applied within a variety of patient populations. There is strong evidence to support that the use of MBSR can improve a range of biological and psychological outcomes in a variety of medical illnesses, including acute and chronic pain, hypertension, and disease prevention. This article will review the many ways APNs can incorporate MBSR approaches for health promotion and disease/symptom management into their practice. We conclude with a discussion of how nurses can obtain training and certification in MBSR. Given the significant and growing literature supporting the use of MBSR in the prevention and treatment of chronic disease, increased attention on how APNs can incorporate MBSR into clinical practice is necessary. © The Author(s) 2015.

Exploring the opinions of registered nurses working in a clinical transfusion environment on the contribution of e-learning to personal learning and clinical practice: results of a small scale educational research study.

PubMed

Cottrell, Susan; Donaldson, Jayne H

2013-05-01

To explore the opinions of registered nurses on the Learnbloodtransfusion Module 1: Safe Transfusion Practice e-learning programme to meeting personal learning styles and learning needs. A qualitative research methodology was applied based on the principles of phenomenology. Adopting a convenience sampling plan supported the recruitment of participants who had successfully completed the e-learning course. Thematic analysis from the semi-structured interviews identified common emerging themes through application of Colaizzis framework. Seven participants of total sample population (89) volunteered to participate in the study. Five themes emerged which included learning preferences, interactive learning, course design, patient safety and future learning needs. Findings positively show the e-learning programme captures the learning styles and needs of learners. In particular, learning styles of a reflector, theorist and activist as well as a visual learner can actively engage in the online learning experience. In an attempt to bridge the knowledge practice gap, further opinions are offered on the course design and the application of knowledge to practice following completion of the course. The findings of the small scale research study have shown that the e-learning course does meet the diverse learning styles and needs of nurses working in a clinical transfusion environment. However, technology alone is not sufficient and a blended approach to learning must be adopted to meet bridging the theory practice gap supporting the integration of knowledge to clinical practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

The PBRN Initiative

PubMed Central

Curro, F.A.; Vena, D.; Naftolin, F.; Terracio, L.; Thompson, V.P.

2012-01-01

The NIDCR-supported Practice-based Research Network initiative presents dentistry with an unprecedented opportunity by providing a pathway for modifying and advancing the profession. It encourages practitioner participation in the transfer of science into practice for the improvement of patient care. PBRNs vary in infrastructure and design, and sustaining themselves in the long term may involve clinical trial validation by regulatory agencies. This paper discusses the PBRN concept in general and uses the New York University College of Dentistry’s Practitioners Engaged in Applied Research and Learning (PEARL) Network as a model to improve patient outcomes. The PEARL Network is structured to ensure generalizability of results, data integrity, and to provide an infrastructure in which scientists can address clinical practitioner research interests. PEARL evaluates new technologies, conducts comparative effectiveness research, participates in multidisciplinary clinical studies, helps evaluate alternative models of healthcare, educates and trains future clinical faculty for academic positions, expands continuing education to include “benchmarking” as a form of continuous feedback to practitioners, adds value to dental schools’ educational programs, and collaborates with the oral health care and pharmaceutical industries and medical PBRNs to advance the dental profession and further the integration of dental research and practice into contemporary healthcare (NCT00867997, NCT01268605). PMID:22699662

The informal curriculum - general practitioner perceptions of ethics in clinical practice.

PubMed

Sturman, Nancy J; Parker, Malcolm; van Driel, Mieke L

2012-12-01

Australian medical students should graduate with an understanding of the principles of medical law and ethics, and their application to clinical settings. Although student perspectives have been studied previously, the teacher experience of ethical issues also needs to be understood, particularly in the general practice setting. Interviews were conducted with a convenience sample of 13 general practitioner teachers. They were asked to reflect on common and/or important ethical issues in their day-to-day practice. An inductive thematic analysis of the data was performed by two investigators, who reached a consensus on major themes using an iterative, dialogic process. Participants reported negotiating ethical issues frequently. Major themes included patient-doctor relationships, professional differences, truth-telling, ethically 'grey' areas and the personal demands of ethical decision making. General practitioners in this study describe sometimes needing to apply judgement and compromise in situations involving legal or ethical issues, in order to act in the best interests of patients and to successfully negotiate the patient-doctor relationship. Students learning in this clinical context may perceive mixed messages and ethical lapses in these challenging 'grey' areas. The ethical acumen and emotional resilience of both students and clinical teachers may be enhanced by ongoing reflective discussion with colleagues.

To take responsibility or to be an onlooker. Nursing students' experiences of two models of supervision.

PubMed

Hellström-Hyson, Eva; Mårtensson, Gunilla; Kristofferzon, Marja-Leena

2012-01-01

The present study aimed at describing how nursing students engaged in their clinical practice experienced two models of supervision: supervision on student wards and traditional supervision. Supervision for nursing students in clinical practice can be organized in different ways. In the present study, parts of nursing students' clinical practice were carried out on student wards in existing hospital departments. The purpose was to give students the opportunity to assume greater responsibility for their clinical education and to apply the nursing process more independently through peer learning. A descriptive design with a qualitative approach was used. Interviews were carried out with eight nursing students in their final semester of a 3-year degree program in nursing. The data were analyzed using content analysis. Two themes were revealed in the data analysis: When supervised on the student wards, nursing students experienced assuming responsibility and finding one's professional role, while during traditional supervision, they experienced being an onlooker and having difficulties assuming responsibility. Supervision on a student ward was found to give nursing students a feeling of acknowledgment and more opportunities to develop independence, continuity, cooperation and confidence. Copyright © 2011 Elsevier Ltd. All rights reserved.

Applying sport psychology to improve clinical performance.

PubMed

Church, Helen R; Rumbold, James L; Sandars, John

2017-12-01

Preparedness for practice has become an international theme within Medical Education: for healthcare systems to maintain their highest clinical standards, junior doctors must "hit the ground running" on beginning work. Despite demonstrating logical, structured assessment and management plans during their undergraduate examinations, many newly qualified doctors report difficulty in translating this theoretical knowledge into the real clinical environment. "Preparedness" must constitute more than the knowledge and skills acquired during medical school. Complexities of the clinical environment overwhelm some junior doctors, who acknowledge that they lack strategies to manage their anxieties, under-confidence and low self-efficacy. If uncontrolled, such negative emotions and behaviors may impede the delivery of time-critical treatment for acutely unwell patients and compound junior doctors' self-doubt, thus impacting future patient encounters. Medical Education often seeks inspiration from other industries for potential solutions to challenges. To address "preparedness for practice," this AMEE Guide highlights sport psychology: elite sportspeople train both physically and psychologically for their discipline. The latter promotes management of negative emotions, distractions and under-confidence, thus optimizing performance despite immense pressures of career-defining moments. Similar techniques might allow junior doctors to optimize patient care, especially within stressful situations. This AMEE Guide introduces the novel conceptual model, PERFORM, which targets the challenges faced by junior doctors on graduation. The model applies pre-performance routines from sport psychology with the self-regulatory processes of metacognition to the clinical context. This model could potentially equip junior doctors, and other healthcare professionals facing similar challenges, with strategies to optimize clinical care under the most difficult circumstances.

The development and evaluation of a 'blended' enquiry based learning model for mental health nursing students: "making your experience count".

PubMed

Rigby, Lindsay; Wilson, Ian; Baker, John; Walton, Tim; Price, Owen; Dunne, Kate; Keeley, Philip

2012-04-01

To meet the demands required for safe and effective care, nurses must be able to integrate theoretical knowledge with clinical practice (Kohen and Lehman, 2008; Polit and Beck, 2008; Shirey, 2006). This should include the ability to adapt research in response to changing clinical environments and the changing needs of service users. It is through reflective practice that students develop their clinical reasoning and evaluation skills to engage in this process. This paper aims to describe the development, implementation and evaluation of a project designed to provide a structural approach to the recognition and resolution of clinical, theoretical and ethical dilemmas identified by 3rd year undergraduate mental health nursing students. This is the first paper to describe the iterative process of developing a 'blended' learning model which provides students with an opportunity to experience the process of supervision and to become more proficient in using information technology to develop and maintain their clinical skills. Three cohorts of student nurses were exposed to various combinations of face to face group supervision and a virtual learning environment (VLE) in order to apply their knowledge of good practice guidelines and evidenced-based practice to identified clinical issues. A formal qualitative evaluation using independently facilitated focus groups was conducted with each student cohort and thematically analysed (Miles & Huberman, 1994). The themes that emerged were: relevance to practice; facilitation of independent learning; and the discussion of clinical issues. The results of this study show that 'blending' face-to-face groups with an e-learning component was the most acceptable and effective form of delivery which met the needs of students' varied learning styles. Additionally, students reported that they were more aware of the importance of clinical supervision and of their role as supervisees. Copyright © 2011 Elsevier Ltd. All rights reserved.

An interactive quality of work life model applied to organizational transition.

PubMed

Knox, S; Irving, J A

1997-01-01

Most healthcare organizations in the United States are in the process of some type of organizational change or transition. Professional nurses and other healthcare providers practicing in U.S. healthcare delivery organizations are very aware of the dramatic effects of restructuring processes. A phenomenal amount of change and concern is occurring with organizational redesign, generating many questions and uncertainties. These transitions challenge the basic assumptions and principles guiding the practice of clinical and management roles in healthcare.

Mutual information based feature selection for medical image retrieval

NASA Astrophysics Data System (ADS)

Zhi, Lijia; Zhang, Shaomin; Li, Yan

2018-04-01

In this paper, authors propose a mutual information based method for lung CT image retrieval. This method is designed to adapt to different datasets and different retrieval task. For practical applying consideration, this method avoids using a large amount of training data. Instead, with a well-designed training process and robust fundamental features and measurements, the method in this paper can get promising performance and maintain economic training computation. Experimental results show that the method has potential practical values for clinical routine application.

Urological cancer care pathways: development and use in the context of systematic reviews and clinical practice guidelines.

PubMed

Maclennan, Sara Jane; Maclennan, Steven J; Imamura, Mari; Omar, Muhammad Imran; Vale, Luke; Lam, Thomas; Royle, Pamela; Royle, Justine; Swami, Satchi; Pickard, Rob; McClinton, Sam; Griffiths, T R Leyshon; Dahm, Philipp; N'dow, James

2011-06-01

Making healthcare treatment decisions is a complex process involving a broad stakeholder base including patients, their families, health professionals, clinical practice guideline developers and funders of healthcare. This paper presents a review of a methodology for the development of urological cancer care pathways (UCAN care pathways), which reflects an appreciation of this broad stakeholder base. The methods section includes an overview of the steps in the development of the UCAN care pathways and engagement with clinical content experts and patient groups. The development process is outlined, the uses of the urological cancer care pathways discussed and the implications for clinical practice highlighted. The full set of UCAN care pathways is published in this paper. These include care pathways on localised prostate cancer, locally advanced prostate cancer, metastatic prostate cancer, hormone-resistant prostate cancer, localised renal cell cancer, advanced renal cell cancer, testicular cancer, penile cancer, muscle invasive and metastatic bladder cancer and non-muscle invasive bladder cancer. The process provides a useful framework for improving urological cancer care through evidence synthesis, research prioritisation, stakeholder involvement and international collaboration. Although the focus of this work is urological cancers, the methodology can be applied to all aspects of urology and is transferable to other clinical specialties.

Comparsion analysis of data mining models applied to clinical research in traditional Chinese medicine.

PubMed

Zhao, Yufeng; Xie, Qi; He, Liyun; Liu, Baoyan; Li, Kun; Zhang, Xiang; Bai, Wenjing; Luo, Lin; Jing, Xianghong; Huo, Ruili

2014-10-01

To help researchers selecting appropriate data mining models to provide better evidence for the clinical practice of Traditional Chinese Medicine (TCM) diagnosis and therapy. Clinical issues based on data mining models were comprehensively summarized from four significant elements of the clinical studies: symptoms, symptom patterns, herbs, and efficacy. Existing problems were further generalized to determine the relevant factors of the performance of data mining models, e.g. data type, samples, parameters, variable labels. Combining these relevant factors, the TCM clinical data features were compared with regards to statistical characters and informatics properties. Data models were compared simultaneously from the view of applied conditions and suitable scopes. The main application problems were the inconsistent data type and the small samples for the used data mining models, which caused the inappropriate results, even the mistake results. These features, i.e. advantages, disadvantages, satisfied data types, tasks of data mining, and the TCM issues, were summarized and compared. By aiming at the special features of different data mining models, the clinical doctors could select the suitable data mining models to resolve the TCM problem.

Knowledge Translation: The Bridging Function of Cochrane Rehabilitation.

PubMed

Negrini, Stefano; Gimigliano, Francesca; Arienti, Chiara; Kiekens, Carlotte

2018-06-01

Cochrane Rehabilitation is aimed to ensure that all rehabilitation professionals can apply Evidence Based Clinical Practice and take decisions according to the best and most appropriate evidence in this specific field, combining the best available evidence as gathered by high-quality Cochrane systematic reviews, with their own clinical expertise and the values of patients. This mission can be pursued through knowledge translation. The aim of this article is to shortly present what knowledge translation is, how and why Cochrane (previously known as Cochrane Collaboration) is trying to reorganize itself in light of knowledge translation, and the relevance that this process has for Cochrane Rehabilitation and in the end for the whole world of rehabilitation. It is well known how it is difficult to effectively apply in everyday life what we would like to do and to apply the scientific knowledge in the clinical field: this is called the know-do gap. In the field of evidence-based medicine, where Cochrane belongs, it has been proven that high-quality evidence is not consistently applied in practice. A solution to these problems is the so-called knowledge translation. In this context, Cochrane Rehabilitation is organized to provide the best possible knowledge translation in both directions (bridging function), obviously toward the world of rehabilitation (spreading reviews), but also to the Cochrane community (production of reviews significant for rehabilitation). Cochrane is now strongly pushing to improve its knowledge translation activities, and this creates a strong base for Cochrane Rehabilitation work, focused not only on spreading the evidence but also on improving its production to make it more meaningful for the world of rehabilitation. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Assessment of personality-related levels of functioning: a pilot study of clinical assessment of the DSM-5 level of personality functioning based on a semi-structured interview.

PubMed

Thylstrup, Birgitte; Simonsen, Sebastian; Nemery, Caroline; Simonsen, Erik; Noll, Jane Fjernestad; Myatt, Mikkel Wanting; Hesse, Morten

2016-08-25

The personality disorder categories in the Diagnostic and Statistical Manual of Mental Disorders IV have been extensively criticized, and there is a growing consensus that personality pathology should be represented dimensionally rather than categorically. The aim of this pilot study was to test the Clinical Assessment of the Level of Personality Functioning Scale, a semi-structured clinical interview, designed to assess the Level of Personality Functioning Scale of the DSM-5 (Section III) by applying strategies similar to what characterizes assessments in clinical practice. The inter-rater reliability of the assessment of the four domains and the total impairment in the Level of Personality Functioning Scale were measured in a patient sample that varied in terms of severity and type of pathology. Ratings were done independently by the interviewer and two experts who watched a videotaped Clinical Assessment of the Level of Personality Functioning Scale interview. Inter-rater reliability coefficients varied between domains and were not sufficient for clinical practice, but may support the use of the interview to assess the dimensions of personality functioning for research purposes. While designed to measure the Level of Personality Functioning Scale with a high degree of similarity to clinical practice, the Clinical Assessment of the Level of Personality Functioning Scale had weak reliabilities and a rating based on a single interview should not be considered a stand-alone assessment of areas of functioning for a given patient.

Development of a novel, multilayered presentation format for clinical practice guidelines.

PubMed

Kristiansen, Annette; Brandt, Linn; Alonso-Coello, Pablo; Agoritsas, Thomas; Akl, Elie A; Conboy, Tara; Elbarbary, Mahmoud; Ferwana, Mazen; Medani, Wedad; Murad, Mohammad Hassan; Rigau, David; Rosenbaum, Sarah; Spencer, Frederick A; Treweek, Shaun; Guyatt, Gordon; Vandvik, Per Olav

2015-03-01

Bridging the gap between clinical research and everyday health-care practice requires effective communication strategies. To address current shortcomings in conveying practice recommendations and supporting evidence, we are creating and testing presentation formats for clinical practice guidelines (CPGs). We carried out multiple cycles of brainstorming and sketching, developing a prototype. Physicians participating in the user testing viewed CPG formats linked to clinical scenarios and engaged in semistructured interviews applying a think-aloud method for exploring important aspects of user experience. We developed a multilayered presentation format that allows clinicians to successively view more in-depth information. Starting with the recommendations, clinicians can, on demand, access a rationale and a key information section containing statements on quality of the evidence, balance between desirable and undesirable consequences, values and preferences, and resource considerations. We collected feedback from 27 stakeholders and performed user testing with 47 practicing physicians from six countries. Advisory group feedback and user testing of the first version revealed problems with conceptual understanding of underlying CPG methodology, as well as difficulties with the complexity of the layout and content. Extensive revisions made before the second round of user testing resulted in most participants expressing overall satisfaction with the final presentation format. We have developed an electronic, multilayered, CPG format that enhances the usability of CPGs for frontline clinicians. We have implemented the format in electronic guideline tools that guideline organizations can now use when authoring and publishing their guidelines.

Nursing Clinical Instructor Experiences of Empowerment in Rwanda: Applying Kanter's and Spreitzer's Theories.

PubMed

Thuss, Mary; Babenko-Mould, Yolanda; Andrusyszyn, Mary-Anne; Laschinger, Heather K S

2016-10-15

The purpose of this study was to explore Rwandan nursing clinical instructors' (CIs) experiences of structural and psychological empowerment. CIs play a vital role in students' development by facilitating learning in health care practice environments. Quality nursing education hinges on the CI's ability to enact a professional role. A descriptive qualitative method was used to obtain an understanding of CIs empowerment experiences in practice settings. Kanter's Theory of Structural Power in Organizations and Spreitzer's Psychological Empowerment Theory were used as theoretical frameworks to interpret experiences. Interview data from 21 CIs were used to complete a secondary analysis. Most participants perceived the structural components of informal power, resources, and support while formal power and opportunity were limited, diminishing their sense of structural empowerment. Psychological empowerment for CIs stemmed from a sense of competence, meaning, impact and self-determination they had for their teaching roles and responsibilities in the practice setting.

Developing practical knowledge content of emergency nursing professionals.

PubMed

Chu, Wen; Hsu, Li-Ling

2011-06-01

There is a paucity of published research on clinical or practical nursing knowledge. The ways that nurses acquire, develop, and maintain emergency room (ER) nursing care skills is a research area, in particular, that deserves further investigation. This study examined clinical setting learning processes to better understand the practical knowledge content of ER nurses. This study used a phenomenological approach and in-depth interviews of 10 nurses. Each participant had at least 3 years of ER experience. Researchers used Moustakas' method to analyze interview data. Findings were checked for credibility, transferability, dependability, and confirmability. The authors identified four major practical knowledge themes for ER professionals. These were (a) basic emergency treatment procedure routines and symptom management; (b) disease mechanisms, pharmacodynamics, and treatment responses; (c) newly identified diseases, updated emergency treatments and techniques, and medical treatment discussions; and (d) identifying nursing values including nursing attitudes and continuing patient care. Participants in this study had experience with the first three themes and successfully combined various types of nursing knowledge in their nursing care duties. Only few participants indicated experience with the fourth theme. Findings clarify that clinical or practical knowledge in ER nurses evolves first from declarative knowledge (e.g., basic emergency treatment routines and operating procedures) to procedural knowledge (e.g., instructions from supervisors, actual practice, and drills) to conditional knowledge (e.g., observation and treatment involving direct interactions with patients). Nurses should combine and apply the various knowledge types in their nursing practice to assess comprehensively each patient's condition and administer effective treatment and service.

Closing the research to practice gap in children's mental health: structures, solutions, and strategies.

PubMed

Jensen, Peter S; Foster, Michael

2010-03-01

Failure to apply research on effective interventions spans all areas of medicine, including children's mental health services. This article examines the policy, structural, and economic problems in which this gap originates. We identify four steps to close this gap. First, the field should develop scientific measures of the research-practice gap. Second, payors should link incentives to outcomes-based performance measures. Third, providers and others should develop improved understanding and application of effective dissemination and business models. Fourth, efforts to link EBP to clinical practice should span patient/consumers, providers, practices, plans, and purchasers. The paper discusses each of these in turn and relates them to fundamental problems of service delivery.

Discovering eHealth Technology: An Innovative Interprofessional Graduate Student Learning Experience.

PubMed

Estes, Krista; Gilliam, Eric; Knapfel, Sarah; Lee, Chanmi; Skiba, Diane

2016-01-01

The use of eHealth has grown in recent years and is projected to continue to increase exponentially. In order to empower and prepare advanced practice providers to integrate eHealth into their clinical practice, curricular changes need to occur. The iTEAM grant provides a unique opportunity to prepare advanced practice disciplines to provide collaborative care using eHealth. Through the integration of a simulated telehealth using a standardized patient, Doctor of Pharmacy and Advanced Practice Registered Nursing students learned how to apply health information technology and coordinate care in an interprofessional manner. Opportunities and challenges to guide future efforts to integrate eHealth-learning experiences into the curriculum are identified.

Role of research in occupational therapy clinical practice: applying action learning and action research in pursuit of evidence-based practice.

PubMed

du Toit, Sanet H J; Wilkinson, Annette C; Adam, Kerry

2010-10-01

 In South Africa, as in many other countries, the development of research capacity in students and their early professional career is regarded as of major importance. Within the context of clinical education for occupational therapy students at the University of the Free State, a lecturer and her students embarked on a collaborative journey while fulfilling the requirements of their undergraduate curriculum. The outcome is a model promoting evidence-based practice (EBP) during service development on a dementia care ward. The practical use of action learning, action research (ALAR) approach in the clinical context, was used to encourage student engagement in successive small-scale research projects while simulating EBP. The projects ranged from the development of therapeutic multi-sensory environments to compiling activity profiles for identified residents. At the same time, students had the opportunity to experience the value of a scientific approach to practice development, which stimulated their awareness of the importance of research. Reflection by the researcher contributed towards more effective ways for compiling project assignments and a formalised approach for assessing projects. Students described personal and professional gains because of participation in projects against the life-changing experience of rendering a service to elderly persons suffering from dementia. The formalised approach guiding thoughts and actions finally assisted in developing a practical process model that could support EBP. The ALAR model contributed towards a scholarship of practice where the students, clinical educator and residents of a dementia unit all experienced the value of research. © 2010 The Authors. Australian Occupational Therapy Journal © 2010 Australian Association of Occupational Therapists.

Experimental and clinical psychopharmacology: National Institute on Drug Abuse's clinical research agenda.

PubMed

Leshner, Alan I

2002-08-01

Studies of drugs and behavior are a core component of virtually every portfolio within the broad purview of the National Institute on Drug Abuse (NIDA). Moreover, psychopharmacological research is an important vehicle for advancing understanding of how drugs of abuse produce their effects, particularly including addiction. However, as with all major public health issues, simply understanding the issue is not enough. NIDA's psychopharmacology projects, therefore, span basic, clinical, and applied (e.g., medication development) research activities. These include the establishment of a nationwide clinical trials network designed to provide an infrastructure to test both behavioral and psychopharmacological treatments in a real-life practice setting with diverse patients.

Developing Traditional Chinese Medicine in the Era of Evidence-Based Medicine: Current Evidences and Challenges

PubMed Central

Fung, Foon Yin; Linn, Yeh Ching

2015-01-01

Evidence-based medicine (EBM), by integrating individual clinical expertise with the best available clinical evidence from systematic research, has in recent years been established as the standard of modern medical practice for greater treatment efficacy and safety. Traditional Chinese Medicine (TCM), on the other hand, evolved as a system of medical practice from ancient China more than 2000 years ago based on empirical knowledge as well as theories and concepts which are yet to be mapped by scientific equivalents. Despite the expanding TCM usage and the recognition of its therapeutic benefits worldwide, the lack of robust evidence from the EBM perspective is hindering acceptance of TCM by the Western medicine community and its integration into mainstream healthcare. For TCM to become an integral component of the healthcare system so that its benefits can be rationally harnessed in the best interests of patients, it is essential for TCM to demonstrate its efficacy and safety by high-level evidence in accordance with EBM, though much debate remains on the validity and feasibility of applying the EBM model on this traditional practice. This review aims to discuss the current status of research in TCM, explore the evidences available on its efficacy and safety, and highlight the issues and challenges faced in applying EBM to TCM. PMID:25949261

Novel survey disseminated through Twitter supports its utility for networking, disseminating research, advocacy, clinical practice and other professional goals.

PubMed

Borgmann, Hendrik; DeWitt, Sasha; Tsaur, Igor; Haferkamp, Axel; Loeb, Stacy

2015-01-01

Twitter use has grown exponentially within the urological community. We aimed to determine the perceptions of the impact of Twitter on users' clinical practice, research, and other professional activities. We performed an 11-item online survey of Twitter contributors during two major urological meetings: the European Association of Urology (EAU) and the American Urological Association (AUA) annual meetings. During the EAU 2014 meeting, we distributed the survey via the meeting official Twitter feed. During the AUA 2014 meeting, we applied a new method by directly sending the survey to Twitter contributors. We performed a subset analysis for assessing the perceived impact of Twitter on the clinical practice of physicians. Among 312 total respondents, the greatest perceived benefits of Twitter among users were for networking (97%) and disseminating information (96%), followed by research (75%), advocacy (74%) and career development (62%). In total, 65% of Twitter users have dealt with guidelines on online medical professionalism and 71% of physician users found that Twitter had an impact on their clinical practice, and 33% had made a clinical decision based on an online case discussion. Our results suggest that Twitter users in the urological community perceive important benefits. These benefits extend to multiple professional domains, particularly networking, disseminating information, remote conference participation, research, and advocacy. This is the first study that has been disseminated to targeted individuals from the urological community directly through tweets, providing a proof of principle for this research method.

Nurse teacher models in clinical education from the perspective of student nurses--A mixed method study.

PubMed

Gustafsson, Margareta; Kullén Engström, Agneta; Ohlsson, Ulla; Sundler, Annelie J; Bisholt, Birgitta

2015-12-01

The aim was to describe and compare the clinical teacher's role in different models of clinical practice from the perspective of student nurses. The study took place in collaboration with two Swedish universities that applied different educational models in clinical practice. A mixed method approach was used. The quantitative part had a comparative design and the qualitative part had a descriptive design. The study group consisted of 114 student nurses (response rate 87%). Fifty-three of them had met clinical teachers employed at the university and not participating in the daily clinical work (University Nurse Teachers, UNTs), whilst 61 had met clinical teachers dividing their time between teaching and nursing (Clinical Nurse Teachers, CNTs). Eight students participated in the qualitative part of the study. A questionnaire including the CLES+T scale was used to ascertain the students' perception of the clinical teacher's role, complemented by interviews directed towards an enrichment of this perception. Students meeting CNTs agreed more strongly than those meeting UNTs that the teacher had the ability to help them integrate theory and practice. Whilst spontaneous meetings between students and CNTs occurred, students mostly met UNTs in seminars. Students meeting UNTs felt alone but did appreciate having someone outside the clinical environment to provide support if they did not get along with their preceptor. In the case of UNTs, it is important that they keep their knowledge of clinical issues updated and visit the clinical placement not only for seminars but also to give students emotional support. In the case of CNTs, it is important that they are members of the faculty at the university, take part in the planning of the clinical courses and are able to explain the learning goals to the students. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Survey on Turkish nursing students' perception of clinical learning environment and its association with academic motivation and clinical decision making.

PubMed

Aktaş, Yeşim Yaman; Karabulut, Neziha

2016-01-01

Nursing education is a process that includes theoretical and practical learning and requires the acquisition of theoretical knowledge and skill. Nursing students need a good clinical practice environment in order to apply their knowledge and skills due to the fact that the clinical practice settings play an important role in the nursing profession. This study was carried out in an effort to explore nursing students' perception of the clinical learning environment and its association with academic motivation and clinical decision making. A descriptive survey design was used. This study was conducted in Giresun University in Turkey. Participants were second-, third- and fourth-year undergraduate students (n=222) in the Bachelor of Nursing Science Degree in the academic spring term of 2014-2015. The data was collected using the 'Clinical Learning Environment Scale', the 'Academic Motivation, and the 'The Clinical Decision Making in Nursing Scale'. Of the respondents in this study, 45% of the students were second class, 30.6% of the students were third class and 24.3% of the students were fourth class. There was a statistically significant positive correlation found between the clinical learning environment and the nursing students' academic motivation (r=0.182, p<.05). However, there was no correlation between the clinical learning environment and clinical decision making (r=0.082, p>.05). One of the prerequisites for the training of qualified students is to provide nursing students with a qualified clinical environment. It was found that nursing students' academic motivation increased as the quality of their clinical learning environment improved. Copyright © 2015 Elsevier Ltd. All rights reserved.

Danish research-active clinical nurses overcome barriers in research utilization.

PubMed

Adamsen, Lis; Larsen, Kristian; Bjerregaard, Lene; Madsen, Jan K

2003-03-01

The aim of this study was to examine whether there was a difference between clinical nurses who were research-active, and clinical nurses who were nonresearch-active in utilization of research. A further aim was to identify the most significant barriers faced by a group of Danish clinical nurses in their use of research. Discrepancy between the improved quality of research results and the lack of implementing them was the starting point for a series of studies which showed the types of barriers clinical nurses found especially cumbersome when applying the research results of other researchers. This study investigates whether the clinical nurses' own engagement in research had any impact on their perception of research utilization. The study had an exploratory and descriptive design. Seventy-nine Danish clinical nurses participated and semi-structured interviewing was used as the research method. There was a statistically significant difference between the research-active and nonresearch-active nurses on various variables. The study showed that, to a larger extent, research-active nurses used evidence-based knowledge and were generally more internationally orientated. Furthermore, two important barriers for research utilization were identified by all 79 clinical nurses included in the study, i.e. 90% of the nurses explained that the quantity of research results was overwhelming, and 75% of them found that they were unable to evaluate the quality of the research. Clinical nurses, who were research-active themselves, experienced more success in overcoming some of the barriers, which existed in applying research to practice. The research potential found amongst clinical nurses in Denmark needed to be further supported through training and guidance in research methodology, establishing introductory stipends and part-time research positions. By doing so, some of the barriers affecting research utilization and the so-called theory-practice gap might be reduced. Further empirical studies, based on Giddens theory of sociological reflectivity, might see clinical nurses in a more serious light and simultaneously perceive them as producers of knowledge.

A blended-learning programme regarding professional ethics in physiotherapy students.

PubMed

Aguilar-Rodríguez, Marta; Marques-Sule, Elena; Serra-Añó, Pilar; Espí-López, Gemma Victoria; Dueñas-Moscardó, Lirios; Pérez-Alenda, Sofía

2018-01-01

In the university context, assessing students' attitude, knowledge and opinions when applying an innovative methodological approach to teach professional ethics becomes fundamental to know if the used approach is enough motivating for students. To assess the effect of a blended-learning model, based on professional ethics and related to clinical practices, on physiotherapy students' attitude, knowledge and opinions towards learning professional ethics. Research design and participants: A simple-blind clinical trial was performed (NLM identifier NCT03241693) (control group, n = 64; experimental group, n = 65). Both groups followed clinical practices for 8 months. Control group performed a public exposition of a clinical case about professional ethics. By contrast, an 8-month blended-learning programme regarding professional ethics was worked out for experimental group. An online syllabus and online activities were elaborated, while face-to-face active participation techniques were performed to discuss ethical issues. Students' attitudes, knowledge and opinions towards learning professional ethics were assessed. Ethical considerations: The study was approved by the University Ethic Committee of Human Research and followed the ethical principles according to the Declaration of Helsinki. After the programme, attitudes and knowledge towards learning professional ethics of experimental group students significantly improved, while no differences were observed in control group. Moreover, opinions reported an adequate extension of themes and temporization, importance of clinical practices and interest of topics. Case study method and role playing were considered as the most helpful techniques. The blended-learning programme proposed, based on professional ethics and related to clinical practices, improves physiotherapy students' attitudes, knowledge and opinions towards learning professional ethics.

Comprehensive Psychopathological Assessment Based on the Association for Methodology and Documentation in Psychiatry (AMDP) System: Development, Methodological Foundation, Application in Clinical Routine, and Research.

PubMed

Stieglitz, Rolf-Dieter; Haug, Achim; Fähndrich, Erdmann; Rösler, Michael; Trabert, Wolfgang

2017-01-01

The documentation of psychopathology is core to the clinical practice of the psychiatrist and clinical psychologist. However, both in initial as well as further training and specialization in their fields, this particular aspect of their work receives scanty attention only. Yet, for the past 50 years, the Association for Methodology and Documentation in Psychiatry (AMDP) System has been in existence and available as a tool to serve precisely the purpose of offering a systematic introduction to the terminology and documentation of psychopathology. The motivation for its development was based on the need for an assessment procedure for the reliable documentation of the effectiveness of newly developed psychopharmacological substances. Subsequently, the AMDP-System began to be applied in the context of investigations into a number of methodological issues in psychiatry (e.g., the frequency and specificity of particular symptoms, the comparison of rating scales). The System then became increasingly important also in clinical practice and, today, represents the most used instrument for the documentation of psychopathology in the German-speaking countries of Europe. This paper intends to offer an overview of the AMDP-System, its origins, design, and functionality. After an initial account of the history and development of the AMDP-System, the discussion will in turn focus on the System's underlying methodological principles, the transfer of clinical skills and competencies in its practical application, and its use in research and clinical practice. Finally, potential future areas of development in relation to the AMDP-System are explored.

Comprehensive Psychopathological Assessment Based on the Association for Methodology and Documentation in Psychiatry (AMDP) System: Development, Methodological Foundation, Application in Clinical Routine, and Research

PubMed Central

Stieglitz, Rolf-Dieter; Haug, Achim; Fähndrich, Erdmann; Rösler, Michael; Trabert, Wolfgang

2017-01-01

The documentation of psychopathology is core to the clinical practice of the psychiatrist and clinical psychologist. However, both in initial as well as further training and specialization in their fields, this particular aspect of their work receives scanty attention only. Yet, for the past 50 years, the Association for Methodology and Documentation in Psychiatry (AMDP) System has been in existence and available as a tool to serve precisely the purpose of offering a systematic introduction to the terminology and documentation of psychopathology. The motivation for its development was based on the need for an assessment procedure for the reliable documentation of the effectiveness of newly developed psychopharmacological substances. Subsequently, the AMDP-System began to be applied in the context of investigations into a number of methodological issues in psychiatry (e.g., the frequency and specificity of particular symptoms, the comparison of rating scales). The System then became increasingly important also in clinical practice and, today, represents the most used instrument for the documentation of psychopathology in the German-speaking countries of Europe. This paper intends to offer an overview of the AMDP-System, its origins, design, and functionality. After an initial account of the history and development of the AMDP-System, the discussion will in turn focus on the System’s underlying methodological principles, the transfer of clinical skills and competencies in its practical application, and its use in research and clinical practice. Finally, potential future areas of development in relation to the AMDP-System are explored. PMID:28439242

A characterization of clinical questions asked by rehabilitation therapists.

PubMed

Kloda, Lorie Andrea; Bartlett, Joan C

2014-04-01

This study explored the information needs of rehabilitation therapists (occupational therapists, physical therapists, and speech-language pathologists) working with patients who have had strokes in order to characterize their clinical questions, defined as their formalized information needs arising in the context of everyday clinical practice. The researchers took a constructivist, interpretive approach, in which fifteen rehabilitation therapists working in various settings were recruited. Data were gathered using diaries, followed by diary-guided interviews, and thematically analyzed using template analysis. Rehabilitation therapists' clinical questions were characterized as having one or more of twelve foci and containing one or more of eight possible structural elements. Findings demonstrate that the evidence-based practice framework currently applied for questions relating to rehabilitation is inadequate for representing rehabilitation therapists' clinical questions. A new framework that is more comprehensive and descriptive is proposed. Librarians working with students and clinicians in rehabilitation can employ knowledge of the twelve foci and the question structure for rehabilitation to guide the reference interview. Instruction on question formulation in evidence-based practice can employ the revised structure for rehabilitation, offering students and clinicians an alternative to the traditional patient, intervention, comparison, outcome (PICO) structure. Information products, including bibliographic databases and synopsis services, can tailor their interfaces according to question foci and prompt users to enter search terms corresponding to any of the eight possible elements found in rehabilitation therapists' clinical questions.

Stent longitudinal strength assessed using point compression: insights from a second-generation, clinically related bench test.

PubMed

Ormiston, John A; Webber, Bruce; Ubod, Ben; White, Jonathon; Webster, Mark W I

2014-02-01

Stent longitudinal distortion, while infrequent, can lead to adverse clinical events. Our first bench comparison of susceptibility of different stent designs to distortion applied force to the entire circumference of the proximal stent hoop. The test increased understanding of stent design and led to recommendations for design change in some. Our second-generation test more closely mimics clinical scenarios by applying force to a point on the proximal hoop of a malapposed stent. Each 3-mm-diameter stent was secured in a test apparatus so that its proximal 5 mm was malapposed in a 3.5-mm tube. An instron applied force to the proximal hoop of each of 5 examples of each of 6 stent designs using a narrow rod so that force applied and distance compressed could be measured. Hoops on the side of the force were pushed together, became malapposed, and obstructed the lumen. In addition, the proximal stent hoop tilted causing malapposition, the contralateral side of the stent from the applied force causing lumen obstruction. This second-generation, more clinically relevant test showed the Biomatrix Flex was the most resistant to deformation and the Element the most easily deformed. The addition of more connectors between the proximal hoops in the Promus Premier design has reduced the potential for distortion when compared with the Element, so that distortion was similar to the Vision, Multi-Link 8, and Integrity designs. The test also provided insight into the way in which stents are likely to distort in clinical practice.

Terror management theory applied clinically: implications for existential-integrative psychotherapy.

PubMed

Lewis, Adam M

2014-01-01

Existential psychotherapy and Terror Management Theory (TMT) offer explanations for the potential psychological effects of death awareness, although their respective literatures bases differ in clarity, research, and implications for treating psychopathology. Existential therapy is often opaque to many therapists, in part due to the lack of consensus on what constitutes its practice, limited published practical examples, and few empirical studies examining its efficacy. By contrast, TMT has an extensive empirical literature base, both within social psychology and spanning multiple disciplines, although previously unexplored within clinical and counseling psychology. This article explores the implications of a proposed TMT integrated existential therapy (TIE), bridging the gap between disciplines in order to meet the needs of the aging population and current challenges facing existential therapists.

A practical approach to evidence-based dentistry: VI: How to use a systematic review.

PubMed

Carrasco-Labra, Alonso; Brignardello-Petersen, Romina; Glick, Michael; Guyatt, Gordon H; Azarpazhooh, Amir

2015-04-01

Dental practitioners face new clinical challenges on a daily basis. New treatment options and diagnostic tools are disseminated quickly, and the volume of articles and new evidence is overwhelming. Systematic reviews summarize and synthesize the available evidence related to diagnosis, therapy, prognosis, and harm for clinicians, patients, and decision makers. Such reviews represent one of the most powerful tools to translate knowledge into action. The critical appraisal of this type of study involves assessing the risk of bias, results, and applicability of such study. The authors provide guidance for clinicians to critically appraise systematic reviews and apply the findings in clinical practice. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

Core informatics competencies for clinical and translational scientists: what do our customers and collaborators need to know?

PubMed Central

Valenta, Annette L; Meagher, Emma A; Tachinardi, Umberto

2016-01-01

Since the inception of the Clinical and Translational Science Award (CTSA) program in 2006, leaders in education across CTSA sites have been developing and updating core competencies for Clinical and Translational Science (CTS) trainees. By 2009, 14 competency domains, including biomedical informatics, had been identified and published. Since that time, the evolution of the CTSA program, changes in the practice of CTS, the rapid adoption of electronic health records (EHRs), the growth of biomedical informatics, the explosion of big data, and the realization that some of the competencies had proven to be difficult to apply in practice have made it clear that the competencies should be updated. This paper describes the process undertaken and puts forth a new set of competencies that has been recently endorsed by the Clinical Research Informatics Workgroup of AMIA. In addition to providing context and background for the current version of the competencies, we hope this will serve as a model for revision of competencies over time. PMID:27121608

An Empirically Derived Taxonomy for Personality Diagnosis: Bridging Science and Practice in Conceptualizing Personality

PubMed Central

Westen, Drew; Shedler, Jonathan; Bradley, Bekh; DeFife, Jared A.

2013-01-01

Objective The authors describe a system for diagnosing personality pathology that is empirically derived, clinically relevant, and practical for day-to-day use. Method A random national sample of psychiatrists and clinical psychologists (N=1,201) described a randomly selected current patient with any degree of personality dysfunction (from minimal to severe) using the descriptors in the Shedler-Westen Assessment Procedure–II and completed additional research forms. Results The authors applied factor analysis to identify naturally occurring diagnostic groupings within the patient sample. The analysis yielded 10 clinically coherent personality diagnoses organized into three higher-order clusters: internalizing, externalizing, and borderline-dysregulated. The authors selected the most highly rated descriptors to construct a diagnostic prototype for each personality syndrome. In a second, independent sample, research interviewers and patients’ treating clinicians were able to diagnose the personality syndromes with high agreement and minimal comorbidity among diagnoses. Conclusions The empirically derived personality prototypes described here provide a framework for personality diagnosis that is both empirically based and clinically relevant. PMID:22193534

The diagnosis of premenstrual syndromes and premenstrual dysphoric disorder--clinical procedures and research perspectives.

PubMed

Halbreich, U

2004-12-01

Premenstrual syndromes (PMS) are quite prevalent among women of reproductive age. In up to 20% of women they are severe enough to warrant treatment, which is available and marketed as such. The impact of the cumulative burden of PMS is substantial and is in the same magnitude as affective disorders. Nevertheless, the definitions and diagnoses of PMS are still fragmented, not widely accepted and, if accepted, not always applied in day-to-day clinical practice. In the present paper, the current diagnostic entities are critically reviewed, problems with the current definitions are delineated and a unified definition is proposed. For clinical purposes, the recommended dinical practical diagnostic process and differential diagnosis are described. For clinical trials of medications for treatment of PMS/premenstrual dysphoric disorder, research diagnostic criteria, inclusion and exclusion criteria, as well as well-defined outcome measures, are of utmost importance; they are described here. The gaps of knowledge in the description and diagnosis of PMS are described, with suggestions for future directions for research.

[The Contribution of GMP-grade Hospital Preparation to Translational Research].

PubMed

Yonezawa, Atsushi; Kajiwara, Moto; Minami, Ikuko; Omura, Tomohiro; Nakagawa, Shunsaku; Matsubara, Kazuo

2015-01-01

Translational research is important for applying the outcomes of basic research studies to practical medical treatments. In exploratory early-phase clinical trials for an innovative therapy, researchers should generally manufacture investigational agents by themselves. To provide investigational agents with safety and high quality in clinical studies, appropriate production management and quality control are essential. In the Department of Pharmacy of Kyoto University Hospital, a manufacturing facility for sterile drugs was established, independent of existing manufacturing facilities. Manuals on production management and quality control were developed according to Good Manufacturing Practices (GMP) for Investigational New Drugs (INDs). Advanced clinical research has been carried out using investigational agents manufactured in our facility. These achievements contribute to both the safety of patients and the reliability of clinical studies. In addition, we are able to do licensing-out of our technique for the manufacture of investigational drugs. In this symposium, we will introduce our GMP grade manufacturing facility for sterile drugs and discuss the role of GMP grade hospital preparation in translational research.

Recognition of central sensitization in patients with musculoskeletal pain: Application of pain neurophysiology in manual therapy practice.

PubMed

Nijs, Jo; Van Houdenhove, Boudewijn; Oostendorp, Rob A B

2010-04-01

Central sensitization plays an important role in the pathophysiology of numerous musculoskeletal pain disorders, yet it remains unclear how manual therapists can recognize this condition. Therefore, mechanism based clinical guidelines for the recognition of central sensitization in patients with musculoskeletal pain are provided. By using our current understanding of central sensitization during the clinical assessment of patients with musculoskeletal pain, manual therapists can apply the science of nociceptive and pain processing neurophysiology to the practice of manual therapy. The diagnosis/assessment of central sensitization in individual patients with musculoskeletal pain is not straightforward, however manual therapists can use information obtained from the medical diagnosis, combined with the medical history of the patient, as well as the clinical examination and the analysis of the treatment response in order to recognize central sensitization. The clinical examination used to recognize central sensitization entails the distinction between primary and secondary hyperalgesia. Copyright 2009 Elsevier Ltd. All rights reserved.

Evidence-based Management: From Theory to Practice in Health Care

PubMed Central

Walshe, Kieran; Rundall, Thomas G.

2001-01-01

The rise of evidence-based clinical practice in health care has caused some people to start questioning how health care managers and policymakers make decisions, and what role evidence plays in the process. Though managers and policymakers have been quick to encourage clinicians to adopt an evidence-based approach, they have been slower to apply the same ideas to their own practice. Yet, there is evidence that the same problems (of the underuse of effective interventions and the overuse of ineffective ones) are as widespread in health care management as they are in clinical practice. Because there are important differences between the culture, research base, and decision-making processes of clinicians and managers, the ideas of evidence-based practice, while relevant, need to be translated for management rather than simply transferred. The experience of the Center for Health Management Research (CHMR) is used to explore how to bring managers and researchers together and promote the use of evidence in managerial decision-making. However, health care funders, health care organizations, research funders, and academic centers need wider and more concerted action to promote the development of evidence-based managerial practice. PMID:11565163

Helping or hindering: the role of nurse managers in the transfer of practice development learning.

PubMed

Currie, Kay; Tolson, Debbie; Booth, Jo

2007-09-01

This paper reports selected findings from a recent PhD study exploring how graduates from a BSc Specialist Nursing programme, with an NMC-approved Specialist Practitioner Qualification, engage in practice development during their subsequent careers. The UKCC (1998) defines specialist practice as requiring higher levels of judgement, discretion and decision-making, with leadership in clinical practice development forming a core dimension of this level of practice. However, there is little evidence in the published literature that describes or evaluates the practice development role of graduate specialist practitioners. This study applied a modified Glaserian approach to grounded theory methods. A preliminary descriptive survey questionnaire was posted to all graduates from the programme, response rate of 45% (n=102). From these respondents, theoretical sampling decisions directed the selection of 20 participants for interview, permitting data saturation. The grounded theory generated by this study discovered a basic social process labelled 'making a difference', whereby graduate specialist practitioners are increasingly able to impact in developing patient care at a strategic level by coming to own the identity of an expert practitioner (Currie, 2006). Contextual factors strongly influence the practitioner journey, with organizational position and other people presenting enabling or blocking conditions. The line manager plays a crucial role in helping or hindering graduate specialist practitioners to transfer their learning to the clinical setting and become active in practice development. Recommendations to enhance managerial support for the practice development role of graduate specialist practitioners are proposed. ADDING TO CURRENT KNOWLEDGE: This work adds to currently limited knowledge of the graduate specialist practitioners' role in the leadership of clinical practice development. In addition, the findings emphasize the potential influence of the workplace environment by analyzing organizational factors in the specific context of the graduate specialist practitioner attempting to develop practice.

An Interactive Teddy Bear Clinic Tour: Teaching Veterinary Students How to Interact with Young Children.

PubMed

Dalley, Jessica S; Creary, Patricia R; Durzi, Tiffany; McMurtry, C Meghan

Although there are existing guidelines for teaching and learning skillful client communication, there remains a need to integrate a developmental focus into veterinary medical curricula to prepare students for interactions with children who accompany their companion animals. The objectives of this teaching tip are (1) to describe the use of a Teddy Bear Clinic Tour as an innovative, applied practice method for teaching veterinary students about clinical communication with children, and (2) to provide accompanying resources to enable use of this method to teach clinical communication at other facilities. This paper includes practical guidelines for organizing a Teddy Bear Clinic Tour at training clinics or colleges of veterinary medicine; an anecdotal description of a pilot study at the Ontario Veterinary College Smith Lane Animal Hospital; and printable resources, including a list of specific clinical communication skills, a sample evaluation sheet for supervisors and students, recommendations for creating a child-friendly environment, examples of child-friendly veterinary vocabulary, and a sample script for a Teddy Bear Clinic Tour. Informed by the resources provided in this teaching tip paper, the Teddy Bear Clinic Tour can be used at your facility as a unique teaching method for clinical communication with children and as a community outreach program to advertise the services at the facility.

Medicinal herbs and phytochitodeztherapy in oncology.

PubMed

Treskunov, Karp; Treskunova, Olga; Komarov, Boris; Goroshetchenko, Alex; Glebov, Vlad

2003-01-01

Application of clinical phytology in treatment of oncology diseases was limited by intensive development of chemical pharmaceuticals and surgery. The authors had set the task to develop the computer database for phytotherapy application. The database included full information on patient's clinical status (identified diseases, symptoms, syndromes) and applied phytotherapy treatment. Special attention was paid to the application of phyto preparations containing chitosan. The computer database contains information on 2335 patients. It supports reliable data on efficiency of phytotherapy in general and allows to evaluate the efficiency of some particular medicinal herbs and to develop efficient complex phyto preparations for treatment of specific diseases. The application of phytotherapy in treatment of oncology patients confirmed the positive effect on patient's quality of life. In conclusion it should be emphasized that the present situation of practical application of phytotherapy could be considered as unacceptable because of absence of necessary knowledge and practical experience in using phytotherapy in outpatient clinics, hospitals and medicinal centers.

Integration of targeted sequencing and NIPT into clinical practice in a Chinese family with maple syrup urine disease.

PubMed

You, Yanqin; Sun, Yan; Li, Xuchao; Li, Yali; Wei, Xiaoming; Chen, Fang; Ge, Huijuan; Lan, Zhangzhang; Zhu, Qian; Tang, Ying; Wang, Shujuan; Gao, Ya; Jiang, Fuman; Song, Jiaping; Shi, Quan; Zhu, Xuan; Mu, Feng; Dong, Wei; Gao, Vince; Jiang, Hui; Yi, Xin; Wang, Wei; Gao, Zhiying

2014-08-01

This article demonstrates a prominent noninvasive prenatal approach to assist the clinical diagnosis of a single-gene disorder disease, maple syrup urine disease, using targeted sequencing knowledge from the affected family. The method reported here combines novel mutant discovery in known genes by targeted massively parallel sequencing with noninvasive prenatal testing. By applying this new strategy, we successfully revealed novel mutations in the gene BCKDHA (Ex2_4dup and c.392A>G) in this Chinese family and developed a prenatal haplotype-assisted approach to noninvasively detect the genotype of the fetus (transmitted from both parents). This is the first report of integration of targeted sequencing and noninvasive prenatal testing into clinical practice. Our study has demonstrated that this massively parallel sequencing-based strategy can potentially be used for single-gene disorder diagnosis in the future.

Revised definition of neuropathic pain and its grading system: an open case series illustrating its use in clinical practice.

PubMed

Geber, Christian; Baumgärtner, Ulf; Schwab, Rainer; Müller, Harald; Stoeter, Peter; Dieterich, Marianne; Sommer, Clemens; Birklein, Frank; Treede, Rolf-Detlef

2009-10-01

The definition of neuropathic pain has recently been revised by an expert committee of the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (NeuPSIG) as "pain arising as direct consequence of a lesion or disease affecting the somatosensory system," and a grading system of "definite," "probable," and "possible" neuropathic pain has been introduced. This open case series of 5 outpatients (3 men, 2 women; mean age 48 +/- 12 years) demonstrates how the grading system can be applied, in combination with appropriate confirmatory testing, to diagnosis neuropathic conditions in clinical practice. The proposed grading system includes a dynamic algorithm that enhances the physician's ability to determine with a greater level of certainty whether a pain condition is neuropathic. Its clinical use should be further validated in prospective studies.

Sinecatechins and imiquimod as proactive sequential therapy of external genital and perianal warts in adults.

PubMed

Schöfer, Helmut; Tatti, Silvio; Lynde, Charles W; Skerlev, Mihael; Hercogová, Jana; Rotaru, Maria; Ballesteros, Juan; Calzavara-Pinton, Piergiacomo

2017-12-01

This review about the proactive sequential therapy (PST) of external genital and perianal warts (EGW) is based on the most current available clinical literature and on the broad clinical experience of a group of international experts, physicians who are well versed in the treatment of human papillomavirus-associated diseases. It provides a practical guide for the treatment of EGW, including epidemiology, etiology, clinical appearance, and diagnostic procedures for these viral infections. Furthermore, the treatment goals and current treatment options, elucidating provider- and patient-applied therapies, and the parameters driving treatment decisions are summarized. Specifically, the mode of action of the topical treatments sinecatechins and imiquimod, as well as the PST for EGW to achieve rapid and sustained clearance is discussed. The group of experts has developed a treatment algorithm giving healthcare providers a practical tool for the treatment of EGW which is very valuable in the presence of many different treatment options.

[Evidence based practice of nurses working in university hospitals in the French speaking part of Switzerland: a descriptive and correlational study

PubMed

Gentizon, Jenny; Borrero, Patricia; Vincent-Suter, Sonja; Ballabeni, Pierluigi; Morin, Diane; Eicher, Manuela

2016-12-01

Introduction : evidence-based practice (EBP) is too scarcely applied in nursing and is a key contemporary challenge for the discipline. Method and objective : This descriptive and correlational study invited 221 nurses working in three different clinical settings of university hospitals in Switzerland. The objective of this study was to describe their level of knowledge, beliefs and implementation of EBP. Results : of the 221 nurses in this study, only 67 were familiar EBP (30%). These demonstrate favorable beliefs and attitudes towards EBP, but indicate a lack of skills and knowledge to implement it. Compared to both internal medicine and geriatric nurses clinical nurse specialists (ISC) were significantly more familiar with EBP and its implementation. Results also indicate that positive nurses’ beliefs and attitudes toward EBP are predictive of better implementation in clinical practice. Discussion and Conclusion : as demonstrated in other studies, our results show that knowledge about EBP is not that widespread and its implementation remains a challenge even in university hospitals. Future work could include testing EBP implementation strategies to overcome the barriers identified.

Critical thinking: the development of an essential skill for nursing students.

PubMed

Papathanasiou, Ioanna V; Kleisiaris, Christos F; Fradelos, Evangelos C; Kakou, Katerina; Kourkouta, Lambrini

2014-08-01

Critical thinking is defined as the mental process of actively and skillfully perception, analysis, synthesis and evaluation of collected information through observation, experience and communication that leads to a decision for action. In nursing education there is frequent reference to critical thinking and to the significance that it has in daily clinical nursing practice. Nursing clinical instructors know that students face difficulties in making decisions related to clinical practice. The main critical thinking skills in which nursing students should be exercised during their studies are critical analysis, introductory and concluding justification, valid conclusion, distinguish of facts and opinions, evaluation the credibility of information sources, clarification of concepts and recognition of conditions. Specific behaviors are essentials for enhancing critical thinking. Nursing students in order to learn and apply critical thinking should develop independence of thought, fairness, perspicacity in personal and social level, humility, spiritual courage, integrity, perseverance, self-confidence, interest for research and curiosity. Critical thinking is an essential process for the safe, efficient and skillful nursing practice. The nursing education programs should adopt attitudes that promote critical thinking and mobilize the skills of critical reasoning.

Critical Thinking: The Development of an Essential Skill for Nursing Students

PubMed Central

Papathanasiou, Ioanna V.; Kleisiaris, Christos F.; Fradelos, Evangelos C.; Kakou, Katerina; Kourkouta, Lambrini

2014-01-01

Critical thinking is defined as the mental process of actively and skillfully perception, analysis, synthesis and evaluation of collected information through observation, experience and communication that leads to a decision for action. In nursing education there is frequent reference to critical thinking and to the significance that it has in daily clinical nursing practice. Nursing clinical instructors know that students face difficulties in making decisions related to clinical practice. The main critical thinking skills in which nursing students should be exercised during their studies are critical analysis, introductory and concluding justification, valid conclusion, distinguish of facts and opinions, evaluation the credibility of information sources, clarification of concepts and recognition of conditions. Specific behaviors are essentials for enhancing critical thinking. Nursing students in order to learn and apply critical thinking should develop independence of thought, fairness, perspicacity in personal and social level, humility, spiritual courage, integrity, perseverance, self-confidence, interest for research and curiosity. Critical thinking is an essential process for the safe, efficient and skillful nursing practice. The nursing education programs should adopt attitudes that promote critical thinking and mobilize the skills of critical reasoning. PMID:25395733

Scholarship of Practice in the Care of People with Dementia: Creating the Future Through Collaborative Efforts.

PubMed

Forsyth, Kirsty; Melton, Jane; Raber, Christine; Burke, Janice P; Piersol, Catherine Verrier

2015-01-01

A scholarship of practice approach sets the stage for collaborative partnerships across academic and clinical practice settings that result in positive gains for all stakeholders. These gains include an enhanced ability to generate and apply relevant evidence in practice, disseminate knowledge and innovation, and ensure best practice is relevant to and effective for, people receiving services and their caregivers. This paper discusses national and international examples of collaborative, research-based practice initiatives that have implemented a scholarship of practice approach. The exemplars described here are framed within the Model of Human Occupation, which addresses the importance of volition, habits, roles, environment, and performance capacities in facilitating engagement in occupation for people with dementia. Research that focuses on how therapists adopt and use evidence in practice, as well as the opportunities and challenges for supporting therapists and their use of theory and evidence are discussed.

Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice.

PubMed

Anderson, Jaclyn; Caplan, Liron; Yazdany, Jinoos; Robbins, Mark L; Neogi, Tuhina; Michaud, Kaleb; Saag, Kenneth G; O'Dell, James R; Kazi, Salahuddin

2012-05-01

Although the systematic measurement of disease activity facilitates clinical decision making in rheumatoid arthritis (RA), no recommendations currently exist on which measures should be applied in clinical practice in the US. The American College of Rheumatology (ACR) convened a Working Group (WG) to comprehensively evaluate the validity, feasibility, and acceptability of available RA disease activity measures and derive recommendations for their use in clinical practice. The Rheumatoid Arthritis Clinical Disease Activity Measures Working Group conducted a systematic review of the literature to identify RA disease activity measures. Using exclusion criteria, input from an Expert Advisory Panel (EAP), and psychometric analysis, a list of potential measures was created. A survey was administered to rheumatologists soliciting input. The WG used these survey results in conjunction with the psychometric analyses to derive final recommendations. Systematic review of the literature resulted in identification of 63 RA disease activity measures. Application of exclusion criteria and ratings by the EAP narrowed the list to 14 measures for further evaluation. Practicing rheumatologists rated 9 of these 14 measures as most useful and feasible. From these 9 measures, the WG selected 6 with the best psychometric properties for inclusion in the final set of ACR-recommended RA disease activity measures. We recommend the Clinical Disease Activity Index, Disease Activity Score with 28-joint counts (erythrocyte sedimentation rate or C-reactive protein), Patient Activity Scale (PAS), PAS-II, Routine Assessment of Patient Index Data with 3 measures, and Simplified Disease Activity Index because they are accurate reflections of disease activity; are sensitive to change; discriminate well between low, moderate, and high disease activity states; have remission criteria; and are feasible to perform in clinical settings. Copyright © 2012 by the American College of Rheumatology.

[Evidence-based medicine and 'The Cochrane Collaboration'].

PubMed

Kawamura, T; Tamakoshi, A; Wakai, K; Ohno, Y

1999-06-01

In Evidence-Based Medicine (EBM), a clinical decision is based neither on pathophysiological theories nor personal experience but on the results derived from scientifically designed clinical epidemiological studies (i.e., evidence). EBM is used in various clinical applications, such as therapy, diagnosis, and prognosis prediction. The process includes (1) asking a clinical question consisting of the three elements of "patient", "exposure", and "outcome"; (2) searching for the best evidence using MEDLINE or Cochrane Library; (3) appraising critically the validity of the method and the magnitude and probability of the result; and finally (4) applying the evidence of the patient. In actual clinical practice, clinical expertise and patient preferences should be as much regarded as research evidence. 'The Cochrane Collaboration' supplies systematic reviews of clinical trials carried out all over the world to its consumers. Its fruit, 'The Cochrane Library (CD-ROM),' is a highly valuable resource. 'The Cochrane Collaboration' serves as the infrastructure for EBM. EBM, which was originally developed for the individual patient care, can also be applicable to community- or workplace-healthcare and policy making by governments. Thus, EBM is both a philosophy and a method to provide people with the most appropriate medical practice.

Implementing web-based ping-pong-type e-communication to enhance staff satisfaction, multidisciplinary cooperation, and clinical effectiveness

PubMed Central

Yeh, Pei-Han; Hung, Shih-Kai; Lee, Moon-Sing; Chiou, Wen-Yen; Lai, Chun-Liang; Tsai, Wei-Ta; Hsieh, Hui-Ling; Shih, Yi-Ting; Chen, Liang-Cheng; Huang, Li-Wen; Lin, Yi-An; Lin, Po-Hao; Lin, Yung-Hsiang; Liu, Dai-Wei; Hsu, Feng-Chun; Tsai, Shiang-Jiun; Liu, Jia-Chi; Chung, En-Seu; Lin, Hon-Yi

2016-01-01

Abstract Background: Frequent multidisciplinary communication is essential in conducting daily radiotherapy (RT) practice. However, traditional oral or paper-based communication has limitations. E-communication has been suggested, but its effects are still not well demarcated in the field of radiation oncology. Objects: In our web-based integrated information platform, we constructed a ping-pong-type e-communication function to transfer specific notations among multidisciplinary RT staffs. The purpose was to test whether applying this e-communication can increase effectiveness of multidisciplinary cooperation when compared with oral or paper-based practice. Staff satisfaction and clinical benefits were also demonstrated. Design and setting: A real-world quality-improving study was conducted in a large center of radiation oncology. Participants and dataset used: Before and after applying multidisciplinary e-communication (from 2014 to 2015), clinical RT staffs were surveyed for their user experience and satisfaction (n = 23). For measuring clinical effectiveness, a secondary database of irradiated head and neck cancer patients was re-analyzed for comparing RT toxicities (n = 402). Interventions: Applying ping-pong-type multidisciplinary reflective e-communication was the main intervention. Outcome measures: For measuring staff satisfaction, eight domains were surveyed, such as timeliness, convenience, and completeness. For measuring clinical effectiveness of multidisciplinary cooperation, event rates of severe (i.e., grade 3–4) RT mucositis and dermatitis were recorded. Results: Overall, when compared with oral communication only, e-communication demonstrated multiple benefits, particularly on notation-review convenience (2.00 ± 1.76 vs 9.19 ± 0.81; P < 0.0001). When compared with paper-based practice, e-communication showed statistically significant benefits on all eight domains, especially on notation-review convenience (5.05 ± 2.11 vs 9.19 ± 0.81; P < 0.0001) and convenience of feedback notation (4.81 ± 1.72 vs 8.76 ± 1.09; P < 0.0001). Moreover, staff satisfaction was gradually increased from oral (3.57 ± 1.94), paper-based (5.57 ± 2.06), to e-communication (8.76 ± 0.70; P < 0.0001). Secondary measurement confirmed these observations. Before and after facilitating multidisciplinary cooperation by using e-communication, severe (i.e., grade 3–4) mucositis and dermatitis were decreased from 21.7% to 10% then to 5.1%. Conclusions: Replacing oral or paper-based practice with e-communication is useful in facilitating RT multidisciplinary teamwork. Staff satisfaction and clinical effectiveness can be increased. PMID:27858876

The application of the Practitioners in Applied Practice Model during breaking bad news communication training for medical students: a case study.

PubMed

Dunning, Rose; Laidlaw, Anita

2015-11-01

Breaking bad news is a key skill within clinical communication and one which can impact outcomes for both the patient and practitioner. The evidence base for effective clinical communication training in breaking bad news is scarce. Frameworks have been found to assist the practitioner, such as SPIKES; however, the pedagogical approach used alongside such frameworks can vary. This study sought to examine the impact of utilising the Practitioners in Applied Practice Model (PAPM) alongside the SPIKES framework for training undergraduate medical students in breaking bad news. A case study approach is used to highlight the impact of training based on the PAPM and SPIKES on patient-centred communication and simulated patient satisfaction with the clinical communication behaviour. Results showed that following training, both patient-centred behaviour and patient satisfaction improved. With detailed communication behaviour changes, a balance was established between rapport building behaviour, lifestyle and psychosocial talk alongside biomedical information. This case study shows how the PAPM could be utilised alongside the SPIKES framework to improve breaking bad news communication in medical undergraduate students and describes the behavioural basis of the improvement. Further research is required to show the generalisability of this training intervention. © The Author(s) 2015.

[THE VIRTUAL CYTOLOGIC SLIDES FOR EXTERNAL EVALUATION OF QUALITY OF IMPLEMENTATION OF CYTOLOGIC ANALYSES IN CLINICAL DIAGNOSTIC LABORATORIES: POSSIBILITIES AND PERSPECTIVES].

PubMed

Djangirova, T V; Shabalova, I P; Pronichev, A N; Polyakov, E V

2015-08-01

The article considers application of technology of analysis of cytological slides in external quality control of clinical diagnostic laboratories. The advantages of virtual slides are demonstrated against other applied technologies of external evaluation of quality i.e. slide plate and digital micro-photography. The conditions of formation of virtual slides for external evaluation of quality of clinical diagnostic laboratories. The technology of their application is described. The success of practical application of considered technology in the Federal system of external evaluation of quality is emphasized.

Methicillin-resistant Staphylococcus aureus and skin infections among personnel at a pediatric clinic.

PubMed

Carpenter, L Rand; Kainer, Marion; Woron, Amy; Schaffner, William; Jones, Timothy F

2008-11-01

Ambulatory care visits for methicillin-resistant Staphylococcus aureus (MRSA) infections are increasing dramatically. We investigated a pediatric clinic worker's death caused by MRSA. Among 45 clinic personnel, 16 reported recent skin infections, and 4% were colonized with MRSA. Among 262 patients, 3.4% were colonized with MRSA. Standard precautions were inconsistently applied when treating skin infections. Eight (11%) of 71 environmental swipes contained S aureus. Health care workers in outpatient settings are increasingly exposed to substantial numbers of persons with MRSA, and infection control practices in the ambulatory care setting deserve reemphasis.

Clinical Applications of Gastrointestinal Manometry in Children

PubMed Central

2014-01-01

Manometry is a noninvasive diagnostic tool for identifying motility dysfunction of the gastrointestinal tract. Despite the great technical advances in monitoring motility, performance of the study in pediatric patients has several limitations that should be considered during the procedure and interpretation of the test results. This article reviews the clinical applications of conventional esophageal and anorectal manometries in children by describing a technique for performing the test. This review will develop the uniformity required for the methods of performance, the parameters for measurement, and interpretation of test results that could be applied in pediatric clinical practice. PMID:24749084

Medical student preparedness for an era of personalized medicine: findings from one US medical school.

PubMed

Eden, Caroline; Johnson, Kipp W; Gottesman, Omri; Bottinger, Erwin P; Abul-Husn, Noura S

2016-03-01

The objective of this research was to assess medical student preparedness for the use of personalized medicine. A survey instrument measuring attitude toward personalized medicine, perceived knowledge of genomic testing concepts and perceived ability to apply genomics to clinical care was distributed to students in medical school (MS) years 1-4. Of 212 participants, 79% felt that it was important to learn about personalized medicine, but only 6% thought that their medical education had adequately prepared them to practice personalized medicine. Attitude did not vary across years; knowledge and ability increased after MS1, but not after MS2. While medical students support the use of personalized medicine, they do not feel prepared to apply genomics to clinical care.

Exploring the Needs of Students Experiencing Homelessness from School Counselors' Perspectives

ERIC Educational Resources Information Center

Havlik, Stacey A.; Brady, Jennifer; Gavin, Kathleen

2014-01-01

An increased understanding of the needs of students experiencing homelessness will better inform educational and clinical practices to ensure student success. Through an analysis of survey data using the Knowledge and Skills with Homeless Students Survey (Gaenzle & Bryan, 2013), this exploratory study applied a mixed methods approach to assess…

From Awareness to Practice: An Online Workshop on Bringing Culture into the Counselling Room

ERIC Educational Resources Information Center

Rapacki, Tomasz Michal; McBride, Dawn Lorraine

2014-01-01

The purpose of this project is to enhance the counselling services offered to diverse clients by supplying counsellors-in-training with a professional development resource that combines the best available outcome evidence and applied clinical wisdom, with the most current cultural adaptation frameworks. A comprehensive literature review was…

Comorbidity of Anxiety and Conduct Problems in Children: Implications for Clinical Research and Practice

ERIC Educational Resources Information Center

Cunningham, Natoshia Raishevich; Ollendick, Thomas H.

2010-01-01

Given the relative lack of research on the comorbidity of anxiety disorders (ADs) and conduct problems (oppositional defiant disorder, conduct disorder) in youth, we examine this comorbidity from both basic and applied perspectives. First, we review the concept of comorbidity and provide a framework for understanding issues pertaining to…

Learning curves in health care.

PubMed

Waldman, J Deane; Yourstone, Steven A; Smith, Howard L

2003-01-01

This article explores the uses of learning curve theory in medicine. Though effective application of learning curve theory in health care can result in higher quality and lower cost, it is seldom methodically applied in clinical practice. Fundamental changes are necessary in the corporate culture of medicine in order to capitalize maximally on the benefits of learning.

The Role of Creativity in Models of Resilience: Theoretical Exploration and Practical Applications

ERIC Educational Resources Information Center

Metzl, Einat S.; Morrell, Malissa A.

2008-01-01

This exploration reviews current conceptualizations of resilience and creativity, suggesting important links between these two concepts, and offers a modified model for future research and applied clinical interventions. First, the authors examine four main models of resilience. Then, an overview of definitions and characteristics of creativity is…

Teaching Single-Case Evaluation to Graduate Social Work Students: A Replication

ERIC Educational Resources Information Center

Wong, Stephen E.; O'Driscoll, Janice

2017-01-01

A course teaching graduate social work students to use an evidence-based model and to evaluate their own practice was replicated and evaluated. Students conducted a project in which they reviewed published research to achieve a clinical goal, applied quantitative measures for ongoing assessment, implemented evidence-based interventions, and…

What is health-related quality of life? Perspectives from pediatric and adult diabetes care providers

USDA-ARS?s Scientific Manuscript database

While health-related quality of life (HRQOL) is gaining recognition as an important patient-reported outcome in clinical care and research, an understanding of how diabetes care providers define HRQOL or apply it in practice has not been established. The purpose of this study was to characterize the...

Translating the Theoretical into Practical: A Logical Framework of Functional Analytic Psychotherapy Interactions for Research, Training, and Clinical Purposes

ERIC Educational Resources Information Center

Weeks, Cristal E.; Kanter, Jonathan W.; Bonow, Jordan T.; Landes, Sara J.; Busch, Andrew M.

2012-01-01

Functional analytic psychotherapy (FAP) provides a behavioral analysis of the psychotherapy relationship that directly applies basic research findings to outpatient psychotherapy settings. Specifically, FAP suggests that a therapist's in vivo (i.e., in-session) contingent responding to targeted client behaviors, particularly positive reinforcement…

Self-injurious behaviour in people with intellectual disability and autism spectrum disorder.

PubMed

Oliver, Chris; Licence, Lucy; Richards, Caroline

2017-03-01

This review summarises the recent trends in research in the field of self-injurious behaviour in people with intellectual disability and autism spectrum disorder. New data on incidence, persistence and severity add to studies of prevalence to indicate the large scale of the clinical need. A number of person characteristics have been repeatedly identified in prevalence and cohort studies that: can be considered as risk markers (e.g. stereotyped behaviour, autism spectrum disorder) and indicate possible causal mechanisms (e.g. sleep disorder, anxiety). Studies have started to integrate traditional operant learning paradigms with known person characteristics and reviews and meta-analyses of applied behaviour analytic procedures can now inform practice. Despite these positive developments interventions and appropriate support falls far short of the required need. Expansions in applied research are warranted to develop and evaluate innovative service delivery models that can translate knowledge of risk markers and operant learning paradigms into widespread, low cost routine clinical practice. Alongside this, further pure research is needed to elucidate the direction of causality of implicated risk factors, in order to understand and intervene more effectively in self-injury.

The role and functions of Clinical Nurse Consultants, an Australian advanced practice role: a descriptive exploratory cohort study.

PubMed

Baldwin, Richard; Duffield, Christine Margaret; Fry, Margaret; Roche, Michael; Stasa, Helen; Solman, Annette

2013-03-01

The NSW Health Policy Directive (NSW Department of Health, 2000) lists clinical service and consultancy; clinical leadership; research; education; clinical services planning and management as the five domains of practice for nurses appointed as Clinical Nurse Consultants (CNCs), an Australian advanced practice nurse (APN) role. However, there is no clear definition of what is meant by advanced practice in the Australian nursing context. Nowhere is this more evident than in differentiating between the roles of Clinical Nurse Consultants (CNCs) and Nurse Practitioners (NP) in NSW. To date, limited empirical research has been done to characterise or delineate CNC role activity and responsibility. To investigate (i) the nature of CNC roles, activities and responsibilities, (ii) differentiate between CNCs by their work patterns and activities, and (iii) empirically conceptualize and differentiate ways CNCs practice in terms of an APN typology. The study sample was 56 CNCs at one tertiary level public hospital in Australia. A descriptive exploratory cohort study was conducted to explore CNC role characteristics and patterns of activity. Data were triangulated using an online survey, a follow-up survey, and semi-structured interviews. The data were analysed using descriptive statistics to examine differences between CNC work patterns and role activities. The survey data and the individual reports were thematically analysed to investigate for difference across the population of CNCs. Interpretation of survey and interview data led to an analyst-developed CNC typology of four CNC categories based on the work patterns and activities of Sole Practitioner, Clinic Coordinator, Clinical Team Coordinator and Clinical Leader. The typology was based on the themes interprofessional, role focus, clinical focus and setting as these themes distinguished and differentiated CNC roles. The study provides evidence of great diversity and prioritization within CNC roles. The CNC typology identified in this study is similar to the categorisation of the roles of APNs reported by other researchers. With further testing, the CNC typology could be useful to service managers and policy makers in making decision on the category of CNC required for a position and may also be able to be applied to other APN roles. Copyright © 2012 Elsevier Ltd. All rights reserved.

Evidence-Based Medicine: Rhinoplasty.

PubMed

Lee, Matthew K; Most, Sam P

2015-08-01

Evidence-based medicine has become increasingly prominent in the climate of modern day healthcare. The practice of evidence-based medicine involves the integration of the best available evidence with clinical experience and expertise to help guide clinical decision-making. The essential tenets of evidence-based medicine can be applied to both functional and aesthetic rhinoplasty. Current outcome measures in functional and aesthetic rhinoplasty, including objective, subjective, and clinician-reported measures, is summarized and the current data is reviewed. Copyright © 2015 Elsevier Inc. All rights reserved.

PET/SPECT: Instrumentation, radiopharmaceuticals, neurology and physiological measurement. Proceedings

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1988-12-31

The following collection of papers was presented at the Department of Energy sponsored symposium ``Frontiers in Nuclear Medicine - PET/SPECT 1987`` held in Washington, D.C. September 27-- 28, 1987. The meeting and these manuscripts concentrate on the techniques of tomography, useful radiopharmaceuticals, and clinical neurologic and cardiac evaluation. The authors of these papers are for the most part those who either developed the techniques or who have extensively applied them to clinical practice. Individual reports are processed separately for the databases.

Inertial sensors to quantify the pivot shift test in the treatment of anterior cruciate ligament injury

PubMed Central

ZAFFAGNINI, STEFANO; LOPOMO, NICOLA; SIGNORELLI, CECILIA; MUCCIOLI, GIULIO MARIA MARCHEGGIANI; BONANZINGA, TOMMASO; GRASSI, ALBERTO; RAGGI, FEDERICO; VISANI, ANDREA; MARCACCI, MAURILIO

2014-01-01

The main purpose of this article was to describe in detail, from the perspective of the clinical end user, a previously presented non-invasive methodology, applied in the treatment of anterior cruciate ligament injury, in which inertial sensors are used to quantify the pivot shift test. The outcomes obtained and relative considerations were compared with findings emerging from a review of the relevant updated literature. The detailed description here provided covers the system, the parameters identified and the testing procedure; it also includes the technical specifications of the hardware, the features introduced in the updated version of the software and the application of the system in clinical practice. The comparison of the technical considerations and clinical results with the updated literature confirmed the system’s optimal ergonomics, good reproducibility and clinical reliability. The novel approach here analyzed has been shown to overcome the weaknesses of other available devices and systems. Therefore, since it can be considered a new paradigm in the quantification of pivot shift test, we can recommend its routine use in clinical practice. PMID:25606555

Improving family medicine resident training in dementia care: an experiential learning opportunity in Primary Care Collaborative Memory Clinics.

PubMed

Lee, Linda; Weston, W Wayne; Hillier, Loretta; Archibald, Douglas; Lee, Joseph

2018-06-21

Family physicians often find themselves inadequately prepared to manage dementia. This article describes the curriculum for a resident training intervention in Primary Care Collaborative Memory Clinics (PCCMC), outlines its underlying educational principles, and examines its impact on residents' ability to provide dementia care. PCCMCs are family physician-led interprofessional clinic teams that provide evidence-informed comprehensive assessment and management of memory concerns. Within PCCMCs residents learn to apply a structured approach to assessment, diagnosis, and management; training consists of a tutorial covering various topics related to dementia followed by work-based learning within the clinic. Significantly more residents who trained in PCCMCs (sample = 98), as compared to those in usual training programs (sample = 35), reported positive changes in knowledge, ability, and confidence in ability to assess and manage memory problems. The PCCMC training intervention for family medicine residents provides a significant opportunity for residents to learn about best clinical practices and interprofessional care needed for optimal dementia care integrated within primary care practice.

EBP partners: doctoral students and practicing clinicians bridging the theory-practice gap.

PubMed

Peck, Sydney; Lester, Jennifer; Hinshaw, Ginger; Stiles, Anne; Dingman, Sharon K

2009-01-01

The theory-practice gap is one component of the barriers to implementing evidence-based practice. Texas Woman's University College of Nursing and Presbyterian Hospital of Denton joined forces to bridge this gap, allowing doctoral students to provide educational offerings to practicing nurses. Through a Graduate Assistance in Areas of National Need grant, doctoral students completed supervised teaching practicums at the hospital, assisting the hospital to implement evidence-based practice with the ultimate goal of applying for Magnet status. The hospital benefited from the addition of research expertise and mentoring for the staff members. The students benefited from the opportunities to teach and to share knowledge with these clinical experts. This program has been successful in meeting the needs of both parties. Recommendations are given for other institutions interested in establishing similar relationships.

Implementation of Patient Decision Support Interventions in Primary Care: The Role of Relational Coordination.

PubMed

Tietbohl, Caroline K; Rendle, Katharine A S; Halley, Meghan C; May, Suepattra G; Lin, Grace A; Frosch, Dominick L

2015-11-01

The benefits of patient decision support interventions (DESIs) have been well documented. However, DESIs remain difficult to incorporate into clinical practice. Relational coordination (RC) has been shown to improve performance and quality of care in health care settings. This study aims to demonstrate how applying RC theory to DESI implementation could elucidate underlying issues limiting widespread uptake. Five primary care clinics in Northern California participated in a DESI implementation project. We used a deductive thematic approach guided by behaviors outlined in RC theory to analyze qualitative data collected from ethnographic field notes documenting the implementation process and focus groups with health care professionals. We then systematically compared the qualitative findings with quantitative DESI distribution data. Based on DESI distribution rates, clinics were placed into 3 performance categories: high, middle, and low. Qualitative data illustrated how each clinic's performance related to RC behaviors. Consistent with RC theory, the high-performing clinic exhibited frequent, timely, and accurate communication and positive working relationships. The 3 middle-performing clinics exhibited high-quality communication within physician-staff teams but limited communication regarding DESI implementation across the clinic. The lowest-performing clinic was characterized by contentious relationships and inadequate communication. Limitations of the study include nonrandom selection of clinics and limited geographic diversity. In addition, ethnographic data collected documented only DESI implementation practices and not larger staff interactions contributing to RC. These findings suggest that a high level of RC within clinical settings may be a key component and facilitator of successful DESI implementation. Future attempts to integrate DESIs into clinical practice should consider incorporating interventions designed to increase positive RC behaviors as a potential means to improve uptake. © The Author(s) 2015.

'Good ethics and moral standing': a qualitative study of aesthetic leadership in clinical nursing practice.

PubMed

Mannix, Judy; Wilkes, Lesley; Daly, John

2015-06-01

To explore how aesthetic leadership is embodied by clinical leaders in the nursing workplace. A number of different leadership styles have been developed, theorised and applied to the nursing workforce over the years. Many of these styles lack an explicit moral dimension in their identified leader attributes, due to a shift in theorising of leadership to focus on the impact of leader traits on followers. It is timely to look at aesthetic leadership, with its explicit moral dimension, as a way of improving outcomes for nurses, patients and health care organisations. Qualitative design, using conversation-style interviews with experienced registered nurses in designated clinical leadership roles. Twelve experienced registered nurses who worked in designated clinical leadership roles participated in an individual, digitally recorded, semi-structured conversation-style interview. Narrative data were transcribed and subject to thematic analysis. Three main themes emerged: 'True to their beliefs': embodying principled practice; 'Not all policies fit every patient': ethical leadership in ambiguous situations; and 'Being open to people's concerns': providing fair and just solutions. A strong moral compass shaped and guided participants' day-to-day clinical leadership activities. Participants provided a rich narrative on how aesthetic leadership is embodied in the clinical nursing setting. It was evident that their clinical leadership is shaped and guided by a strong moral compass. By incorporating into their practice an aesthetic world-view with its strong moral purpose, participants in this study have shown how aesthetic leadership can enhance the clinical nursing workplace. Nurses in the clinical setting value clinical leaders who embrace and operate with a strong moral compass. Aesthetic leadership, with its explicit strong moral purpose, offers a way of incorporating morality into clinical leadership in the nursing workplace. © 2015 John Wiley & Sons Ltd.

Problem-oriented drug information: physicians' expectations and impact on clinical practice.

PubMed

Hedegaard, U; Damkier, P

2009-05-01

Problem-oriented drug information (POD) is a service in which health professionals provide evidence-based answers to clinical questions posed by physicians. The objective of this study was to evaluate the user satisfaction and clinical impact of POD, to investigate predictors for use and to examine the kind of sources physicians search before applying for POD. To evaluate POD, a questionnaire was distributed with problem-oriented answers sent from a drug information centre to physicians during the period of April 2006 to March 2007. Of 197 questionnaires, 183 (93%) were returned. The information from the POD service was highly valued by the physicians, and 90% of the answers led to reported impact on clinical practice in the specific clinical situation. Furthermore, 74% of the answers were intended to be used in a wider context either for future patients (67%) or for dissemination to colleagues (51%). Secondary-care physicians more often than general practitioners (GPs) used the information for dissemination to colleagues (63 vs. 39%, P = 0.0008), while GPs more often used the answer to support patient information (88 vs. 70%, P = 0.0029). The most prominent motive for applying for POD was a request for evidence-based information (78%), and the service was used to overcome barriers to practicing evidence-based medicine such as lack of time (36%), skills for searching (26%), and appraising the literature (13%). Before inquiring, 74% of the physicians had tried other information sources; the most frequent sources used were a drug reference (68%) and consulting a colleague (24%). Secondary-care physicians reported fewer barriers than GPs when seeking information, and secondary-care physicians searched other sources more often than GPs before contacting the service (81 vs. 67%, P = 0.031). POD represents a useful source for acquiring evidence-based drug information by physicians. POD is highly valued by the users. It was reported to have an impact on clinical practice for the specific patient but is also intended to be used in a wider context for future patients or for dissemination to colleagues. GPs' and secondary-care physicians' use of POD differs with GPs having more focus on patient information and secondary-care physicians having more focus on dissemination of the information to colleagues.

What attributions do Australian high-performing general practices make for their success? Applying the clinical microsystems framework: a qualitative study.

PubMed

Dunham, Annette H; Dunbar, James A; Johnson, Julie K; Fuller, Jeff; Morgan, Mark; Ford, Dale

2018-04-10

To identify the success attributions of high-performing Australian general practices and the enablers and barriers they envisage for practices wishing to emulate them. Qualitative study using semi-structured interviews and content analysis of the data. Responses were recorded, transcribed verbatim and coded according to success characteristics of high-performing clinical microsystems. Primary healthcare with the participating general practices representing all Australian states and territories, and representing metropolitan and rural locations. Twenty-two general practices identified as high performing via a number of success criteria. The 52 participants were 19 general practitioners, 18 practice managers and 15 practice nurses. Participants most frequently attributed success to the interdependence of the team members, patient-focused care and leadership of the practice. They most often signalled practice leadership, team interdependence and staff focus as enablers that other organisations would need to emulate their success. They most frequently identified barriers that might be encountered in the form of potential deficits or limitations in practice leadership, staff focus and mesosystem support. Practice leaders need to empower their teams to take action through providing inclusive leadership that facilitates team interdependence. Mesosystem support for quality improvement in general practice should focus on enabling this leadership and team building, thereby ensuring improvement efforts are converted into effective healthcare provision. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Refining knowledge, attitude and practice of evidence-based medicine (EBM) among pharmacy students for professional challenges.

PubMed

Abu-Gharbieh, Eman; Khalidi, Doaa Al; Baig, Mirza R; Khan, Saeed A

2015-04-01

Practicing evidence based medicine (EBM) is a professional need for the future clinical pharmacist in UAE and around the world. An attempt was made to evaluate pharmacy student's knowledge, attitude and proficiency in the practice of EBM. A within-subject study design with pre and post survey and skill test were conducted using case based practice of EBM through a validated questionnaire. The results were tabulated and there was a statistically significant increase in pharmacy students' perceived ability to go through steps of EBM, namely: formulating PICO questions (95.3%), searching for evidence (97%), appraising the evidence (81%), understanding statistics (78.1%), and applying evidence at point of care (81.2%). In this study, workshops and (Problem Based Learning) PBLs were used as a module of EBM teaching and practices, which has been shown to be an effective educational method in terms of improving students' skills, knowledge and attitude toward EBM. Incorporating hands on experience, PBLs will become an impetus for developing EBM skills and critical appraisal of research evidence alongside routine clinical practice. This integration would constitute the cornerstone in lifting EBM in UAE up to the needed standards and would enable pharmacy students to become efficient pharmacists that rely on evidence in their health practice.

Integrative intervention: a new perspective and brief review in aphasia.

PubMed

Marshall, Rebecca Shisler; Mohapatra, Bijoyaa

2017-09-01

While integrative treatment practices have become a popular treatment in different areas of study, its use in the field of aphasiology is still limited. The following paper is an attempt to address the different alternative practices that could potentially be used to remediate aphasia. A narrative review was completed regarding integrative intervention that could potentially apply to aphasia population. Through this article we have explored various treatment options for integrative health care in aphasiology. Integrative treatments including brain specific antioxidants, progesterone and estradiol therapy, nutrition, synbiotic treatment, exercise, yoga, meditation and positive mood states have demonstrated positive changes in health and behavior in healthy aging or disorders such as stroke and aphasia. Offering integrative treatment for people with aphasia allows potential for high impact gains when combined with current speech language therapeutic practices. This paper highlights the rehabilitation possibilities for aphasia therapy. Combining complementary and traditional treatment approaches could be viewed as one of the contemporary approaches to clinical practice and research for practitioners and health care systems. Implications for Rehabilitation There has been very little research that explores the potential of various types of integrative treatment for individuals with aphasia. An integrative approach to the treatment of aphasia has potential for future clinical application. Combining treatment approaches could be viewed as a viable approach to clinical practice and in the health care system.

Blood transfusion practice in the UK and Ireland: a survey of palliative care physicians.

PubMed

Neoh, Karen; Stanworth, Simon; Bennett, Michael I

2018-03-23

Red cell (blood) transfusions are used in palliative care to manage patients with symptomatic anaemia or when patients have lost blood. We aimed to understand current blood transfusion practice among palliative medicine doctors and compare this with National Institute for Health and Care Excellence (NICE) guidance. NICE guidance advocates more restrictive transfusion practice but is based on clinical trials in non-palliative care contexts; the extent to which these findings should be applied to palliative care remains unclear. Four clinical vignettes of common clinical palliative care scenarios were developed. Members of the Association for Palliative Medicine were invited to complete the survey. Results were compared with acceptable responses based on current NICE recommendations and analysed to determine the influence of respondents' gender, experience or work setting. 27% of 1070 members responded. Overall, ideal or acceptable responses were selected by less than half of doctors to all four vignettes. Doctors were more liberal in prescribing blood transfusions than NICE guidance would advocate. Senior doctors were less likely to choose an acceptable response than junior colleagues. Palliative care practice is varied and not consistent with a restrictive blood transfusion policy. More recently trained doctors follow less liberal practices than senior colleagues. More direct evidence of benefits and harms of blood transfusion is needed in palliative care to inform practice. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Evidence-based dentistry: a model for clinical practice.

PubMed

Faggion, Clóvis M; Tu, Yu-Kang

2007-06-01

Making decisions in dentistry should be based on the best evidence available. The objective of this study was to demonstrate a practical procedure and model that clinicians can use to apply the results of well-conducted studies to patient care by critically appraising the evidence with checklists and letter grade scales. To demonstrate application of this model for critically appraising the quality of research evidence, a hypothetical case involving an adult male with chronic periodontitis is used as an example. To determine the best clinical approach for this patient, a four-step, evidence-based model is demonstrated, consisting of the following: definition of a research question using the PICO format, search and selection of relevant literature, critical appraisal of identified research reports using checklists, and the application of evidence. In this model, the quality of research evidence was assessed quantitatively based on different levels of quality that are assigned letter grades of A, B, and C by evaluating the studies against the QUOROM (Quality of Reporting Meta-Analyses) and CONSORT (Consolidated Standards of Reporting Trials) checklists in a tabular format. For this hypothetical periodontics case, application of the model identified the best available evidence for clinical decision making, i.e., one randomized controlled trial and one systematic review of randomized controlled trials. Both studies showed similar answers for the research question. The use of a letter grade scale allowed an objective analysis of the quality of evidence. A checklist-driven model that assesses and applies evidence to dental practice may substantially improve dentists' decision making skill.

Predictive models in cancer management: A guide for clinicians.

PubMed

Kazem, Mohammed Ali

2017-04-01

Predictive tools in cancer management are used to predict different outcomes including survival probability or risk of recurrence. The uptake of these tools by clinicians involved in cancer management has not been as common as other clinical tools, which may be due to the complexity of some of these tools or a lack of understanding of how they can aid decision-making in particular clinical situations. The aim of this article is to improve clinicians' knowledge and understanding of predictive tools used in cancer management, including how they are built, how they can be applied to medical practice, and what their limitations may be. Literature review was conducted to investigate the role of predictive tools in cancer management. All predictive models share similar characteristics, but depending on the type of the tool its ability to predict an outcome will differ. Each type has its own pros and cons, and its generalisability will depend on the cohort used to build the tool. These factors will affect the clinician's decision whether to apply the model to their cohort or not. Before a model is used in clinical practice, it is important to appreciate how the model is constructed, what its use may add over and above traditional decision-making tools, and what problems or limitations may be associated with it. Understanding all the above is an important step for any clinician who wants to decide whether or not use predictive tools in their practice. Copyright © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Scientific Skills as Core Competences in Medical Education: What do medical students think?

NASA Astrophysics Data System (ADS)

Ribeiro, Laura; Severo, Milton; Pereira, Margarida; Amélia Ferreira, Maria

2015-08-01

Background: Scientific excellence is one of the most fundamental underpinnings of medical education and its relevance is unquestionable. To be involved in research activities enhances students' critical thinking and problem-solving capacities, which are mandatory competences for new achievements in patient care and consequently to the improvement of clinical practice. Purposes: This work aimed to study the relevance given by Portuguese medical students to a core of scientific skills, and their judgment about their own ability to execute those skills. Methods: A cross-sectional study was conducted on students attending the first, fourth and sixth years of medical course in the same period. An assessment istrument, exploring the importance given by Portuguese medical students to scientific skills in high school, to clinical practice and to their own ability to execute them, was designed, adapted and applied specifically to this study. Results: Students' perceptions were associated with gender, academic year, previous participation in research activities, positive and negative attitudes toward science, research integration into the curriculum and motivation to undertake research. The viewpoint of medical students about the relevance of scientific skills overall, and the ability to execute them, was independently associated with motivation to be enrolled in research. Conclusions: These findings have meaningful implications in medical education regarding the inclusion of a structural research program in the medical curriculum. Students should be aware that clinical practice would greatly benefit from the enrollment in research activities. By developing a solid scientific literacy future physicians will be able to apply new knowledge in patient care.

ProvenCare perinatal: a model for delivering evidence/ guideline-based care for perinatal populations.

PubMed

Berry, Scott A; Laam, Leslie A; Wary, Andrea A; Mateer, Harry O; Cassagnol, Hans P; McKinley, Karen E; Nolan, Ruth A

2011-05-01

Geisinger Health System (GHS) has applied its ProvenCare model to demonstrate that a large integrated health care delivery system, enabled by an electronic health record (EHR), could reengineer a complicated clinical process, reduce unwarranted variation, and provide evidence-based care for patients with a specified clinical condition. In 2007 GHS began to apply the model to a more complicated, longer-term condition of "wellness"--perinatal care. ADAPTING PROVENCARE TO PERINATAL CARE: The ProvenCare Perinatal initiative was more complex than the five previous ProvenCare endeavors in terms of breadth, scope, and duration. Each of the 22 sites created a process flow map to depict the current, real-time process at each location. The local practice site providers-physicians and mid-level practitioners-reached consensus on 103 unique best practice measures (BPMs), which would be tracked for every patient. These maps were then used to create a single standardized pathway that included the BPMs but also preserved some unique care offerings that reflected the needs of the local context. A nine-phase methodology, expanded from the previous six-phase model, was implemented on schedule. Pre- to postimplementation improvement occurred for all seven BPMs or BPM bundles that were considered the most clinically relevant, with five statistically significant. In addition, the rate of primary cesarean sections decreased by 32%, and birth trauma remained unchanged as the number of vaginal births increased. Preliminary experience suggests that integrating evidence/guideline-based best practices into work flows in inpatient and outpatient settings can achieve improvements in daily patient care processes and outcomes.

Arts practices in unreasonable doubt? Reflections on understandings of arts practices in healthcare contexts.

PubMed

Broderick, Sheelagh

2011-09-01

This article suggests that the discourse on arts and health encompass contemporary arts practices as an active and engaged analytical activity. Distinctions between arts therapy and arts practice are made to suggest that clinical evidence-based evaluation, while appropriate for arts therapy, is not appropriate for arts practice and in effect cast them in unreasonable doubt. Themes in current discourse on "arts" and "health" are broadly sketched to provide a context for discussion of arts practices. Approaches to knowledge validation in relation to each domain are discussed. These discourses are applied to the Irish healthcare context, offering a reading of three different art projects; it suggests a multiplicity of analyses beyond causal positive health gains. It is suggested that the social turn in medicine and the social turn in arts practices share some similar pre-occupations that warrant further attention.

Nurse education regarding agitated patients and its effects on clinical practice.

PubMed

Ozdemir, Leyla; Karabulut, Erdem

This study identified the impact of an education program on nurses' practices for agitated patients and documented the changes in practice after completion of the training. Eighteen cardiac intensive care nurses were included to the study. Prior to nurses' participation in an education program, a pre-test indicating nurses' current practices for 40 agitated patients was evaluated with the 'Nurse Practice Form'. After the pre-test data collection period was completed, the 2-day training program on caring for agitated patients was conducted. The last step of the study was evaluation of post-test nurses' practices for 40 agitated patients using the 'Nurse Practice Form'. The findings indicated that instead of pre-test nurses' use of physical restraints for controlling agitated patients without a physician order, none of post-test nurses applied them. The training program provided nurses the knowledge and skills needed to evaluate and to manage the causes of agitation.

Transition of Care in Adolescents With Cerebral Palsy: A Survey of Current Practices.

PubMed

Bolger, Ashlee; Vargus-Adams, Jilda; McMahon, Mary

2017-03-01

Transition of care from pediatric to adult health care providers for youth with special needs (including cerebral palsy [CP]) is of current interest because these individuals are now living well into adulthood. Studies have attempted to identify barriers to transition, ideal timing for transition of care, and key elements for successful transition programs. These studies often encompass a wide range of diagnoses, and results cannot be fully applied to those with CP. To identify and describe current transition-of-care (TOC) practices and beliefs among physician providers of adolescents with CP in multidisciplinary CP clinics. Descriptive survey. Multidisciplinary CP clinics in the United States. Physician leaders in the aforementioned CP clinics. Respondents completed an electronic survey. Responses were deidentified and reported in aggregate by the use of descriptive statistics. Electronic survey addressing 3 domains: demographics of clinics, current opinions/practices related to TOC processes, and perceived barriers to successful TOC. Fifteen surveys were sent with 11 returned (response rate = 73%). TOC practices varied among clinics surveyed. Fifty-five percent of clinics had a structured transition program, but only one transitioned 100% of their patients to adult providers by 22 years of age. Only one clinic had an absolute upper age limit for seeing patients, and 36% of clinics accepted new patients older than 21 years. No respondent was "completely satisfied" with their transition process, and only one respondent was "moderately satisfied." The majority of respondents felt the ideal care setting for adults with CP was a comprehensive, multidisciplinary adult-focused clinic in an adult hospital/clinic with primarily adult providers. They noted the top 3 perceived barriers to successful TOC were limited adult providers willing to accept CP patients, concern about the level of care in the adult health care system, and lack of financial resources. Current TOC practices vary considerably among multidisciplinary pediatric CP clinics and are not satisfactory to individual physician providers within these clinics. Respondents desired a multidisciplinary clinic in an adult care setting with adult providers; however, the top 3 perceived barriers involved the adult health care system, making it difficult for pediatric providers to develop effective TOC programs. Not applicable. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Practice, science and governance in interaction: European effort for the system-wide implementation of the International Classification of Functioning, Disability and Health (ICF) in Physical and Rehabilitation Medicine.

PubMed

Stucki, Gerold; Zampolini, Mauro; Juocevicius, Alvydas; Negrini, Stefano; Christodoulou, Nicolas

2017-04-01

Since its launch in 2001, relevant international, regional and national PRM bodies have aimed to implement the International Classification of Functioning, Disability and Health (ICF) in Physical and Rehabilitation Medicine (PRM), whereby contributing to the development of suitable practical tools. These tools are available for implementing the ICF in day-to-day clinical practice, standardized reporting of functioning outcomes in quality management and research, and guiding evidence-informed policy. Educational efforts have reinforced PRM physicians' and other rehabilitation professionals' ICF knowledge, and numerous implementation projects have explored how the ICF is applied in clinical practice, research and policy. Largely lacking though is the system-wide implementation of ICF in day-to-day practice across all rehabilitation services of national health systems. In Europe, system-wide implementation of ICF requires the interaction between practice, science and governance. Considering its mandate, the UEMS PRM Section and Board have decided to lead a European effort towards system-wide ICF implementation in PRM, rehabilitation and health care at large, in interaction with governments, non-governmental actors and the private sector, and aligned with ISPRM's collaboration plan with WHO. In this paper we present the current PRM internal and external policy agenda towards system-wide ICF implementation and the corresponding implementation action plan, while highlighting priority action steps - promotion of ICF-based standardized reporting in national quality management and assurance programs, development of unambiguous rehabilitation service descriptions using the International Classification System for Service Organization in Health-related Rehabilitation, development of Clinical Assessment Schedules, qualitative linkage and quantitative mapping of data to the ICF, and the cultural adaptation of the ICF Clinical Data Collection Tool in European languages.

Creativity and power: a qualitative, exploratory study of student learning acquired in a community nursing setting that is applied in future settings.

PubMed

Merritt, Alan; Boogaerts, Marina

2014-01-01

Nursing students undertake clinical placements in a wide range of clinical areas as part of their preparation for professional practice, offering students the opportunity to learn about the clinical context and the work that nurses do. This descriptive study explores the implicit learnings that occur for students in a community nursing placement and whether they transfer the knowledge they gain in the community setting into practice in other settings. Participants in this research study described implicit learning from a community nursing context which they were able to utilise in their current practice. Three major themes emerged. Firstly, participants recognised that power relationships manifest differently in a community based setting. This manifest in a recognition of patient autonomy and a creative approach to enhancing the patient's power. The second, related theme involved the enabling of self-determination through collaborative decision making between nurse and the person receiving care. The third theme was the development of an understanding of self-management which manifest in appropriate referrals and what the participants considered high quality discharge planning. This recognition of practice beyond technical, rationalist manifestations suggests that students grasped the unarticulated, implicit dimensions of the community nurse role through their experiences in a community nursing placement.

Integrated Theory of Health Behavior Change

PubMed Central

RYAN, POLLY

2009-01-01

An essential characteristic of advanced practice nurses is the use of theory in practice. Clinical nurse specialists apply theory in providing or directing patient care, in their work as consultants to staff nurses, and as leaders influencing and facilitating system change. Knowledge of technology and pharmacology has far outpaced knowledge of how to facilitate health behavior change, and new theories are needed to better understand how practitioners can facilitate health behavior change. In this article, the Integrated Theory of Health Behavior Change is described, and an example of its use as foundation to intervention development is presented. The Integrated Theory of Health Behavior Change suggests that health behavior change can be enhanced by fostering knowledge and beliefs, increasing self-regulation skills and abilities, and enhancing social facilitation. Engagement in self-management behaviors is seen as the proximal outcome influencing the long-term distal outcome of improved health status. Person-centered interventions are directed to increasing knowledge and beliefs, self-regulation skills and abilities, and social facilitation. Using a theoretical framework improves clinical nurse specialist practice by focusing assessments, directing the use of best-practice interventions, and improving patient outcomes. Using theory fosters improved communication with other disciplines and enhances the management of complex clinical conditions by providing holistic, comprehensive care. PMID:19395894

Wound-healing outcomes using standardized assessment and care in clinical practice.

PubMed

Bolton, Laura; McNees, Patrick; van Rijswijk, Lia; de Leon, Jean; Lyder, Courtney; Kobza, Laura; Edman, Kelly; Scheurich, Anne; Shannon, Ron; Toth, Michelle

2004-01-01

Wound-healing outcomes applying standardized protocols have typically been measured within controlled clinical trials, not natural settings. Standardized protocols of wound care have been validated for clinical use, creating an opportunity to measure the resulting outcomes. Wound-healing outcomes were explored during clinical use of standardized validated protocols of care based on patient and wound assessments. This was a prospective multicenter study of wound-healing outcomes management in real-world clinical practice. Healing outcomes from March 26 to October 31, 2001, were recorded on patients in 3 long-term care facilities, 1 long-term acute care hospital, and 12 home care agencies for wounds selected by staff to receive care based on computer-generated validated wound care algorithms. After diagnosis, wound dimensions and status were assessed using a tool adapted from the Pressure Sore Status Toolfor use on all wounds. Wound, ostomy, and continence nursing professionals accessed consistent protocols of care, via telemedicine in home care or paper forms in long-term care. A physician entered assessments into a desktop computer in the wound clinic. Based on evidence that healing proceeds faster with fewer infections in environments without gauze, the protocols generally avoided gauze dressings. Most of the 767 wounds selected to receive the standardized-protocols of care were stage III-IV pressure ulcers (n = 373; mean healing time 62 days) or full-thickness venous ulcers (n = 124; mean healing time 57 days). Partial-thickness wounds healed faster than same-etiology full-thickness wounds. These results provide benchmarks for natural-setting healing outcomes and help to define and address wound care challenges. Outcomes primarily using nongauze protocols of care matched or surpassed best previously published results on similar wounds using gauze-based protocols of care, including protocols applying gauze impregnated with growth factors or other agents.

Fatigue as a Driver of Overall Quality of Life in Cancer Patients.

PubMed

McCabe, Ryan M; Grutsch, James F; Braun, Donald P; Nutakki, Swetha B

2015-01-01

This manuscript describes an approach for analyzing large amounts of disparate clinical data to elucidate the most impactful factor(s) that relate to a meaningful clinical outcome, in this case, the quality of life of cancer patients. The relationships between clinical and quality of life variables were evaluated using the EORTC QLQ-C30 global health domain--a validated surrogate variable for overall cancer patient well-being. A cross-sectional study design was used to evaluate the determinants of global health in cancer patients who initiated treatment at two regional medical centers between January 2001 and December 2009. Variables analyzed included 15 EORTC QLQ-C30 scales, age at diagnosis, gender, newly diagnosed/ recurrent disease status, and stage. The decision tree algorithm, perhaps unfamiliar to practicing clinicians, evaluates the relative contribution of individual parameters in classifying a clinically meaningful functional endpoint, such as the global health of a patient. Multiple patient characteristics were identified as important contributors. Fatigue, in particular, emerged as the most prevalent indicator of cancer patients' quality of life in 16/23 clinically relevant subsets. This analysis allowed results to be stated in a clinically-intuitive, rule set format using the language and quantities of the Quality of Life (QoL) tool itself. By applying the classification algorithms to a large data set, identification of fatigue as a root factor in driving global health and overall QoL was revealed. The ability to practice mining of clinical data sets to uncover critical clinical insights that are immediately applicable to patient care practices is illustrated.

Fatigue as a Driver of Overall Quality of Life in Cancer Patients

PubMed Central

McCabe, Ryan M.; Grutsch, James F.; Braun, Donald P.; Nutakki, Swetha B.

2015-01-01

Background This manuscript describes an approach for analyzing large amounts of disparate clinical data to elucidate the most impactful factor(s) that relate to a meaningful clinical outcome, in this case, the quality of life of cancer patients. The relationships between clinical and quality of life variables were evaluated using the EORTC QLQ-C30 global health domain—a validated surrogate variable for overall cancer patient well-being. Methods A cross-sectional study design was used to evaluate the determinants of global health in cancer patients who initiated treatment at two regional medical centers between January 2001 and December 2009. Variables analyzed included 15 EORTC QLQ-C30 scales, age at diagnosis, gender, newly diagnosed/ recurrent disease status, and stage. The decision tree algorithm, perhaps unfamiliar to practicing clinicians, evaluates the relative contribution of individual parameters in classifying a clinically meaningful functional endpoint, such as the global health of a patient. Findings Multiple patient characteristics were identified as important contributors. Fatigue, in particular, emerged as the most prevalent indicator of cancer patients’ quality of life in 16/23 clinically relevant subsets. This analysis allowed results to be stated in a clinically-intuitive, rule set format using the language and quantities of the Quality of Life (QoL) tool itself. Interpretation By applying the classification algorithms to a large data set, identification of fatigue as a root factor in driving global health and overall QoL was revealed. The ability to practice mining of clinical data sets to uncover critical clinical insights that are immediately applicable to patient care practices is illustrated. PMID:26070133

Information management to enable personalized medicine: stakeholder roles in building clinical decision support.

PubMed

Downing, Gregory J; Boyle, Scott N; Brinner, Kristin M; Osheroff, Jerome A

2009-10-08

Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures), and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In addition, to represent meaningful benefits to personalized decision-making, a comparison of current and future applications of clinical decision support to enable individualized medical treatment plans is presented. If clinical decision support tools are to impact outcomes in a clear and positive manner, their development and deployment must therefore consider the needs of the providers, including specific practice needs, information workflow, and practice environment.

Information management to enable personalized medicine: stakeholder roles in building clinical decision support

PubMed Central

2009-01-01

Background Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Discussion Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures), and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. Summary This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In addition, to represent meaningful benefits to personalized decision-making, a comparison of current and future applications of clinical decision support to enable individualized medical treatment plans is presented. If clinical decision support tools are to impact outcomes in a clear and positive manner, their development and deployment must therefore consider the needs of the providers, including specific practice needs, information workflow, and practice environment. PMID:19814826

Team science as interprofessional collaborative research practice: a systematic review of the science of team science literature

PubMed Central

Little, Meg M; St Hill, Catherine A; Ware, Kenric B; Swanoski, Michael T; Chapman, Scott A; Lutfiyya, M Nawal; Cerra, Frank B

2017-01-01

The National Institute of Health's concept of team science is a means of addressing complex clinical problems by applying conceptual and methodological approaches from multiple disciplines and health professions. The ultimate goal is the improved quality of care of patients with an emphasis on better population health outcomes. Collaborative research practice occurs when researchers from >1 health-related profession engage in scientific inquiry to jointly create and disseminate new knowledge to clinical and research health professionals in order to provide the highest quality of patient care to improve population health outcomes. Training of clinicians and researchers is necessary to produce clinically relevant evidence upon which to base patient care for disease management and empirically guided team-based patient care. In this study, we hypothesized that team science is an example of effective and impactful interprofessional collaborative research practice. To assess this hypothesis, we examined the contemporary literature on the science of team science (SciTS) produced in the past 10 years (2005–2015) and related the SciTS to the overall field of interprofessional collaborative practice, of which collaborative research practice is a subset. A modified preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach was employed to analyze the SciTS literature in light of the general question: Is team science an example of interprofessional collaborative research practice? After completing a systematic review of the SciTS literature, the posed hypothesis was accepted, concluding that team science is a dimension of interprofessional collaborative practice. PMID:27619555

Team science as interprofessional collaborative research practice: a systematic review of the science of team science literature.

PubMed

Little, Meg M; St Hill, Catherine A; Ware, Kenric B; Swanoski, Michael T; Chapman, Scott A; Lutfiyya, M Nawal; Cerra, Frank B

2017-01-01

The National Institute of Health's concept of team science is a means of addressing complex clinical problems by applying conceptual and methodological approaches from multiple disciplines and health professions. The ultimate goal is the improved quality of care of patients with an emphasis on better population health outcomes. Collaborative research practice occurs when researchers from >1 health-related profession engage in scientific inquiry to jointly create and disseminate new knowledge to clinical and research health professionals in order to provide the highest quality of patient care to improve population health outcomes. Training of clinicians and researchers is necessary to produce clinically relevant evidence upon which to base patient care for disease management and empirically guided team-based patient care. In this study, we hypothesized that team science is an example of effective and impactful interprofessional collaborative research practice. To assess this hypothesis, we examined the contemporary literature on the science of team science (SciTS) produced in the past 10 years (2005-2015) and related the SciTS to the overall field of interprofessional collaborative practice, of which collaborative research practice is a subset. A modified preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach was employed to analyze the SciTS literature in light of the general question: Is team science an example of interprofessional collaborative research practice? After completing a systematic review of the SciTS literature, the posed hypothesis was accepted, concluding that team science is a dimension of interprofessional collaborative practice. Copyright © 2016 American Federation for Medical Research.

Impact of Biomarkers on Personalized Medicine.

PubMed

Carrigan, Patricia; Krahn, Thomas

2016-01-01

The field of personalized medicine that involves the use of measuring biomarkers in clinical samples is an area of high interest and one that has tremendous impact on drug development. With the emergence of more sensitive and specific technologies that are now able to be run in clinical settings and the ability to accurately measure biomarkers, there is a need to understand how biomarkers are defined, how they are used in clinical trials, and most importantly how they are used in conjunction with drug treatment. Biomarker approaches have entered into early clinical trials and are increasingly being used to develop new diagnostics that help to differentiate or stratify the likely outcomes of therapeutic intervention. Tremendous efforts have been made to date to discover novel biomarkers for use in clinical practice. Still, the number of markers that make it into clinical practice is rather low. In the next following chapters, we will explain the various classifications of biomarkers, how they are applied, measured, and used in personalized medicine specifically focusing on how they are used in de-risking the 10 plus years drug development process and lastly how they are validated and transformed into companion diagnostic assays.

Teaching quality improvement.

PubMed

Murray, Marry Ellen; Douglas, Stephen; Girdley, Diana; Jarzemsky, Paula

2010-08-01

Practicing nurses are required to engage in quality improvement work as a part of their clinical practice, but few undergraduate nursing education programs offer course work and applied experience in this area. This article presents a description of class content and teaching strategies, assignments, and evaluation strategies designed to achieve the Quality and Safety Education in Nursing competencies related to quality improvement and interdisciplinary teams. Students demonstrate their application of the quality improvement process by designing and implementing a small-scale quality improvement project that they report in storyboard format on a virtual conference Web site.

Accreditation of ambulatory facilities.

PubMed

Urman, Richard D; Philip, Beverly K

2014-06-01

With the continued growth of ambulatory surgical centers (ASC), the regulation of facilities has evolved to include new standards and requirements on both state and federal levels. Accreditation allows for the assessment of clinical practice, improves accountability, and better ensures quality of care. In some states, ASC may choose to voluntarily apply for accreditation from a recognized organization, but in others it is mandated. Accreditation provides external validation of safe practices, benchmarking performance against other accredited facilities, and demonstrates to patients and payers the facility's commitment to continuous quality improvement. Copyright © 2014 Elsevier Inc. All rights reserved.

Digital storytelling: an innovative tool for practice, education, and research.

PubMed

Lal, Shalini; Donnelly, Catherine; Shin, Jennifer

2015-01-01

Digital storytelling is a method of using storytelling, group work, and modern technology to facilitate the creation of 2-3 minute multi-media video clips to convey personal or community stories. Digital storytelling is being used within the health care field; however, there has been limited documentation of its application within occupational therapy. This paper introduces digital storytelling and proposes how it can be applied in occupational therapy clinical practice, education, and research. The ethical and methodological challenges in relation to using the method are also discussed.

Beyond positivism: Understanding and addressing childhood obesity disparities through a Critical Theory perspective.

PubMed

Schroeder, Krista; Kulage, Kristine M; Lucero, Robert

2015-10-01

We apply Critical Theory to examine menu labeling with the aim of uncovering important implications for nursing practice, research, and policy. Our critical analysis uncovers barriers to menu labeling's effectiveness, particularly for vulnerable populations. Nurses must work to minimize the impact of these barriers and optimize the effectiveness of menu labeling, in order to strengthen the fight against obesity. We suggest changes, guided by this critical analysis, which can be implemented by nurses working in clinical practice, research, and policy. © 2015, Wiley Periodicals, Inc.

[Controlling instruments in radiology].

PubMed

Maurer, M

2013-10-01

Due to the rising costs and competitive pressures radiological clinics and practices are now facing, controlling instruments are gaining importance in the optimization of structures and processes of the various diagnostic examinations and interventional procedures. It will be shown how the use of selected controlling instruments can secure and improve the performance of radiological facilities. A definition of the concept of controlling will be provided. It will be shown which controlling instruments can be applied in radiological departments and practices. As an example, two of the controlling instruments, material cost analysis and benchmarking, will be illustrated.

Plain Language Summary: Evaluation of the Neck Mass in Adults.

PubMed

Pynnonen, Melissa A; Colandrea, Maria; Finestone, Sandra A; O'Connor, Sarah S

2017-09-01

This plain language summary serves as an overview in explaining the evaluation of the neck mass in adults. The summary applies to patients aged ≥18 years and is based on the 2017 "Clinical Practice Guideline: Evaluation of the Neck Mass in Adults." The evidence-based guideline includes research to support more effective evaluation and diagnosis of the neck mass in adults. The guideline was developed as a quality improvement opportunity for evaluation of the neck mass by creating clear recommendations to use in medical practice.

Clinical decision support systems in child and adolescent psychiatry: a systematic review.

PubMed

Koposov, Roman; Fossum, Sturla; Frodl, Thomas; Nytrø, Øystein; Leventhal, Bennett; Sourander, Andre; Quaglini, Silvana; Molteni, Massimo; de la Iglesia Vayá, María; Prokosch, Hans-Ulrich; Barbarini, Nicola; Milham, Michael Peter; Castellanos, Francisco Xavier; Skokauskas, Norbert

2017-11-01

Psychiatric disorders are amongst the most prevalent and impairing conditions in childhood and adolescence. Unfortunately, it is well known that general practitioners (GPs) and other frontline health providers (i.e., child protection workers, public health nurses, and pediatricians) are not adequately trained to address these ubiquitous problems (Braddick et al. Child and Adolescent mental health in Europe: infrastructures, policy and programmes, European Communities, 2009; Levav et al. Eur Child Adolesc Psychiatry 13:395-401, 2004). Advances in technology may offer a solution to this problem with clinical decision support systems (CDSS) that are designed to help professionals make sound clinical decisions in real time. This paper offers a systematic review of currently available CDSS for child and adolescent mental health disorders prepared according to the PRISMA-Protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols). Applying strict eligibility criteria, the identified studies (n = 5048) were screened. Ten studies, describing eight original clinical decision support systems for child and adolescent psychiatric disorders, fulfilled inclusion criteria. Based on this systematic review, there appears to be a need for a new, readily available CDSS for child neuropsychiatric disorder which promotes evidence-based, best practices, while enabling consideration of national variation in practices by leveraging data-reuse to generate predictions regarding treatment outcome, addressing a broader cluster of clinical disorders, and targeting frontline practice environments.

Perceptions of Personalized Medicine in an Academic Health System: Educational Findings.

PubMed

Vorderstrasse, Allison; Katsanis, Sara Huston; Minear, Mollie A; Yang, Nancy; Rakhra-Burris, Tejinder; Reeves, Jason W; Cook-Deegan, Robert; Ginsburg, Geoffrey S; Ann Simmons, Leigh

Prior reports demonstrate that personalized medicine implementation in clinical care is lacking. Given the program focus at Duke University on personalized medicine, we assessed health care providers' perspectives on their preparation and educational needs to effectively integrate personalized medicine tools and applications into their clinical practices. Data from 78 health care providers who participated in a larger study of personalized and precision medicine at Duke University were analyzed using Qualtrics (descriptive statistics). Individuals age 18 years and older were recruited for the larger study through broad email contacts across the university and health system. All participants completed an online 35-question survey that was developed, pilot-tested, and administered by a team of interdisciplinary researchers and clinicians at the Center for Applied Genomics and Precision Medicine. Overall, providers reported being ill-equipped to implement personalized medicine in clinical practice. Many respondents identified educational resources as critical for strengthening personalized medicine implementation in both research and clinical practice. Responses did not differ significantly between specialists and primary providers or by years since completion of the medical degree. Survey findings support prior calls for provider and patient education in personalized medicine. Respondents identified focus areas in training, education, and research for improving personalized medicine uptake. Given respondents' emphasis on educational needs, now may be an ideal time to address these needs in clinical training and public education programs.

Virginia Henderson's principles and practice of nursing applied to organ donation after brain death.

PubMed

Nicely, Bruce; DeLario, Ginger T

2011-03-01

Registered nurses were some of the first nonphysician organ transplant and donation specialists in the field, both in procurement and clinical arenas. Nursing theories are abundant in the literature and in nursing curricula, but none have been applied to the donation process. Noted nursing theorist Virginia Henderson (1897-1996), often referred to as the "first lady of nursing," developed a nursing model based on activities of living. Henderson had the pioneering view that nursing stands separately from medicine and that nursing consists of more than simply following physicians' orders. Henderson's Principles and Practice of Nursing is a grand theory that can be applied to many types of nursing. In this article, Henderson's theory is applied to the intensely focused and specialized area of organ donation for transplantation. Although organ donation coordinators may have backgrounds as physicians' assistants, paramedics, or other allied health professions, most are registered nurses. By virtue of the inherent necessity for involvement of the family and friends of the potential donor, Henderson's concepts are applied to the care and management of the organ donor, to the donor's family and friends, and in some instances, to the caregivers themselves.

Informed consent in a multicultural cancer patient population: implications for nursing practice.

PubMed

Barnes, D M; Davis, A J; Moran, T; Portillo, C J; Koenig, B A

1998-09-01

Obtaining informed consent, an ethical obligation of nurses and other health care providers, occurs routinely when patients make health care decisions. The values underlying informed consent (promotion of patients' well-being and respect for their self-determination) are embedded in the dominant American culture. Nurses who apply the USA's cultural values of informed consent when caring for patients who come from other cultures encounter some ethical dilemmas. This descriptive study, conducted with Latino, Chinese and Anglo-American cancer patients in a large, public, west-coast clinic, describes constraints on the informed consent process in a multicultural setting, including language barriers, the clinical environment, control in decision making, and conflicting desired health outcomes for health care providers and patients, and suggests some implications for nursing practice.

Midwifery education roundtable discussion: transitions to the workplace.

PubMed

Lydon-Rochelle, Mona T; Kantrowitz-Gordon, Ira; Tower, Martha J Jody; Trego, Lori; Lagerberg, Ruth

2002-01-01

A snapshot of four graduates' views on their educational experience at a research institution as well as their perspective on how it prepared them for the challenges they faced in entering the workplace is presented. Discussants stated that research knowledge is a critical aspect to clinical practice. Their educational experience provided them with the ability to understand information technology applications, identify and access relevant scientific research, evaluate the integrity and comparability of research findings, and apply research findings to clinical practice. Areas within the curriculum that were identified as needing more content and/or greater emphasis included primary health care, how to work competently and effectively with persons from diverse cultural, socioeconomic, and racial and ethnic backgrounds, experience with public health providers, and content such as intimate partner violence and adolescent behaviors.

[Artificial intelligence--the knowledge base applied to nephrology].

PubMed

Sancipriano, G P

2005-01-01

The idea that efficacy efficiency, and quality in medicine could not be reached without sorting the huge knowledge of medical and nursing science is very common. Engineers and computer scientists have developed medical software with great prospects for success, but currently these software applications are not so useful in clinical practice. The medical doctor and the trained nurse live the 'information age' in many daily activities, but the main benefits are not so widespread in working activities. Artificial intelligence and, particularly, export systems charm health staff because of their potential. The first part of this paper summarizes the characteristics of 'weak artificial intelligence' and of expert systems important in clinical practice. The second part discusses medical doctors' requirements and the current nephrologic knowledge bases available for artificial intelligence development.

The Diagnosis and Management of Hyperthyroidism in Korea: Consensus Report of the Korean Thyroid Association

PubMed Central

Moon, Jae Hoon

2013-01-01

Hyperthyroidism is one of the causes of thyrotoxicosis and the most common cause of hyperthyroidism in Korea is Graves disease. The diagnosis and treatment of Graves disease are different according to geographical area. Recently, the American Thyroid Association and the American Association of Clinical Endocrinologists suggested new management guidelines for hyperthyroidism. However, these guidelines are different from clinical practice in Korea and are difficult to apply. Therefore, the Korean Thyroid Association (KTA) conducted a survey of KTA members regarding the diagnosis and treatment of hyperthyroidism, and reported the consensus on the management of hyperthyroidism. In this review, we summarized the KTA report on the contemporary practice patterns in the diagnosis and management of hyperthyroidism, and compared this report with guidelines from other countries. PMID:24396691

Tethered capsule endomicroscopy: from bench to bedside at a primary care practice

NASA Astrophysics Data System (ADS)

Gora, Michalina J.; Simmons, Leigh H.; Quénéhervé, Lucille; Grant, Catriona N.; Carruth, Robert W.; Lu, Weina; Tiernan, Aubrey; Dong, Jing; Walker-Corkery, Beth; Soomro, Amna; Rosenberg, Mireille; Metlay, Joshua P.; Tearney, Guillermo J.

2016-10-01

Due to the relatively high cost and inconvenience of upper endoscopic biopsy and the rising incidence of esophageal adenocarcinoma, there is currently a need for an improved method for screening for Barrett's esophagus. Ideally, such a test would be applied in the primary care setting and patients referred to endoscopy if the result is suspicious for Barrett's. Tethered capsule endomicroscopy (TCE) is a recently developed technology that rapidly acquires microscopic images of the entire esophagus in unsedated subjects. Here, we present our first experience with clinical translation and feasibility of TCE in a primary care practice. The acceptance of the TCE device by the primary care clinical staff and patients shows the potential of this device to be useful as a screening tool for a broader population.

Novel survey disseminated through Twitter supports its utility for networking, disseminating research, advocacy, clinical practice and other professional goals

PubMed Central

Borgmann, Hendrik; DeWitt, Sasha; Tsaur, Igor; Haferkamp, Axel; Loeb, Stacy

2015-01-01

Introduction: Twitter use has grown exponentially within the urological community. We aimed to determine the perceptions of the impact of Twitter on users’ clinical practice, research, and other professional activities. Methods: We performed an 11-item online survey of Twitter contributors during two major urological meetings: the European Association of Urology (EAU) and the American Urological Association (AUA) annual meetings. During the EAU 2014 meeting, we distributed the survey via the meeting official Twitter feed. During the AUA 2014 meeting, we applied a new method by directly sending the survey to Twitter contributors. We performed a subset analysis for assessing the perceived impact of Twitter on the clinical practice of physicians. Results: Among 312 total respondents, the greatest perceived benefits of Twitter among users were for networking (97%) and disseminating information (96%), followed by research (75%), advocacy (74%) and career development (62%). In total, 65% of Twitter users have dealt with guidelines on online medical professionalism and 71% of physician users found that Twitter had an impact on their clinical practice, and 33% had made a clinical decision based on an online case discussion. Conclusions: Our results suggest that Twitter users in the urological community perceive important benefits. These benefits extend to multiple professional domains, particularly networking, disseminating information, remote conference participation, research, and advocacy. This is the first study that has been disseminated to targeted individuals from the urological community directly through tweets, providing a proof of principle for this research method. PMID:26664662

Clinical algorithms to aid osteoarthritis guideline dissemination.

PubMed

Meneses, S R F; Goode, A P; Nelson, A E; Lin, J; Jordan, J M; Allen, K D; Bennell, K L; Lohmander, L S; Fernandes, L; Hochberg, M C; Underwood, M; Conaghan, P G; Liu, S; McAlindon, T E; Golightly, Y M; Hunter, D J

2016-09-01

Numerous scientific organisations have developed evidence-based recommendations aiming to optimise the management of osteoarthritis (OA). Uptake, however, has been suboptimal. The purpose of this exercise was to harmonize the recent recommendations and develop a user-friendly treatment algorithm to facilitate translation of evidence into practice. We updated a previous systematic review on clinical practice guidelines (CPGs) for OA management. The guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation for quality and the standards for developing trustworthy CPGs as established by the National Academy of Medicine (NAM). Four case scenarios and algorithms were developed by consensus of a multidisciplinary panel. Sixteen guidelines were included in the systematic review. Most recommendations were directed toward physicians and allied health professionals, and most had multi-disciplinary input. Analysis for trustworthiness suggests that many guidelines still present a lack of transparency. A treatment algorithm was developed for each case scenario advised by recommendations from guidelines and based on panel consensus. Strategies to facilitate the implementation of guidelines in clinical practice are necessary. The algorithms proposed are examples of how to apply recommendations in the clinical context, helping the clinician to visualise the patient flow and timing of different treatment modalities. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

[Inter-rater reliability and construct validity of the OPD-CA axis structure: first study results regarding the integration of OPD-CA into clinical practice].

PubMed

Cropp, Carola; Salzer, Simone; Häusser, Leonard F; Streeck-Fischer, Annette

2013-01-01

The axis structure of the Operationalized Psychodynamic Diagnostics in childhood and adolescence (OPD-CA) has proven to be a reliable and valid diagnostic tool under research conditions. However, corresponding data regarding the integration of OPD-CA axis structure into clinical practice is still lacking. Hence, this aspect was examined as part of a randomized controlled clinical trial realized at Asklepios Fachklinikum Tiefenbrunn. Here, the OPD-CA axis structure has been applied to assess the structural level of 42 adolescent patients (15-19 years). In contrast to previous studies, the assessment was not carried out by independent raters using a videotaped OPD-CA interview, but the rating was part of clinical routine procedures. Also under these conditions, inter-rater reliability was high, in particular regarding the four subscales of the OPD-CA axis structure. With respect to construct validity, the results of our study supported a two-factor solution, which is in accordance with the findings of two previous works. One factor corresponded to the dimension "self-regulation" while the other factor included both the dimension "self-perception and object perception" as well as the dimension "communication skills". Implications of the findings for research and practice are discussed.

Conceptualising 'materialities of care': making visible mundane material culture in health and social care contexts.

PubMed

Buse, Christina; Martin, Daryl; Nettleton, Sarah

2018-02-01

'Materialities of care' is outlined as a heuristic device for making visible the mundane and often unnoticed aspects of material culture within health and social care contexts, and exploring interrelations between materials and care in practice. Three analytic strands inherent to the concept are delineated: spatialities of care, temporalities of care and practices of care. These interconnecting themes span the articles in this special issue. The articles explore material practice across a range of clinical and non-clinical spaces, including hospitals, hospices, care homes, museums, domestic spaces, and community spaces such as shops and tenement stairwells. The collection addresses fleeting moments of care, as well as choreographed routines that order bodies and materials. Throughout there is a focus on practice, and relations between materials and care as ongoing, emergent and processual. We conclude by reflecting on methodological approaches for examining 'materialities of care', and offer some thoughts as to how this analytic approach might be applied to future research within the sociology of health and illness. © 2018 Foundation for the Sociology of Health & Illness.

Counseling women with early pregnancy failure: utilizing evidence, preserving preference.

PubMed

Wallace, Robin R; Goodman, Suzan; Freedman, Lori R; Dalton, Vanessa K; Harris, Lisa H

2010-12-01

To apply principles of shared decision-making to EPF management counseling. To present a patient treatment priority checklist developed from review of available literature on patient priorities for EPF management. Review of evidence for patient preferences; personal, emotional, physical and clinical factors that may influence patient priorities for EPF management; and the clinical factors, resources, and provider bias that may influence current practice. Women have strong and diverse preferences for EPF management and report higher satisfaction when treated according to these preferences. However, estimates of actual treatment patterns suggest that current practice does not reflect the evidence for safety and acceptability of all options, or patient preferences. Multiple practice barriers and biases exist that may be influencing provider counseling about options for EPF management. Choosing management for EPF is a preference-sensitive decision. A patient-centered approach to EPF management should incorporate counseling about all treatment options. Providers can integrate a counseling model into EPF management practice that utilizes principles of shared decision-making and an organized method for eliciting patient preferences, priorities, and concerns about treatment options. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

A survey validation and analysis of undergraduate medical biochemistry practical curriculum in maharashtra, India.

PubMed

Dandekar, Sucheta P; Maksane, Shalini N; McKinley, Danette

2012-01-01

In order to review the strengths and weaknesses of medical biochemistry practical curriculum for undergraduates and to generate ideas to improve it, a questionnaire was sent to 50 biochemistry faculty members selected (through simple random sampling method) from 42 medical colleges of Maharashtra, India. 39 responded to the questionnaire, representing a 78% response rate. The internal consistency of the questionnaire sections was found to be satisfactory (>0.7). The respondents did not agree that the ongoing curriculum was in alignment with learning outcomes (8%), that it encouraged active learning (28%), helped to apply knowledge to clinical situations (18%) and promoted critical thinking and problem solving skills (28%). There were a number of qualitative experiments that were rated 'irrelevant'. Qualitative and quantitative experiments related to recent advances were suggested to be introduced by the respondents. Checklists for the practicals and new curriculum objectives provided in the questionnaire were also approved. The results of the curriculum evaluation suggest a need for re-structuring of practical biochemistry curriculum and introduction of a modified curriculum with more clinical relevance.

Review of key concepts in magnetic resonance physics.

PubMed

Moore, Michael M; Chung, Taylor

2017-05-01

MR physics can be a challenging subject for practicing pediatric radiologists. Although many excellent texts provide very comprehensive reviews of the field of MR physics at various levels of understanding, the authors of this paper explain several key concepts in MR physics that are germane to clinical practice in a non-rigorous but practical fashion. With the basic understanding of these key concepts, practicing pediatric radiologists can build on their knowledge of current clinical MR techniques and future advances in MR applications. Given the challenges of both the increased need for rapid imaging in non-sedated children and the rapid physiological cardiovascular and respiratory motion in pediatric patients, many advances in complex MR techniques are being applied to imaging these children. The key concepts are as follows: (1) structure of a pulse sequence, (2) k-space, (3) "trade-off triangle" and (4) fat suppression. This review is the first of five manuscripts in a minisymposium on pediatric MR. The authors' goal for this review is to aid in understanding the MR techniques described in the subsequent manuscripts on brain imaging and body imaging in this minisymposium.

Developing a Contextual Consciousness: Learning to Address Gender, Societal Power, and Culture in Clinical Practice

ERIC Educational Resources Information Center

Esmiol, Elisabeth E.; Knudson-Martin, Carmen; Delgado, Sarah

2012-01-01

Despite the growing number of culturally sensitive training models and considerable literature on the importance of training clinicians in larger contextual issues, research examining how students learn to apply these issues is limited. In this participatory action research project, we systematically studied our own process as marriage and family…

Status of Single-Case Research Designs for Evidence-Based Practice

ERIC Educational Resources Information Center

Matson, Johnny L.; Turygin, Nicole C.; Beighley, Jennifer; Matson, Michael L.

2012-01-01

The single-case research design has become a paradoxical methodology in the applied sciences. While various experimental designs have been in place for over 50 years, there has not been wide acceptance of single-case methodology outside clinical and school psychology, or the field of special education. These methods were developed in the U.S.A.,…

Rasch Rating Scale Modeling of the Korean Version of the Beck Depression Inventory

ERIC Educational Resources Information Center

Hong, Sehee; Wong, Eunice C.

2005-01-01

The Beck Depression Inventory (BDI) is one of the most frequently used instruments in the study of depression both within and outside of the United States. Though developed primarily with European American clinical populations, the BDI has been applied in nonclinical and non-Western samples. To determine whether such a practice is warranted, the…

Integrating Homework Assignments Based on Culture: Working with Chinese Patients

ERIC Educational Resources Information Center

Foo, Koong Hean; Kazantzis, Nikolaos

2007-01-01

Cognitive therapy as espoused by A. T. Beck (A. T. Beck, Rush, Shaw, & Emery, 1979) is increasingly used as a therapeutic modality and applied to a variety of cultural groups throughout the world. However, the majority of the literature on empirical and clinical practice has been focused on the use of cognitive therapy for Western cultures. In…

Some Methods of Applied Numerical Analysis to 3d Facial Reconstruction Software

NASA Astrophysics Data System (ADS)

Roşu, Şerban; Ianeş, Emilia; Roşu, Doina

2010-09-01

This paper deals with the collective work performed by medical doctors from the University Of Medicine and Pharmacy Timisoara and engineers from the Politechnical Institute Timisoara in the effort to create the first Romanian 3d reconstruction software based on CT or MRI scans and to test the created software in clinical practice.

The Feasibility of Applying PBL Teaching Method to Surgery Teaching of Chinese Medicine

ERIC Educational Resources Information Center

Tang, Qianli; Yu, Yuan; Jiang, Qiuyan; Zhang, Li; Wang, Qingjian; Huang, Mingwei

2008-01-01

The traditional classroom teaching mode is based on the content of the subject, takes the teacher as the center and gives priority to classroom instruction. While PBL (Problem Based Learning) teaching method breaches the traditional mode, combining the basic science with clinical practice and covering the process from discussion to self-study to…

Artificial Intelligence in Medical Practice: The Question to the Answer?

PubMed

Miller, D Douglas; Brown, Eric W

2018-02-01

Computer science advances and ultra-fast computing speeds find artificial intelligence (AI) broadly benefitting modern society-forecasting weather, recognizing faces, detecting fraud, and deciphering genomics. AI's future role in medical practice remains an unanswered question. Machines (computers) learn to detect patterns not decipherable using biostatistics by processing massive datasets (big data) through layered mathematical models (algorithms). Correcting algorithm mistakes (training) adds to AI predictive model confidence. AI is being successfully applied for image analysis in radiology, pathology, and dermatology, with diagnostic speed exceeding, and accuracy paralleling, medical experts. While diagnostic confidence never reaches 100%, combining machines plus physicians reliably enhances system performance. Cognitive programs are impacting medical practice by applying natural language processing to read the rapidly expanding scientific literature and collate years of diverse electronic medical records. In this and other ways, AI may optimize the care trajectory of chronic disease patients, suggest precision therapies for complex illnesses, reduce medical errors, and improve subject enrollment into clinical trials. Copyright © 2018 Elsevier Inc. All rights reserved.

Application of best practice guidelines for OSCEs-An Australian evaluation of their feasibility and value.

PubMed

Mitchell, Marion L; Henderson, Amanda; Jeffrey, Carol; Nulty, Duncan; Groves, Michele; Kelly, Michelle; Knight, Sabina; Glover, Pauline

2015-05-01

Objective Structured Clinical Examinations (OSCEs) are widely used in health professional education and should be based on sound pedagogical foundations. The aim of this study is to evaluate the feasibility and utility of using Best Practice Guidelines (BPGs) within an OSCE format in a broad range of tertiary education settings with under-graduate and post-graduate nursing and midwifery students. We evaluated how feasible it was to apply the BPGs to modify OSCEs in a course; students' perspective of the OSCE; and finally, if the BPG-revised OSCEs better prepared students for clinical practice when compared with the original OSCEs. A mixed method with surveys, focus groups and semi-structured interviews evaluated the BPGs within an OSCE. Four maximally different contexts across four sites in Australia were used. Participants included lecturers and undergraduate nursing students in high and low fidelity simulation settings; under-graduate midwifery students; and post-graduate rural and remote area nursing students. 691 students participated in revised OSCEs. Surveys were completed by 557 students; 91 students gave further feedback through focus groups and 14 lecturers participated in interviews. At all sites the BPGs were successfully used to modify and implement OSCEs. Students valued the realistic nature of the modified OSCEs which contributed to students' confidence and preparation for clinical practice. The lecturers considered the revised OSCEs enhanced student preparedness for their clinical placements. The BPGs have a broad applicability to OSCEs in a wide range of educational contexts with improved student outcomes. Students and lecturers identified the revised OSCEs enhanced student preparation for clinical practice. Subsequent examination of the BPGs saw further refinement to a set of eight BPGs that provide a sequential guide to their application in a way that is consistent with best practice curriculum design principles. Copyright © 2015 Elsevier Ltd. All rights reserved.

Performance evaluation of a dental handpiece in simulation of clinical finishing using a novel 2DOF in vitro apparatus.

PubMed

Yin, L; Song, X F; Qu, S F; Huang, T; Mei, J P; Yang, Z Y; Li, J

2006-11-01

This paper reports on the performance evaluation of a dental handpiece in simulation of clinical finishing using a novel two-degrees-of-freedom (2DOF) in vitro apparatus. The instrumented apparatus consisted of a two-dimensional computer-controlled coordinate worktable carrying a dental handpiece, a piezoelectric force dynamometer, and a high-speed data acquisition and signal conditioning system for simulating the clinical operations and monitoring the dental finishing processes. The performance of the dental handpiece was experimentally evaluated with respect to rotational speed, torque, and specific finishing energy under the applied clinical finishing conditions. The results show that the rotational speeds of the dental handpiece decreased by increasing either the depth of cut or the feed rate at a constant clinically applied air pressure and water flowrate. They also decreased when increasing both the tangential and normal finishing forces. The specific finishing energy decreased with an increase in either depth of cut or feed rate, while the finishing torque increased as either the depth of cut or the feed rate was increased. Implications of these results were to provide guidance for proper applications of dental handpieces in clinical practice.

Design and analysis issues for economic analysis alongside clinical trials.

PubMed

Marshall, Deborah A; Hux, Margaret

2009-07-01

Clinical trials can offer a valuable and efficient opportunity to collect the health resource use and outcomes data for economic evaluation. However, economic and clinical studies differ fundamentally in the question they seek to answer. The design and analysis of trial-based cost-effectiveness studies require special consideration, which are reviewed in this article. Traditional randomized controlled trials, using an experimental design with a controlled protocol, are designed to measure safety and efficacy for product registration. Cost-effectiveness analysis seeks to measure effectiveness in the context of routine clinical practice, and requires collection of health care resources to allow estimation of cost over an equal timeframe for each treatment alternative. In assessing suitability of a trial for economic data collection, the comparator treatment and other protocol factors need to reflect current clinical practice and the trial follow-up must be sufficiently long to capture important costs and effects. The broadest available population and a measure of effectiveness reflecting important benefits for patients are preferred for economic analyses. Special analytical issues include dealing with missing and censored cost data, assessing uncertainty of the incremental cost-effectiveness ratio, and accounting for the underlying heterogeneity in patient subgroups. Careful consideration also needs to be given to data from multinational studies since practice patterns can differ across countries. Although clinical trials can be an efficient opportunity to collect data for economic evaluation, careful consideration of the suitability of the study design, and appropriate analytical methods must be applied to obtain rigorous results.

The future of practical skills in undergraduate medical education – an explorative Delphi-Study

PubMed Central

Dannenberg, Katja Anne; Stroben, Fabian; Schröder, Therese; Thomas, Anke; Hautz, Wolf E.

2016-01-01

Background: 64% of young medical professionals in Germany do not feel adequately prepared for the practical requirements of the medical profession. The goal of “outcome-orientated training” is to structure medical curricula based on the skills needed when entering the workforce after completing undergraduate medical education, and thus to bridge the gap between the skills graduates have attained and those necessary for a career in the medical profession. Outcome frameworks (OFs) are used for this purpose. In preparation for developing the National Competence-Based Catalogue of Learning Objectives for Medicine (NKLM) – the German OF – the “Consensus Statement of Practical Skills in Undergraduate Medical Education” (which structures the teaching and acquisition of practical skills in Germany and which strongly influenced the “Clinical-Practical Skills” chapter of the NKLM) was published in 2011. It is not uncommon for at least a decade to elapse between the definition and implementation of an OF and the students’ graduation, which can further increase the gap between necessary and acquired skills. Thus, the purpose of this paper is to posit theses for future development in healthcare and to apply these theses to a current OF. Methodology: Partially structured interviews with experts were used to generate theses pertaining to general, future development in healthcare. These theses were assessed by physician experts based on the likelihood of implementation by the year 2025. The 288 learning goals of the consensus statement were assessed for their relevance for medical education in the interim. Results: 11 theses were generated for the development of medicine, and these theses were assessed and discussed by 738 experts. These theses include the increase in diseases associated with old age, the increasing significance of interprofessional cooperation, and the growing prevalence of telemedicine applications. Of the 288 learning goals of the consensus statement, 231 of the goals were assessed as relevant, and 57 were deemed irrelevant for the short-term future. Discussion: The theses on the future of healthcare, which were generated in this study and which were validated by numerous experts, provide indications of future developments of overall requirements for medical school graduates. For example, when applied to the content of the “Clinical-Practical Skills” NKLM chapter, they largely validate the future relevance of developing practical skills while also providing indications for their further development as applied to the consensus statement. PMID:27579362

The future of practical skills in undergraduate medical education - an explorative Delphi-Study.

PubMed

Dannenberg, Katja Anne; Stroben, Fabian; Schröder, Therese; Thomas, Anke; Hautz, Wolf E

2016-01-01

64% of young medical professionals in Germany do not feel adequately prepared for the practical requirements of the medical profession. The goal of "outcome-orientated training" is to structure medical curricula based on the skills needed when entering the workforce after completing undergraduate medical education, and thus to bridge the gap between the skills graduates have attained and those necessary for a career in the medical profession. Outcome frameworks (OFs) are used for this purpose. In preparation for developing the National Competence-Based Catalogue of Learning Objectives for Medicine (NKLM) - the German OF - the "Consensus Statement of Practical Skills in Undergraduate Medical Education" (which structures the teaching and acquisition of practical skills in Germany and which strongly influenced the "Clinical-Practical Skills" chapter of the NKLM) was published in 2011. It is not uncommon for at least a decade to elapse between the definition and implementation of an OF and the students' graduation, which can further increase the gap between necessary and acquired skills. Thus, the purpose of this paper is to posit theses for future development in healthcare and to apply these theses to a current OF. Partially structured interviews with experts were used to generate theses pertaining to general, future development in healthcare. These theses were assessed by physician experts based on the likelihood of implementation by the year 2025. The 288 learning goals of the consensus statement were assessed for their relevance for medical education in the interim. 11 theses were generated for the development of medicine, and these theses were assessed and discussed by 738 experts. These theses include the increase in diseases associated with old age, the increasing significance of interprofessional cooperation, and the growing prevalence of telemedicine applications. Of the 288 learning goals of the consensus statement, 231 of the goals were assessed as relevant, and 57 were deemed irrelevant for the short-term future. The theses on the future of healthcare, which were generated in this study and which were validated by numerous experts, provide indications of future developments of overall requirements for medical school graduates. For example, when applied to the content of the "Clinical-Practical Skills" NKLM chapter, they largely validate the future relevance of developing practical skills while also providing indications for their further development as applied to the consensus statement.

Sports chronobiology consultation: from the lab to the arena.

PubMed

Postolache, Teodor T; Hung, Tsung-Min; Rosenthal, Richard N; Soriano, Joseph J; Montes, Fernando; Stiller, John W

2005-04-01

This final article, coauthored by a chronobiology consultant, a sports psychologist who applied a chronobiology-based program to an Olympic national team, a clinical neurologist, a performance data analyst, a training-conditioning coach from a major league baseball team who applied chronobiology principles to major league pitchers, and a substance abuse expert, discusses practical aspects of a sports chronobiology consultation, including the goals and current arsenal of available interventions. Short vignettes of actual cases are presented for edification, and references are made to appropriate reviews found elsewhere in this issue.

Practice-based small group learning (PBSGL) for CPD: a pilot with general practice trainees to support the transition to independent practice.

PubMed

Rial, Jonathan; Scallan, Samantha

2013-05-01

The paper describes a small-scale enquiry with UK-based general practice specialty trainees (GPSTs) at the time of transition from training to independent practice. It aimed to identify whether they were supported in making this transition through attending practice-based small group learning (PBSGL) sessions. Participants in the study reported that the sessions helped them to consolidate their learning from their third year of training (GPST3), improved their ability to identify and use evidence in practice, and shifted the focus of their learning needs away from the two UK general practice postgraduate exams (applied Knowledge Test or aKT; and Clinical Skills assessment or CSa) and towards 'real world' practice. The two pilot groups have become established as means of peer support and continue to meet, with small changes in composition. The work has led to the wider roll out of PBSGL for newly qualified GPs across Wessex.

Current and long-term technologies of laser therapy

NASA Astrophysics Data System (ADS)

Ulashcyk, Vladimir S.; Volotovskaya, Anna V.

2007-06-01

Laser therapy, using low-energy laser radiation, is being more and more applied. The most applied technology is transcutaneous radiation of tissues by laser radiation. Originally, a direct action on a pathological site was mostly used, but recently more attention is given to reflexogenic areas, acupuncture points, and endocrine organ projection sites. The development of light-conductive engineering made it possible to practically apply intraorgan laser therapy. This technology is widely spread in gynecology, otorhinolaryngology, urology, gastroenterology, etc. Close to it are different versions of intratissue laser therapy (intraosteal, periosteal, myofascial). A special kind of laser therapy is laser hemotherapy. Depending on the techniques and protocol of its application, there are extracorporeal, intravascular, and supravenous ways of action. According to our comparative investigations, supravenous hemotherapy by its therapeutic efficacy and major medicinal effects can be well compared with intravascular laser hemotherapy. With good prospects and efficiency is laser therapy as a combination of laser and other physical factors. Magnetolaser therapy has been scientifically substantiated and practically applied so far. Theoretically and experimentally substantiated is a combined application of laser radiation and physical factors such as ultrasound, direct current field, vacuum, cryotherapy, etc. Experimental research and few so far clinical observations are indicative of prospects of a complex application of laser radiation and drugs. To improve light absorption, laser radiation is combined with different dyes. Photodynamic therapy, originally used in oncology, is applied today in treating different diseases. We showed a possibility of using a number of drugs possessing simultaneously photosensitizing properties to this end. Laser radiation significantly influences pharmacokinetics and pharmacodynamics of drugs, which gives reason to practically implement laser technologies, based on pharmacomodulating action of laser radiation, to practical medicine.

What is new in 2017? Update on fertility preservation in cancer patients.

PubMed

Winkler-Crepaz, Katharina; Böttcher, Bettina; Toth, Bettina; Wildt, Ludwig; Hofer-Tollinger, Susanne

2017-12-01

The prevention of fertility loss due to cancer treatment as well as non-malignant causes has been gaining importance over the last few decades. Clinically applied modalities for fertility preservation in cancer patients include cryopreservation of oocytes and embryos, the application of GnRH agonists, ovarian tissue banking, and cryopreservation of ejaculated or surgically extracted sperm. In addition, several new possibilities to restore fertility are currently being investigated, such as the establishment of in-vitro culture systems for gonadal tissue, the development of artificial gonads, and the application of germline stem cells. This review aims to provide an update on the methods currently applied in clinical practice for fertility preservation, as well as to summarize the progress made in the development of novel strategies for fertility preservation.

[Design and research progress of zero profile cervical Interbody cage].

PubMed

Zhu, Jia; Wang, Song; Liao, Zhenhua; Liu, Weiqiang

2017-02-01

Zero profile cervical interbody cage is an improvement of traditional fusion products and necessary supplement of emerging artificial intervertebral disc products. When applied in Anterior Cervical Decompression Fusion(ACDF), zero profile cervical interbody cage can preserve the advantages of traditional fusion and reduce the incidence of postoperative complications. Moreover, zero profile cervical interbody cage can be applied under the tabu symptoms of Artificial Cervical Disc Replacement(ACDR). This article summarizes zero profile interbody cage products that are commonly recognized and widely used in clinical practice in recent years, and reviews the progress of structure design and material research of zero profile cervical interbody cage products. Based on the latest clinical demands and research progress, this paper also discusses the future development directions of zero profile interbody cage.

Medical student preparedness for an era of personalized medicine: findings from one US medical school

PubMed Central

Eden, Caroline; Johnson, Kipp W; Gottesman, Omri; Bottinger, Erwin P; Abul-Husn, Noura S

2016-01-01

Aim The objective of this research was to assess medical student preparedness for the use of personalized medicine. Materials & methods A survey instrument measuring attitude toward personalized medicine, perceived knowledge of genomic testing concepts and perceived ability to apply genomics to clinical care was distributed to students in medical school (MS) years 1–4. Results Of 212 participants, 79% felt that it was important to learn about personalized medicine, but only 6% thought that their medical education had adequately prepared them to practice personalized medicine. Attitude did not vary across years; knowledge and ability increased after MS1, but not after MS2. Conclusion While medical students support the use of personalized medicine, they do not feel prepared to apply genomics to clinical care. PMID:27528879

The clinical learning environment in nursing education: a concept analysis.

PubMed

Flott, Elizabeth A; Linden, Lois

2016-03-01

The aim of this study was to report an analysis of the clinical learning environment concept. Nursing students are evaluated in clinical learning environments where skills and knowledge are applied to patient care. These environments affect achievement of learning outcomes, and have an impact on preparation for practice and student satisfaction with the nursing profession. Providing clarity of this concept for nursing education will assist in identifying antecedents, attributes and consequences affecting student transition to practice. The clinical learning environment was investigated using Walker and Avant's concept analysis method. A literature search was conducted using WorldCat, MEDLINE and CINAHL databases using the keywords clinical learning environment, clinical environment and clinical education. Articles reviewed were written in English and published in peer-reviewed journals between 1995-2014. All data were analysed for recurring themes and terms to determine possible antecedents, attributes and consequences of this concept. The clinical learning environment contains four attribute characteristics affecting student learning experiences. These include: (1) the physical space; (2) psychosocial and interaction factors; (3) the organizational culture and (4) teaching and learning components. These attributes often determine achievement of learning outcomes and student self-confidence. With better understanding of attributes comprising the clinical learning environment, nursing education programmes and healthcare agencies can collaborate to create meaningful clinical experiences and enhance student preparation for the professional nurse role. © 2015 John Wiley & Sons Ltd.

The Virtual Maternity Clinic: a teaching and learning innovation for midwifery education.

PubMed

Phillips, Diane; Duke, Maxine; Nagle, Cate; Macfarlane, Susie; Karantzas, Gery; Patterson, Denise

2013-10-01

There are challenges for midwifery students in developing skill and competency due to limited placements in antenatal clinics. The Virtual Maternity Clinic, an online resource, was developed to support student learning in professional midwifery practice. Identifying students' perceptions of the Virtual Maternity Clinic; learning about the impact of the Virtual Maternity Clinic on the students' experience of its use and access; and learning about the level of student satisfaction of the Virtual Maternity Clinic. Two interventions were used including pre and post evaluations of the online learning resource with data obtained from questionnaires using open ended and dichotomous responses and rating scales. The pre-Virtual Maternity Clinic intervention used a qualitative design and the post-Virtual Maternity Clinic intervention applied both qualitative and quantitative approaches. Three campuses of Deakin University, located in Victoria, Australia. Midwifery students enrolled in the Bachelor of Nursing/Bachelor of Midwifery and Graduate Diploma of Midwifery were recruited across three campuses of Deakin University (n=140). Thematic analysis of the pre-Virtual Maternity Clinic intervention (return rate n=119) related to students' expectations of this resource. The data for the post-Virtual Maternity Clinic intervention (return rate n=42) including open-ended responses were thematically analysed; dichotomous data examined in the form of frequencies and percentages of agreement and disagreement; and 5-rating scales were analysed using Pearson's correlations (α=.05, two-tailed). Results showed from the pre-Virtual Maternity Clinic intervention that students previously had placements in antenatal clinics were optimistic about the online learning resource. The post-Virtual Maternity Clinic intervention results indicated that students were satisfied with the Virtual Maternity Clinic as a learning resource despite some technological issues. The Virtual Maternity Clinic provides benefits for students in repeated observation of the practice of the midwife to support their professional learning and practice development. Copyright © 2012 Elsevier Ltd. All rights reserved.

SPIRIT: Systematic Planning of Intelligent Reuse of Integrated Clinical Routine Data. A Conceptual Best-practice Framework and Procedure Model.

PubMed

Hackl, W O; Ammenwerth, E

2016-01-01

Secondary use of clinical routine data is receiving an increasing amount of attention in biomedicine and healthcare. However, building and analysing integrated clinical routine data repositories are nontrivial, challenging tasks. As in most evolving fields, recognized standards, well-proven methodological frameworks, or accurately described best-practice approaches for the systematic planning of solutions for secondary use of routine medical record data are missing. We propose a conceptual best-practice framework and procedure model for the systematic planning of intelligent reuse of integrated clinical routine data (SPIRIT). SPIRIT was developed based on a broad literature overview and further refined in two case studies with different kinds of clinical routine data, including process-oriented nursing data from a large hospital group and high-volume multimodal clinical data from a neurologic intensive care unit. SPIRIT aims at tailoring secondary use solutions to specific needs of single departments without losing sight of the institution as a whole. It provides a general conceptual best-practice framework consisting of three parts: First, a secondary use strategy for the whole organization is determined. Second, comprehensive analyses are conducted from two different viewpoints to define the requirements regarding a clinical routine data reuse solution at the system level from the data perspective (BOTTOM UP) and at the strategic level from the future users perspective (TOP DOWN). An obligatory clinical context analysis (IN BETWEEN) facilitates refinement, combination, and integration of the different requirements. The third part of SPIRIT is dedicated to implementation, which comprises design and realization of clinical data integration and management as well as data analysis solutions. The SPIRIT framework is intended to be used to systematically plan the intelligent reuse of clinical routine data for multiple purposes, which often was not intended when the primary clinical documentation systems were implemented. SPIRIT helps to overcome this gap. It can be applied in healthcare institutions of any size or specialization and allows a stepwise setup and evolution of holistic clinical routine data reuse solutions.

[Structural elements of critical thinking of nurses in emergency care].

PubMed

Crossetti, Maria da Graça Oliveira; Bittencourt, Greicy Kelly Gouveia Dias; Lima, Ana Amélia Antunes; de Góes, Marta Georgina Oliveira; Saurin, Gislaine

2014-09-01

The objective of this study was to analyze the structural elements of critical thinking (CT) of nurses in the clinical decision-making process. This exploratory, qualitative study was conducted with 20 emergency care nurses in three hospitals in southern Brazil. Data were collected from April to June 2009, and a validated clinical case was applied from which nurses listed health problems, prescribed care and listed the structural elements of CT. Content analysis resulted in categories used to determine priority structural elements of CT, namely theoretical foundations and practical relationship to clinical decision making; technical and scientific knowledge and clinical experience, thought processes and clinical decision making: clinical reasoning and basis for clinical judgments of nurses: patient assessment and ethics. It was concluded that thinking critically is a skill that enables implementation of a secure and effective nursing care process.

Knowledge 'Translation' as social learning: negotiating the uptake of research-based knowledge in practice.

PubMed

Salter, K L; Kothari, A

2016-02-29

Knowledge translation and evidence-based practice have relied on research derived from clinical trials, which are considered to be methodologically rigorous. The result is practice recommendations based on a narrow view of evidence. We discuss how, within a practice environment, in fact individuals adopt and apply new evidence derived from multiple sources through ongoing, iterative learning cycles. The discussion is presented in four sections. After elaborating on the multiple forms of evidence used in practice, in section 2 we argue that the practitioner derives contextualized knowledge through reflective practice. Then, in section 3, the focus shifts from the individual to the team with consideration of social learning and theories of practice. In section 4 we discuss the implications of integrative and negotiated knowledge exchange and generation within the practice environment. Namely, how can we promote the use of research within a team-based, contextualized knowledge environment? We suggest support for: 1) collaborative learning environments for active learning and reflection, 2) engaged scholarship approaches so that practice can inform research in a collaborative manner and 3) leveraging authoritative opinion leaders for their clinical expertise during the shared negotiation of knowledge and research. Our approach also points to implications for studying evidence-informed practice: the identification of practice change (as an outcome) ought to be supplemented with understandings of how and when social negotiation processes occur to achieve integrated knowledge. This article discusses practice knowledge as dependent on the practice context and on social learning processes, and suggests how research knowledge uptake might be supported from this vantage point.

Research as a standard of care in PICU

PubMed Central

Zimmerman, Jerry J.; Anand, Kanwaljeet J. S.; Meert, Kathleen L.; Willson, Douglas F.; Newth, Christopher J. L.; Harrison, Rick; Carcillo, Joseph A.; Berger, John; Jenkins, Tammara L.; Nicholson, Carol; Dean, J. Michael

2016-01-01

Background Excellence in clinical care coupled with basic and applied research reflects the maturation of a medical subspecialty, advances that field, and provides objective data for identifying best practices. Pediatric intensive care units (PICU) are uniquely suited for conducting translational and clinical research. Moreover, multiple investigations have reported that a majority of parents are interested in their children’s participation in clinical research, even when the research offers no direct benefit to their child. However, such activity may generate ethical conflict with bedside care providers trying to acutely identify the best approach for an individual critically ill child. Ultimately, this conflict may diminish enthusiasm for the generation of scientific evidence that supports application of evidence-based medicine into PICU clinical standard work. Objective Provide an overview of current state PICU clinical research strengths, liabilities, opportunities, and barriers, and contrast this with an established pediatric hematology-oncology iterative research model that constitutes a learning healthcare system. Design Narrative review of medical literature published in English. Conclusions Currently most PICU therapy is not evidence-based. Developing a learning healthcare system in the PICU integrates clinical research into usual practice and fosters a culture of evidence-based learning and continual care improvement. As PICU mortality has significantly decreased, identification and validation of patient-centered, clinically relevant research outcome measures other than mortality is essential for future clinical trial design. Because most pediatric critical illness may be classified as rare diseases, participation in research networks will facilitate iterative, collaborative, multi-institutional investigations that over time identify best practices to improve PICU outcomes. Despite real ethical challenges, critically ill children and their families should have the opportunity to participate in translational/clinical research whenever feasible. PMID:26513203

Designing a system for patients controlling providers' access to their electronic health records: organizational and technical challenges.

PubMed

Leventhal, Jeremy C; Cummins, Jonathan A; Schwartz, Peter H; Martin, Douglas K; Tierney, William M

2015-01-01

Electronic health records (EHRs) are proliferating, and financial incentives encourage their use. Applying Fair Information Practice principles to EHRs necessitates balancing patients' rights to control their personal information with providers' data needs to deliver safe, high-quality care. We describe the technical and organizational challenges faced in capturing patients' preferences for patient-controlled EHR access and applying those preferences to an existing EHR. We established an online system for capturing patients' preferences for who could view their EHRs (listing all participating clinic providers individually and categorically-physicians, nurses, other staff) and what data to redact (none, all, or by specific categories of sensitive data or patient age). We then modified existing data-viewing software serving a state-wide health information exchange and a large urban health system and its primary care clinics to allow patients' preferences to guide data displays to providers. Patients could allow or restrict data displays to all clinicians and staff in a demonstration primary care clinic, categories of providers (physicians, nurses, others), or individual providers. They could also restrict access to all EHR data or any or all of five categories of sensitive data (mental and reproductive health, sexually transmitted diseases, HIV/AIDS, and substance abuse) and for specific patient ages. The EHR viewer displayed data via reports, data flowsheets, and coded and free text data displayed by Google-like searches. Unless patients recorded restrictions, by default all requested data were displayed to all providers. Data patients wanted restricted were not displayed, with no indication they were redacted. Technical barriers prevented redacting restricted information in free textnotes. The program allowed providers to hit a "Break the Glass" button to override patients' restrictions, recording the date, time, and next screen viewed. Establishing patient-control over EHR data displays was complex and required ethical, clinical, database, and programming expertise and difficult choices to overcome technical and health system constraints. Assessing patients' preferences for access to their EHRs and applying them in clinical practice requires wide-ranging technical, clinical, and bioethical expertise, to make tough choices to overcome significant technical and organization challenges.

Tools to share good chairside teaching practice: a clinical scenario and appreciative questionnaire.

PubMed

Sweet, J; Wilson, J; Pugsley, L; Schofield, M

2008-12-13

This article provides a scenario for analysis of good chairside teaching practice to serve as a starting point for continued discussion in this complex field. Documented issues of good chairside teaching practice are cross-referenced to a clinical scenario with explanations in the form of a commentary. This provided the context for generating a set of questions that are provided as tools to support good chairside practice. These tools are designed to be used with 'Appreciative Inquiry', which claims that there is much to be gained by discovering where excellence is possible and elaborating upon this. Although this process can be carried out in single units or departments, it is proposed that collaboration between institutions would allow sharing of valuable innovations and greater understanding of educational training, production of good practice guidance and professional development of staff. This article is the third in a series of three and provides a scaffold for a scenario and questions to encourage collaboration in evolving and sharing good chairside teaching practice. The first article investigated the perceptions of stakeholders in chairside teaching at a single dental school and the second evaluated chairside teaching on a UK wide scale. A further accompanying article reviews some of the educational methodology and innovations in teaching and learning that may be applied to dentistry.

Best Practices for Robotic Surgery Programs

PubMed Central

Goldenberg, David; Winder, Joshua S.; Juza, Ryan M.; Lyn-Sue, Jerome R.

2017-01-01

Background and Objectives: Robotic surgical programs are increasing in number. Efficient methods by which to monitor and evaluate robotic surgery teams are needed. Methods: Best practices for an academic university medical center were created and instituted in 2009 and continue to the present. These practices have led to programmatic development that has resulted in a process that effectively monitors leadership team members; attending, resident, fellow, and staff training; credentialing; safety metrics; efficiency; and case volume recommendations. Results: Guidelines for hospitals and robotic directors that can be applied to one's own robotic surgical services are included with examples of management of all aspects of a multispecialty robotic surgery program. Conclusion: The use of these best practices will ensure a robotic surgery program that is successful and well positioned for a safe and productive environment for current clinical practice. PMID:28729780

Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study.

PubMed

Easter, Joshua S; Bakes, Katherine; Dhaliwal, Jasmeet; Miller, Michael; Caruso, Emily; Haukoos, Jason S

2014-08-01

We evaluate the diagnostic accuracy of clinical decision rules and physician judgment for identifying clinically important traumatic brain injuries in children with minor head injuries presenting to the emergency department. We prospectively enrolled children younger than 18 years and with minor head injury (Glasgow Coma Scale score 13 to 15), presenting within 24 hours of their injuries. We assessed the ability of 3 clinical decision rules (Canadian Assessment of Tomography for Childhood Head Injury [CATCH], Children's Head Injury Algorithm for the Prediction of Important Clinical Events [CHALICE], and Pediatric Emergency Care Applied Research Network [PECARN]) and 2 measures of physician judgment (estimated of <1% risk of traumatic brain injury and actual computed tomography ordering practice) to predict clinically important traumatic brain injury, as defined by death from traumatic brain injury, need for neurosurgery, intubation greater than 24 hours for traumatic brain injury, or hospital admission greater than 2 nights for traumatic brain injury. Among the 1,009 children, 21 (2%; 95% confidence interval [CI] 1% to 3%) had clinically important traumatic brain injuries. Only physician practice and PECARN identified all clinically important traumatic brain injuries, with ranked sensitivities as follows: physician practice and PECARN each 100% (95% CI 84% to 100%), physician estimates 95% (95% CI 76% to 100%), CATCH 91% (95% CI 70% to 99%), and CHALICE 84% (95% CI 60% to 97%). Ranked specificities were as follows: CHALICE 85% (95% CI 82% to 87%), physician estimates 68% (95% CI 65% to 71%), PECARN 62% (95% CI 59% to 66%), physician practice 50% (95% CI 47% to 53%), and CATCH 44% (95% CI 41% to 47%). Of the 5 modalities studied, only physician practice and PECARN identified all clinically important traumatic brain injuries, with PECARN being slightly more specific. CHALICE was incompletely sensitive but the most specific of all rules. CATCH was incompletely sensitive and had the poorest specificity of all modalities. Copyright © 2014 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Transnational connections of health professionals: medicoscapes and assisted reproduction in Ghana and Uganda.

PubMed

Hörbst, Viola; Gerrits, Trudie

2016-08-01

Based on our comparative fieldwork in two private fertility clinics in Accra (Ghana) and Kampala (Uganda), we explore the transnational mobility of providers involved in assisted reproductive technologies (ARTs) and analyze how resulting transnational networks influence the realization and appropriation of these therapeutic treatments. By exploring these case studies from developing countries, this article intends to contribute to the field of studies that examine the diversification and complexity of migration and health care. We first summarize the dynamics affecting the health-care systems in Ghana and Uganda over the last decades. Then, we describe the transnational mobility engaged in the two clinics. Through the case studies, we highlight how ARTs are realized and appropriated in the two receiving countries, and the role transnational contacts play within the negotiations of medical ethos and financial interests. By using the concept of medicoscapes, we analyze the worldwide connections between ART providers, the institutions they work in, their medical practices, artifacts, and their regimes of medical knowledge. Transnational professional contacts have been essential to the setup of both clinics offering ARTs in Ghana and Uganda. These contacts developed along colonial and post-colonial links, integrating also south-south relationship. The clinics' directors act as entrepreneurs and creative decision-makers who capitalize on their transnational professional network. The case studies show the diverse transnational entanglements in both clinics and demonstrate the frictions between the doctors' entrepreneurial interests, medical concerns and cultural values. The transnational professional contacts expose both clinics to varying practices and debates, and make them into sites for negotiating distinct clinical practices. They provoke frictions between entrepreneurial interests and medical concerns including cultural values. In current medicoscapes, in a situation of full absence of any form of financial support and of any national ART regulation in Ghana and Uganda, clinic directors are in the position to apply those practices that fit their interests and local circumstances best.

Probability scores and diagnostic algorithms in pulmonary embolism: are they followed in clinical practice?

PubMed

Sanjuán, Pilar; Rodríguez-Núñez, Nuria; Rábade, Carlos; Lama, Adriana; Ferreiro, Lucía; González-Barcala, Francisco Javier; Alvarez-Dobaño, José Manuel; Toubes, María Elena; Golpe, Antonio; Valdés, Luis

2014-05-01

Clinical probability scores (CPS) determine the pre-test probability of pulmonary embolism (PE) and assess the need for the tests required in these patients. Our objective is to investigate if PE is diagnosed according to clinical practice guidelines. Retrospective study of clinically suspected PE in the emergency department between January 2010 and December 2012. A D-dimer value ≥ 500 ng/ml was considered positive. PE was diagnosed on the basis of the multislice computed tomography angiography and, to a lesser extent, with other imaging techniques. The CPS used was the revised Geneva scoring system. There was 3,924 cases of suspected PE (56% female). Diagnosis was determined in 360 patients (9.2%) and the incidence was 30.6 cases per 100,000 inhabitants/year. Sensitivity and the negative predictive value of the D-dimer test were 98.7% and 99.2% respectively. CPS was calculated in only 24 cases (0.6%) and diagnostic algorithms were not followed in 2,125 patients (54.2%): in 682 (17.4%) because clinical probability could not be estimated and in 482 (37.6%), 852 (46.4%) and 109 (87.9%) with low, intermediate and high clinical probability, respectively, because the diagnostic algorithms for these probabilities were not applied. CPS are rarely calculated in the diagnosis of PE and the diagnostic algorithm is rarely used in clinical practice. This may result in procedures with potential significant side effects being unnecessarily performed or to a high risk of underdiagnosis. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

Quality assurance and quality improvement in U.S. clinical molecular genetic laboratories.

PubMed

Chen, Bin; Richards, C Sue; Wilson, Jean Amos; Lyon, Elaine

2011-04-01

A robust quality-assurance program is essential for laboratories that perform molecular genetic testing to maintain high-quality testing and be able to address challenges associated with performance or delivery of testing services as the use of molecular genetic tests continues to expand in clinical and public health practice. This unit discusses quality-assurance and quality-improvement considerations that are critical for molecular genetic testing performed for heritable diseases and conditions. Specific discussion is provided on applying regulatory standards and best practices in establishing/verifying test performance, ensuring quality of the total testing process, monitoring and maintaining personnel competency, and continuing quality improvement. The unit provides a practical reference for laboratory professionals to use in recognizing and addressing essential quality-assurance issues in human molecular genetic testing. It should also provide useful information for genetics researchers, trainees, and fellows in human genetics training programs, as well as others who are interested in quality assurance and quality improvement for molecular genetic testing. 2011 by John Wiley & Sons, Inc.

Impact of clinical pharmacist on cost of drug therapy in the ICU

PubMed Central

Aljbouri, Tareq M.; Alkhawaldeh, Mohammed S.; Abu-Rumman, Ala’a eddeen K.; Hasan, Thamer A.; Khattar, Hakeem M.; Abu-Oliem, Atallah S.

2013-01-01

Objective To determine whether the presence of Clinical Pharmacist affects the cost of drug therapy for patients admitted to the Intensive Care Unit (ICU) at Al-Hussein hospital at Royal Medical Services in Amman, Jordan. Method This study compares the consumed quantities of drugs over two periods of time. Each period was ten months long. In the second period there was a Clinical Pharmacist. The decrease in consumption rate of drugs is considered to be an indicator of the success of Clinical Pharmacist in the ICU, as any decrease in consumption rate reflects the correct application of Clinical Pharmacy practices. The cost of this decrease in consumption rate represents the total reduction of drug therapy cost. Results The total reduction of drug therapy cost after applying Clinical Pharmacy practices in the ICU over a period of ten months was 149946.80 JD (211574.90 USD), which represents an average saving of 35.8% when compared to the first period in this study. Conclusion The results of this study showed a significant reduction in the consumed quantities of drugs and therefore a reduction in cost of drug therapy. Such findings highlight the importance of the presence of Clinical Pharmacist in all Jordanian hospitals wards and units. PMID:24227956

Beyond a code of ethics: phenomenological ethics for everyday practice.

PubMed

Greenfield, Bruce; Jensen, Gail M

2010-06-01

Physical therapy, like all health-care professions, governs itself through a code of ethics that defines its obligations of professional behaviours. The code of ethics provides professions with a consistent and common moral language and principled guidelines for ethical actions. Yet, and as argued in this paper, professional codes of ethics have limits applied to ethical decision-making in the presence of ethical dilemmas. Part of the limitations of the codes of ethics is that there is no particular hierarchy of principles that govern in all situations. Instead, the exigencies of clinical practice, the particularities of individual patient's illness experiences and the transformative nature of chronic illnesses and disabilities often obscure the ethical concerns and issues embedded in concrete situations. Consistent with models of expert practice, and with contemporary models of patient-centred care, we advocate and describe in this paper a type of interpretative and narrative approach to moral practice and ethical decision-making based on phenomenology. The tools of phenomenology that are well defined in research are applied and examined in a case that illustrates their use in uncovering the values and ethical concerns of a patient. Based on the deconstruction of this case on a phenomenologist approach, we illustrate how such approaches for ethical understanding can help assist clinicians and educators in applying principles within the context and needs of each patient. (c) 2010 John Wiley & Sons, Ltd.

Motivational interviewing: a valuable tool for the psychiatric advanced practice nurse.

PubMed

Karzenowski, Abby; Puskar, Kathy

2011-01-01

Motivational Interviewing (MI) is well known and respected by many health care professionals. Developed by Miller and Rollnick (2002) , it is a way to promote behavior change from within and resolve ambivalence. MI is individualized and is most commonly used in the psychiatric setting; it is a valuable tool for the Psychiatric Advanced Nurse Practice Nurse. There are many resources that talk about what MI is and the principles used to apply it. However, there is little information about how to incorporate MI into a clinical case. This article provides a summary of articles related to MI and discusses two case studies using MI and why advanced practice nurses should use MI with their patients.

[Placebo effect: a contribution of social psychology].

PubMed

Balez, R; Leroyer, C; Couturaud, F

2014-10-01

This article reviews the psychosocial variables, which are of interest in the relationship between the patient and the physician. According to a classical model of social psychology, such a relationship might contribute to the placebo/nocebo effects. We develop herein various relational and contextual variables, taking into account four dimensions (intra-individual, interpersonal, positional and ideological) and their potential effects on therapeutic responses. This applies both in the setting of daily clinical practice and of clinical trials. The placebo effect offers an opportunity for collaboration and dialogue between social scientists and physicians.

Acute brain injury and therapeutic hypothermia in the PICU: A rehabilitation perspective

PubMed Central

Fink, Ericka L.; Beers, Sue R.; Russell, Mary Louise; Bell, Michael J.

2011-01-01

Acquired brain injury from traumatic brain injury, cardiac arrest (CA), stroke, and central nervous system infection is a leading cause of morbidity and mortality in the pediatric population and admission to inpatient rehabilitation. Therapeutic hypothermia is the only intervention shown to have efficacy from bench to bedside in improving neurological outcome after birth asphyxia and adult arrhythmia-induced CA, thought to be due to its multiple mechanisms of action. Research to determine if therapeutic hypothermia should be applied to other causes of brain injury and how to best apply it is underway in children and adults. Changes in clinical practice in the hospitalized brain-injured child may have effects on rehabilitation referral practices, goals and strategies of therapies offered, and may increase the degree of complex medical problems seen in children referred to inpatient rehabilitation. PMID:21791822

Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions

PubMed Central

Rodríguez-Sanjuán, Juan C; Gómez-Ruiz, Marcos; Trugeda-Carrera, Soledad; Manuel-Palazuelos, Carlos; López-Useros, Antonio; Gómez-Fleitas, Manuel

2016-01-01

Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen’s fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated. PMID:26877605

Evaluation of an instructional model to teach clinically relevant medicinal chemistry in a campus and a distance pathway.

PubMed

Alsharif, Naser Z; Galt, Kimberly A

2008-04-15

To evaluate an instructional model for teaching clinically relevant medicinal chemistry. An instructional model that uses Bloom's cognitive and Krathwohl's affective taxonomy, published and tested concepts in teaching medicinal chemistry, and active learning strategies, was introduced in the medicinal chemistry courses for second-professional year (P2) doctor of pharmacy (PharmD) students (campus and distance) in the 2005-2006 academic year. Student learning and the overall effectiveness of the instructional model were assessed. Student performance after introducing the instructional model was compared to that in prior years. Student performance on course examinations improved compared to previous years. Students expressed overall enthusiasm about the course and better understood the value of medicinal chemistry to clinical practice. The explicit integration of the cognitive and affective learning objectives improved student performance, student ability to apply medicinal chemistry to clinical practice, and student attitude towards the discipline. Testing this instructional model provided validation to this theoretical framework. The model is effective for both our campus and distance-students. This instructional model may also have broad-based applications to other science courses.

Virtual and Augmented Reality Systems for Renal Interventions: A Systematic Review.

PubMed

Detmer, Felicitas J; Hettig, Julian; Schindele, Daniel; Schostak, Martin; Hansen, Christian

2017-01-01

Many virtual and augmented reality systems have been proposed to support renal interventions. This paper reviews such systems employed in the treatment of renal cell carcinoma and renal stones. A systematic literature search was performed. Inclusion criteria were virtual and augmented reality systems for radical or partial nephrectomy and renal stone treatment, excluding systems solely developed or evaluated for training purposes. In total, 52 research papers were identified and analyzed. Most of the identified literature (87%) deals with systems for renal cell carcinoma treatment. About 44% of the systems have already been employed in clinical practice, but only 20% in studies with ten or more patients. Main challenges remaining for future research include the consideration of organ movement and deformation, human factor issues, and the conduction of large clinical studies. Augmented and virtual reality systems have the potential to improve safety and outcomes of renal interventions. In the last ten years, many technical advances have led to more sophisticated systems, which are already applied in clinical practice. Further research is required to cope with current limitations of virtual and augmented reality assistance in clinical environments.

A comprehensive clinical assessment tool to inform policy and practice: applications of the minimum data set.

PubMed

Mor, Vincent

2004-04-01

The Minimum Data Set (MDS) for nursing home (NH) resident assessment, designed to assess elders functional status and care needs, exemplifies how the information needs of clinical practice are congruent with those of research. Building on a review of the published literature, this article describes the development of the MDS, its reliability and validity testing, as well as the variety of different policy and research uses to which it has been applied. Interrater reliability of items and internal consistency of MDS summary scales is generally good to excellent. Validation studies reveal good correspondence to research quality instruments for cognition, activities of daily living, and diagnoses with more variable results for vision, pain, mood, and behavior scales. To date, no consistent evidence suggests that applications of MDS data for case-mix reimbursement and quality indicator monitoring systematically bias the data. Although facility variation in data quality could compromise some applications, creation of the MDS as a clinical tool for care planning provides an example of how assessment tools with clinical use can be used in administrative databases for research and policy applications.

Not Your Same Old Story: New Rules for Thematic Apperceptive Techniques (TATs).

PubMed

Jenkins, Sharon Rae

2017-01-01

Stories told about pictures have been used for both research and clinical practice since the beginning of modern personality assessment. However, with the growing science-practice gap, these thematic apperceptive techniques (TATs) have been used differently in those 2 venues. Scientific validation is presumptively general, but clinical application is idiographic and situation-specific. A bridge is needed. The manualized human-scored narrative analysis systems discussed here are valuable scientist-practitioner tools, but they require a validation literature to support further research publication, maintain their role in clinical training, and justify clinicians' reimbursement by third-party payers. To facilitate wider understanding of manualized TAT methodologies, this article addresses long-standing criticisms of TAT reliability and proposes some strategic solutions to the measurement error problem for both researchers and clinicians, including analyzing person-situation interactions, purposeful situation sampling for within-storyteller comparisons, and uses of small samples. The new rules for TATs include conceptual and methodological standards that researchers should aim to meet and report, reviewers should apply to manuscripts, and clinical assessors can use to analyze their own data and justify third-party payment.

A definition for chronic sequelae applied to campylobacter and guillian-barre syndrome (Gbs).

PubMed

Parkin; Davies-Cole; Balbus

2000-10-01

PURPOSE: Chronic sequelae (CS) are increasingly important to drinking water risk assessment and management processes, but there has been relatively little scientific rigor in defining CS or reviewing the literature on water-related CS. Our purposes were to develop a scientific definition for CS and to evaluate the definition's practical merit.METHODS: We examined scientific publications for definitions of "chronic sequela." We developed a definition that is based on scientific concepts and that can be systematically applied to literature to assess whether pathogen-related health outcomes qualify as CS. As a case study, we conducted an extensive Medline search and tested our definition on the epidemiological and clinical literature linking Campylobacter and GBS.RESULTS: We defined "chronic sequela" as the secondary adverse health outcome that 1) occurs as a result of a previous infection by a microbial pathogen, and 2) is clearly distinguishable from the health events that initially result from the causative infection, and 3) lasts 3 months or more after recognition. The 12 Campylobacter and GBS studies (five epidemiological and seven clinical) revealed that current data reporting practices limit the evaluation of all three elements in our definition. Laboratory methods and criteria to characterize infection were not always adequately reported. Primary and secondary health events were always reported, but eight of the studies required obtaining additional articles to determine the GBS criteria used. Ten of the 12 articles contained duration data for the GBS symptoms.CONCLUSIONS: Much of the evidence needed to apply our definition was found in the studies reviewed, but changes in reporting practices would facilitate the scientific evaluation of pathogen-CS relationships and estimation of their public health magnitude.

CASE STUDY ON AN IPILIMUMAB COST-CONTAINMENT STRATEGY IN AN ITALIAN HOSPITAL.

PubMed

Russi, Alberto; Chiarion-Sileni, Vanna; Damuzzo, Vera; Di Sarra, Francesca; Pigozzo, Jacopo; Palozzo, Angelo Claudio

2017-01-01

Ipilimumab is the first licensed immune checkpoint inhibitor for treatment of melanoma. The promising results of the registration clinical study need confirmation in real practice and its clinical success comes together with a relevant budget impact due to the high price of this drug. The aim of this work is to describe a new model of economical sustainability of ipilimumab developed in an Italian reference center for melanoma treatment. This retrospective, observational, and monocentric study was carried out at the Veneto Institute of Oncology. Ipilimumab was administered to fifty-seven patients with advanced melanoma. Overall survival, progression free survival, and toxicity were evaluated. A local management procedure was evaluated together with the cost-saving strategies implemented by the Italian Medicines Agency (AIFA). We demonstrated that the use of ipilimumab for metastatic melanoma in real practice had an efficacy and toxicity similar to that reported in the literature. In this scenario, our management model (centralization of compounding + drug-day) permitted savings up to the 11.1 percent of the gross cost for the drug (calculated assuming that no cost saving procedures were applied) while the policy of cost containment designed by AIFA produced an additional 6.2 percent of savings. In real practice conditions, the centralized administration of ipilimumab allows to replicate the results of clinical studies and in the meantime to contain the cost associated with this drug. The local strategy of management can be readily applied to most of the high cost drugs compounded in the hospital pharmacy. Impact of findings on practice: (i) We describe a new model of economic sustainability (drug-day, centralization of compounding, payback systems) of an expensive and innovative drug, ipilimumab, for treatment of melanoma within an Italian cancer center. (ii) This pivotal study demonstrated that a cost containment strategy is feasible and it needs the cooperation of all healthcare providers (oncologists, pharmacists, nurses, and technicians) to guarantee the full efficiency of the process.

A qualitative study of clinic and community member perspectives on intervention toolkits: "Unless the toolkit is used it won't help solve the problem".

PubMed

Davis, Melinda M; Howk, Sonya; Spurlock, Margaret; McGinnis, Paul B; Cohen, Deborah J; Fagnan, Lyle J

2017-07-18

Intervention toolkits are common products of grant-funded research in public health and primary care settings. Toolkits are designed to address the knowledge translation gap by speeding implementation and dissemination of research into practice. However, few studies describe characteristics of effective intervention toolkits and their implementation. Therefore, we conducted this study to explore what clinic and community-based users want in intervention toolkits and to identify the factors that support application in practice. In this qualitative descriptive study we conducted focus groups and interviews with a purposive sample of community health coalition members, public health experts, and primary care professionals between November 2010 and January 2012. The transdisciplinary research team used thematic analysis to identify themes and a cross-case comparative analysis to explore variation by participant role and toolkit experience. Ninety six participants representing primary care (n = 54, 56%) and community settings (n = 42, 44%) participated in 18 sessions (13 focus groups, five key informant interviews). Participants ranged from those naïve through expert in toolkit development; many reported limited application of toolkits in actual practice. Participants wanted toolkits targeted at the right audience and demonstrated to be effective. Well organized toolkits, often with a quick start guide, with tools that were easy to tailor and apply were desired. Irrespective of perceived quality, participants experienced with practice change emphasized that leadership, staff buy-in, and facilitative support was essential for intervention toolkits to be translated into changes in clinic or public -health practice. Given the emphasis on toolkits in supporting implementation and dissemination of research and clinical guidelines, studies are warranted to determine when and how toolkits are used. Funders, policy makers, researchers, and leaders in primary care and public health are encouraged to allocate resources to foster both toolkit development and implementation. Support, through practice facilitation and organizational leadership, are critical for translating knowledge from intervention toolkits into practice.

Scotland's knowledge network: a progress report on Knowledge into Action.

PubMed

Wales, Ann; Boyle, Derek

2015-11-01

Launched in 2012, Knowledge into Action is the national knowledge management strategy for the health and social care workforce in Scotland. It is transforming the role of the national digital knowledge service--NHS Education for Scotlands' Knowledge Network--and the NHSS librarian role to offer more active, tailored support for translating knowledge into frontline clinical practice. This includes the development of a national evidence search and summary service, help with converting knowledge into practical and usable formats for easy use at point of care and with using digital tools to share clinicians' learning, experience and expertise. Through this practical support, Knowledge into Action is contributing to quality and safety outcomes across NHS Scotland, building clinicians' capacity and capability in applying knowledge in frontline practice and service improvement. © The Author(s) 2015.