Sample records for clinical practice part
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Research methodology in Dentistry: Part I – The essentials and relevance of research
Krithikadatta, Jogikalmat
2012-01-01
The need for scientific evidence should be the basis of clinical practice. The field of restorative dentistry and endodontics is evolving at a rapid pace, with the introduction of several materials, instruments, and equipments. However, there is minimal information of their relevance in clinical practice. On the one hand, material and laboratory research is critical, however; its translation into clinical practice is not being substantiated enough with clinical research. This four part review series focuses on methods to improve evidence-based practice, by improving methods to integrate laboratory and clinical research. PMID:22368327
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2017-10-31
Erratum To: Circulating tumor markers: a guide to their appropriate clinical use | Comparative summary of recommendations from clinical practice guidelines (PART 1) Gion M, Trevisiol C, Rutjes AW, Rainato G, Fabricio AS. Int J Biol Markers. 2016 Dec 23;31(4):e332-e367. doi: 10.5301/jbm.5000251. Circulating tumor markers: a guide to their appropriate clinical use | Comparative summary of recommendations from clinical practice guidelines (PART 2).Gion M, Trevisiol C, Rutjes AWS, Rainato G, Fabricio ASC. Int J Biol Markers. 2017 Mar 2;32(1):e1-e52. doi: 10.5301/ijbm.5000259. Circulating tumor markers: a guide to their appropriate clinical use | Comparative summary of recommendations from clinical practice guidelines (PART 3).Gion M, Trevisiol C, Rutjes AWS, Rainato G, Fabricio ASC. Int J Biol Markers. 2017 May 4;32(2):e147-e181. doi: 10.5301/ijbm.5000272. We report an amendment in the Detailed summary tables pages of the three parts of the guidelines above. The correct definition of detailed summary tables is reported below. Definition and target audience Detailed summary tables are tables prepared for every tumor type which report recommendations and supplementary information from different guidance documents with enough details to be useful for health care providers, policy makers (for potential adaptation to specific settings) and staff developing educational material informed by available evidence.
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ERIC Educational Resources Information Center
And Others; Valletta, Michael
1978-01-01
The results of a practical clinical examination in podiatric medicine administered to fourth-year students are presented. The examination could become the prototype of a Part III practical clinical examination under the auspices of the National Board of Podiatry Examiners. Its feasibility is established and problems and issues are discussed.…
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[Science and ethics, therapeutic misconception and mirage].
Raymond, J; Long, H
2008-12-01
Medical practice changes constantly. Ethical imperatives are however incorrigible. How can we reconcile ethics, practice and progress? Some bioethicians argue that research and care should be disentangled to minimize the 'therapeutic misconception', a clinical propensity to believe that patients are the object of medical care, while in fact they are the subjects of a scientific experiment. On the contrary, we believe that clinical research should be an integral part of the good practice. A divorce between research and clinical practice leads to an incorrigible medicine, liable to the therapeutic mirage, that is the false belief that everything modern medicine can offer has been proved beneficial. But both therapeutic misconception and mirage are possible because of a misunderstanding of either research or clinical practice. In this essay we review ethical principles behind clinical trial methodology and attempt to reconcile ethics, science and clinical practice. Not only should clinical research be integrated to the good practice of medicine, it should also be part of training in our specialty.
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Henderson, Amanda; Harrison, Penny; Rowe, Jennifer; Edwards, Sam; Barnes, Margaret; Henderson, Simon; Henderson, Amanda
2018-04-10
To prepare graduate nurses for practice, the curriculum and pedagogy need to facilitate student engagement, active learning and the development of self-efficacy. This pilot project describes and explores an initiative, the Check-in and Check-out process, that aims to engage students as active partners in their learning and teaching in their clinical preparation for practice. Three interdependent elements make up the process: a check-in (briefing) part; a clinical practice part, which supports students as they engage in their learning and practise clinical skills; and a check-out (debriefing) part. A student evaluation of this initiative confirmed the value of the process, which has subsequently been embedded in the preparation for practice and work-integrated learning courses in the undergraduate nursing programs at the participating university. The introduction of a singular learning process provides consistency in the learning approach used across clinical learning spaces, irrespective of their location or focus. A consistent learning process-including a common language that easily transfers across all clinical courses and clinical settings-arguably enhances the students' learning experience, helps them to actively manage their preparation for clinical practice and to develop self-efficacy. Copyright © 2018. Published by Elsevier Ltd.
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Blackstock, Felicity C; Watson, Kathryn M; Morris, Norman R; Jones, Anne; Wright, Anthony; McMeeken, Joan M; Rivett, Darren A; O'Connor, Vivienne; Peterson, Raymond F; Haines, Terry P; Watson, Geoffrey; Jull, Gwendolen Anne
2013-02-01
Simulated learning environments (SLEs) are used worldwide in health professional education, including physiotherapy, to train certain attributes and skills. To date, no randomized controlled trial (RCT) has evaluated whether education in SLEs can partly replace time in the clinical environment for physiotherapy cardiorespiratory practice. Two independent single-blind multi-institutional RCTs were conducted in parallel using a noninferiority design. Participants were volunteer physiotherapy students (RCT 1, n = 176; RCT 2, n = 173) entering acute care cardiorespiratory physiotherapy clinical placements. Two SLE models were investigated as follows: RCT 1, 1 week in SLE before 3 weeks of clinical immersion; RCT 2, 2 weeks of interspersed SLE/clinical immersion (equivalent to 1 SLE week) within the 4-week clinical placement. Students in each RCT were stratified on academic grade and randomly allocated to an SLE plus clinical immersion or clinical immersion control group. The primary outcome was competency to practice measured in 2 clinical examinations using the Assessment of Physiotherapy Practice. Secondary outcomes were student perception of experience and clinical educator and patient rating of student performance. There were no significant differences in student competency between the SLE and control groups in either RCT, although students in the interspersed group (RCT 2) achieved a higher score in 5 of 7 Assessment of Physiotherapy Practice standards (all P < 0.05). Students rated the SLE experience positively. Clinical educators and patients reported comparability between groups. An SLE can replace clinical time in cardiorespiratory physiotherapy practice. Part education in the SLE satisfied clinical competency requirements, and all stakeholders were satisfied.
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Godény, Sándor
2012-02-05
The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.
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New Zealand veterinarians--demography, remuneration and vacancies.
Jackson, R; Goodwin, K A; Perkins, N R; Roddick, J
2004-08-01
To determine levels of remuneration for veterinarians in New Zealand, to examine associations between putative explanatory factors and gross annual remuneration, and to quantify the type and prevalence of vacant positions. A postal survey to 486 identifiable clinical practices and 53 identifiable organisations that employ veterinarians was used to gather data for the 2-month period of December 2001 to January 2002. Data were produced for 972 veterinarians (367 females and 605 males) working in 325 clinical practices, and 299 veterinarians (88 females and 211 males) employed by 32 organisations. Median levels of gross annual remuneration for assistants, partners/ shareholders and sole owners working >/=5 days per week in clinical practice were NZ$60,000, $90,000 and $75,000, respectively, and for veterinarians in organisations, irrespective of number of days per week worked, was $68,000. Pay rates increased linearly as the number of years since graduation increased for all clinicians and with increasing age for veterinarians in organisations. Full-time assistants were likely to be paid more if the practice was rural rather than urban in location, if they were males, and if administrative duties were part of the job. The same factors, except for sex, were significant for remuneration for owners and partners/shareholders working full-time. Their remuneration tended to be higher if the practice was involved with either dairy or deer work but decreased as the number of animal species serviced increased and if they worked >5 days per week. Part-time female veterinarians were generally paid more than male counterparts. Male veterinarians working in organisations were generally paid about 8% more than their female colleagues. Veterinarians in organisations involved with administration at a head office were generally better paid than those without administrative duties. Pay rates were, on the whole, better in private organisations than in universities, state-owned enterprises, government-operated and other types of organisations About 50% of all services provided by clinical practices were directed to small animals, 27% to dairy cattle and about 10%, 6% and 3% to horses, sheep and beef cattle, and deer, respectively. About 31% of veterinarians worked solely with small animals but most had multiple species workloads. Of the 325 respondent practices, 98 reported vacancies for 119 veterinarians, of which 79 were full-time, 27 part-time and 12 locum positions. Of the 32 respondent organisations, seven reported vacancies for 16 mostly full-time positions. Farmer owned co-operative practices were less likely than privately owned practices to have full-time vacant positions. The only factor identified as influencing part-time vacancies in clinical practices was hourly pay rate. Vacancies occurred randomly across practices, irrespective of location, and there was no indication of greater demand for services for any particular species. The odds of a vacancy in organisations was lower for state-owned enterprises and private organisations than for government organisations (odds ratios (OR)=0.14 and 0.18, respectively). Relatively more females than males worked part-time and 23% of all assistants in clinical practice worked part-time. Sex made a significant difference to gross remuneration for full-time assistants in clinical practice and for veterinarians employed by private or government organisations. In both situations, males were generally better paid than females. Female part-time assistants and partners/shareholders or sole owners in clinical practice were generally better rewarded than their male counterparts. Sex had no effect on remuneration levels for owners/ partners working full-time in clinical practices. The study confirmed a serious shortage of veterinarians in New Zealand. The probability of a vacancy occurring in farmer owned co-operative ('club') practices was lower than in private practices. Vacancies were distributed randomly among rural, urban and rural/urban practices with no evidence of rural practices being more severely affected than urban or rural/urban practices.
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Assessment and accountability: part 3 - sign-off mentors.
Houghton, Trish
2016-08-03
Assessment in clinical practice is a complex role undertaken by mentors and practice teachers. This article is the third of three articles about assessment in practice. Part one focused on the importance of assessment and identified assessment methods used in clinical practice, while part two discussed the importance of feedback and managing failing students. This article examines the concepts of responsibility and accountability as well as ethical issues for mentors and practice teachers in relation to the assessment process. The role of the sign-off mentor, the issue of due regard, and ethical principles are discussed. The meaning of competence and partnership working when making assessment decisions are explored. This article relates to the third domain and outcomes of the Nursing and Midwifery Council's Standards to Support Learning and Assessment in Practice on assessment and accountability.
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Are "part-time" general practitioners workforce idlers or committed professionals?
Dwan, Kathryn M; Douglas, Kirsty A; Forrest, Laura E
2014-09-19
The traditional view of general practice holds that only general practitioners (GPs) in full-time clinical practice can provide quality patient care. Nevertheless, increasing numbers of GPs are choosing to work sessionally, that is, ostensibly "part-time". There are concerns about the health workforce's ability to meet demand and also fears that patient care may be compromised. We sought answers to a) what activities do GPs undertake when not consulting patients, b) why do they choose to work sessionally, and c) does sessional general practice reflect a lack of commitment to patients and the profession? Semi-structured interviews were conducted with GPs who worked sessionally, (i.e. six or fewer sessions a week in clinical general practice, where a session comprises four consecutive hours of patient care). These data were analysed qualitatively and saturation was reached. The majority of participants were in full-time paid employment, while part-time in clinical general practice. They reported that consultations increasingly required the management of patients with complex, chronic conditions who also required psychological management. Coupled with unrealistic patient expectations, these factors led GPs to be concerned about maintaining the quality patient care they considered professionally desirable. Many diversified their work activities to ensure that they retained their professional standards. "Part-time" general practice is a misnomer that masks the contribution these GPs make as part of the health workforce. Sessional practice more accurately describes the nature of our participants' clinical work. Their choice of sessional work is a professional response to the increasing demands within the consultation. It enables GPs to maintain their commitment to quality patient care and their profession, while attenuating the challenges of demanding consultations. Sessional general practitioners demonstrate strong commitment to their patients and the profession.
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Part of the fabric and mostly right: an ethnography of ethics in clinical practice.
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.
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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."
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Assessment and accountability: part 2 - managing failing students.
Houghton, Trish
2016-06-08
Assessment in clinical practice is a complex role undertaken by mentors and practice teachers. This article is the second of three articles about assessment in practice. Part one examined the importance of assessment and identified various assessment methods used in clinical practice. This article considers two main themes in the assessment of practice. First, it outlines the importance of providing feedback, and explores preparation for regular feedback and the documentation used to help mentors and practice teachers undertake this activity. Second, it discusses management of failing students, and reviews the literature relating to the 'failure to fail' phenomenon. This article relates to the third domain and outcomes of the Nursing and Midwifery Council's Standards to Support Learning and Assessment in Practice on assessment and accountability.
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Identifying and preparing the next generation of part-time clinical teachers from dental practice.
Radford, D R; Hellyer, P; Meakin, N; Jones, K A
2015-10-09
Part-time general dental practitioners (GDPs) and dental care professionals (DCPs) working in practice are being increasingly utilised to deliver undergraduate clinical dental education to both dental and hygiene/therapy students. As such, there is a need for appropriate recruitment processes and ongoing staff development in the different and complex role of the clinical teacher. Recently a group of experienced dental practitioners, making a journey from GDP to part-time clinical teacher, identified common themes, experiences, challenges and realisations. These were: 'what is clinical dental education?'; 'me as a clinical teacher'; and 'specific teaching issues'. The themes highlighted the complexity of dental education and the different environment of the teaching clinic from general practice. Some of the themes identified could be a starting point for the induction process to facilitate an easier transition from experienced GDP to clinical teacher. With the current demands from both students and patients alike, the 'three way dynamic of patient, student and teacher' needs to be supported if dental schools are to attract and develop the highest quality clinical teachers. It is of critical importance to give an exceptional experience to students in their clinical education as well as to patients in terms of excellent and appropriate treatment. The challenge for deans and directors of education is to find the resources to properly fund teacher recruitment, induction and the development of part-time GDPs in order to produce the expert teachers of tomorrow.
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CRC handbook of neurohypophyseal hormone analogs. Volume 2
DOE Office of Scientific and Technical Information (OSTI.GOV)
Jost, K.; Lebl, M.; Brtnik, F.
1987-01-01
This book is discussed in two parts. The Part 1 discusses the: Prohormones and Hormonogens of Neuro-hypophyseal Hormones, Analogs with Inhibitory properties. Analogs with Dissociated and/or High activities. Introduction. Uterotonic Activity. Galactogogic Activity. Pressor Activity. Antidiuretic Activity. References. Part 2 discusses the Other Important Activities. CNS Activities. Corticotropin- and ..beta..-Entriuretic Action. Natriferic Action. References. Practical Use in Human and Veterinary Medicine. Introduction. Methyloxytocin. Deamino-Oxytocin. Cargutocin. Glypressin. Octapressin. Desmopressin. Analogs Clinically Tried But Not Introduced into Production and Routine Clinical Practice. References. Tables of Analogs and Index.
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Clinical and administrative review in general practice
Stott, N. C. H.; Davis, R. H.
1975-01-01
Clinical and administrative review in primary medical care can be an enjoyable and creative part of group-practice life. A series of such reviews are described which improve internal or external communication for the primary care team. PMID:1223278
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Knepper, Todd C; Bell, Gillian C; Hicks, J Kevin; Padron, Eric; Teer, Jamie K; Vo, Teresa T; Gillis, Nancy K; Mason, Neil T; McLeod, Howard L; Walko, Christine M
2017-02-01
The increasing practicality of genomic sequencing technology has led to its incorporation into routine clinical practice. Successful identification and targeting of driver genomic alterations that provide proliferative and survival advantages to tumor cells have led to approval and ongoing development of several targeted cancer therapies. Within many major cancer centers, molecular tumor boards are constituted to shepherd precision medicine into clinical practice. In July 2014, the Clinical Genomics Action Committee (CGAC) was established as the molecular tumor board companion to the Personalized Medicine Clinical Service (PMCS) at Moffitt Cancer Center in Tampa, Florida. The processes and outcomes of the program were assessed in order to help others move into the practice of precision medicine. Through the establishment and initial 1,400 patients of the PMCS and its associated molecular tumor board at a major cancer center, five practical lessons of broad applicability have been learned: transdisciplinary engagement, the use of the molecular report as an aid to clinical management, clinical actionability, getting therapeutic options to patients, and financial considerations. Value to patients includes access to cutting-edge practice merged with individualized preferences in treatment and care. Genomic-driven cancer medicine is increasingly becoming a part of routine clinical practice. For successful implementation of precision cancer medicine, strategically organized molecular tumor boards are critical to provide objective evidence-based translation of observed molecular alterations into patient-centered clinical action. Molecular tumor board implementation models along with clinical and economic outcomes will define future treatment standards. The Oncologist 2017;22:144-151 Implications for Practice: It is clear that the increasing practicality of genetic tumor sequencing technology has led to its incorporation as part of routine clinical practice. Subsequently, many cancer centers are seeking to develop a personalized medicine services and/or molecular tumor board to shepherd precision medicine into clinical practice. This article discusses the key lessons learned through the establishment and development of a molecular tumor board and personalized medicine clinical service. This article highlights practical issues and can serve as an important guide to other centers as they conceive and develop their own personalized medicine services and molecular tumor boards. © AlphaMed Press 2017.
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Knepper, Todd C.; Bell, Gillian C.; Hicks, J. Kevin; Padron, Eric; Teer, Jamie K.; Vo, Teresa T.; Gillis, Nancy K.; Mason, Neil T.; Walko, Christine M.
2017-01-01
Abstract Background. The increasing practicality of genomic sequencing technology has led to its incorporation into routine clinical practice. Successful identification and targeting of driver genomic alterations that provide proliferative and survival advantages to tumor cells have led to approval and ongoing development of several targeted cancer therapies. Within many major cancer centers, molecular tumor boards are constituted to shepherd precision medicine into clinical practice. Materials and Methods. In July 2014, the Clinical Genomics Action Committee (CGAC) was established as the molecular tumor board companion to the Personalized Medicine Clinical Service (PMCS) at Moffitt Cancer Center in Tampa, Florida. The processes and outcomes of the program were assessed in order to help others move into the practice of precision medicine. Results. Through the establishment and initial 1,400 patients of the PMCS and its associated molecular tumor board at a major cancer center, five practical lessons of broad applicability have been learned: transdisciplinary engagement, the use of the molecular report as an aid to clinical management, clinical actionability, getting therapeutic options to patients, and financial considerations. Value to patients includes access to cutting‐edge practice merged with individualized preferences in treatment and care. Conclusions. Genomic‐driven cancer medicine is increasingly becoming a part of routine clinical practice. For successful implementation of precision cancer medicine, strategically organized molecular tumor boards are critical to provide objective evidence‐based translation of observed molecular alterations into patient‐centered clinical action. Molecular tumor board implementation models along with clinical and economic outcomes will define future treatment standards. Implications for Practice. It is clear that the increasing practicality of genetic tumor sequencing technology has led to its incorporation as part of routine clinical practice. Subsequently, many cancer centers are seeking to develop a personalized medicine services and/or molecular tumor board to shepherd precision medicine into clinical practice. This article discusses the key lessons learned through the establishment and development of a molecular tumor board and personalized medicine clinical service. This article highlights practical issues and can serve as an important guide to other centers as they conceive and develop their own personalized medicine services and molecular tumor boards. PMID:28179575
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Reid, Beth A; Ridoutt, Lee; O'Connor, Paul; Murphy, Deirdre
2017-09-01
This is the second of two articles about best practice in the management of coding services. The best practice project was part of a year-long project conducted in the Republic of Ireland to review the quality of the Hospital Inpatient Enquiry data for its use in activity-based funding. The four methods used to address the best practice aspect of the project were described in detail in Part 1. The results included in this article are those relating to the coding manager's background, preparation and style, clinical coder (CC) workforce adequacy, the CC workforce structure and career pathway, and the physical and psychological work environment for the clinical coding service. Examples of best practice were found in the study hospitals but there were also areas for improvement. Coding managers would benefit from greater support in the form of increased opportunities for management training and a better method for calculating CC workforce numbers. A career pathway is needed for CCs to progress from entry to expert CC, mentor, manager and quality controller. Most hospitals could benefit from investment in infrastructure that places CCs in a physical environment that tells them they are an important part of the hospital and their work is valued.
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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.
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Productivity, Quality, and Patient Satisfaction
Fairchild, David G; McLoughlin, Karen Sax; Gharib, Soheyla; Horsky, Jan; Portnow, Michelle; Richter, James; Gagliano, Nancy; Bates, David W
2001-01-01
CONTEXT Although few data are available, many believe that part-time primary care physicians (PCPs) are less productive and provide lower quality care than full-time PCPs. Some insurers exclude part-time PCPs from their provider networks. OBJECTIVE To compare productivity, qualtiy of preventive care, patient satisfaction, and risk-adjusted resource utilization of part-time and full-time PCPs. DESIGN Retrospective cohort study. SETTING Boston. PARTICIPANTS PCPs affiliated with 2 academic outpatient primary care networks. MEASUREMENTS PCP productivity, patient satisfaction, resource utilization, and compliance with screening guidelines. RESULTS Part-time PCP productivity was greater than that of full-time PCPs (2.1 work relative value units (RVUs)/bookable clinical hour versus 1.3 work RVUs/bookable clinical hour, P < .01). A similar proportion of part-time PCPs (80%) and full-time PCPs (75%) met targets for mammography, Pap smears, and cholesterol screening (P = .67). After adjusting for clinical case mix, practice location, gender, board certification status, and years in practice, resource utilization of part-time PCPs ($138 [95% confidence interval (CI), $108 to $167]) was similar to that of full-time PCPs ($139 [95% CI, $108 to $170], P = .92). Patient satisfation was similar for part-time and full-time PCPs. CONCLUSIONS In these academic primary care practices, rates of patient satisfaction, compliance with screenig guidelines, and resource utilization were similar for part-time PCPs compared to full-time PCPs. Productivity per clinical hour was markedly higher for part-time PCPs are atleast as efficient as full-time PCPs and that the quality of their work is similar. PMID:11679033
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ERIC Educational Resources Information Center
Beckley, Firle; Best, Wendy; Beeke, Suzanne
2017-01-01
Background: Communication strategy training (CST) is a recognized part of UK speech and language therapists' (SLTs) role when working with a person with aphasia. Multiple CST interventions have been published but, to date, there are no published studies exploring clinical practice in this area. Aims: To investigate UK SLTs' current CST practices.…
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Fairchild, D G; McLoughlin, K S; Gharib, S; Horsky, J; Portnow, M; Richter, J; Gagliano, N; Bates, D W
2001-10-01
Although few data are available, many believe that part-time primary care physicians (PCPs) are less productive and provide lower quality care than full-time PCPs. Some insurers exclude part-time PCPs from their provider networks. To compare productivity, quality of preventive care, patient satisfaction, and risk-adjusted resource utilization of part-time and full-time PCPs. Retrospective cohort study. Boston. PCPs affiliated with 2 academic outpatient primary care networks. PCP productivity, patient satisfaction, resource utilization, and compliance with screening guidelines. Part-time PCP productivity was greater than that of full-time PCPs (2.1 work relative value units (RVUs)/bookable clinical hour versus 1.3 work RVUs/bookable clinical hour, P< .01). A similar proportion of part-time PCPs (80%) and full-time PCPs (75%) met targets for mammography, Pap smears, and cholesterol screening (P = .67). After adjusting for clinical case mix, practice location, gender, board certification status, and years in practice, resource utilization of part-time PCPs (138 dollars [95% confidence interval (CI), 108 dollars to 167 dollars]) was similar to that of full-time PCPs (139 dollars [95% CI, 108 dollars to 170 dollars], P = .92). Patient satisfaction was similar for part-time and full-time PCPs. In these academic primary care practices, rates of patient satisfaction, compliance with screening guidelines, and resource utilization were similar for part-time PCPs compared to full-time PCPs. Productivity per clinical hour was markedly higher for part-time PCPs. Despite study limitations, these data suggest that academic part-time PCPs are at least as efficient as full-time PCPs and that the quality of their work is similar.
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Expense comparison of a telemedicine practice versus a traditional clinical practice.
Barker, Gail P; Krupinski, Elizabeth A; Schellenberg, Bonnie; Weinstein, Ronald S
2004-01-01
This paper compares the expenses of a telemedicine program to those of a traditional clinical practice using data from two fiscal years (FY) 1998/1999 and 2000/2001. As part of that evaluation, we compared expenses of the University of Arizona's clinical practice group, the University Physicians Incorporated (UPI), to those of the Arizona Telemedicine Program (ATP) practice. For this study, we used the reporting categories published in the year-end UPI financial statement. These categories included clinical services, administration, equipment depreciation, and overhead. Results showed that clinical service expenses and administrative expenses for FY 2000/2001 were higher in the traditional UPI practice, whereas equipment depreciation and overhead expenses are higher in the telemedicine practice. This differs somewhat from FY 1998/1999, where clinical expenses and overhead were higher in the UPI practice and administration and equipment depreciation were higher in the telemedicine practice. We will discuss the relevance of these results and the critical factors that contribute to these differences.
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The role of emotions in moral case deliberation: theory, practice, and methodology.
Molewijk, Bert; Kleinlugtenbelt, Dick; Widdershoven, Guy
2011-09-01
In clinical moral decision making, emotions often play an important role. However, many clinical ethicists are ignorant, suspicious or even critical of the role of emotions in making moral decisions and in reflecting on them. This raises practical and theoretical questions about the understanding and use of emotions in clinical ethics support services. This paper presents an Aristotelian view on emotions and describes its application in the practice of moral case deliberation. According to Aristotle, emotions are an original and integral part of (virtue) ethics. Emotions are an inherent part of our moral reasoning and being, and therefore they should be an inherent part of any moral deliberation. Based on Aristotle's view, we examine five specific aspects of emotions: the description of emotions, the attitude towards emotions, the thoughts present in emotions, the reliability of emotions, and the reasonable principle that guides an emotion. We then discuss three ways of dealing with emotions in the process of moral case deliberation. Finally, we present an Aristotelian conversation method, and present practical experiences using this method. © 2011 Blackwell Publishing Ltd.
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Risk management in clinical practice. Part 10. Periodontology.
Baker, P; Needleman, I
2010-12-11
A sizeable proportion of patients in clinical practice will have some form of periodontal disease and most of these patients can be well managed in primary care. Unfortunately, dento-legal claims regarding inappropriate periodontal care are increasing rapidly and are now one of the most common reasons for litigation in dentistry. In this paper we will look at aspects of contemporary management of periodontal disease in clinical practice and offer guidance for examination, management and referral.
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ERIC Educational Resources Information Center
Baker, Elise; McLeod, Sharynne
2011-01-01
Purpose: This article provides both a tutorial and a clinical example of how speech-language pathologists (SLPs) can conduct evidence-based practice (EBP) when working with children with speech sound disorders (SSDs). It is a companion paper to the narrative review of 134 intervention studies for children who have an SSD (Baker & McLeod, 2011).…
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ERIC Educational Resources Information Center
Mortier, Teresa
2017-01-01
The clinical laboratory science field requires an abundance of technical knowledge; however, the importance of implicit or tacit knowledge gained through observation and practice is often discounted in this field, even though it is a critical part of reflective thinking, critical thinking, and reflective practice. The "de-skilling" of…
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WE-D-213-04: Preparing for Parts 2 & 3 of the ABR Nuclear Medicine Physics Exam
DOE Office of Scientific and Technical Information (OSTI.GOV)
MacDougall, R.
Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less
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WE-D-213-01: Preparing for Part 1 of the ABR Diagnostic Physics Exam
DOE Office of Scientific and Technical Information (OSTI.GOV)
Simiele, S.
Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less
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WE-D-213-03: Preparing for Part 3 of the ABR Diagnostic Physics Exam
DOE Office of Scientific and Technical Information (OSTI.GOV)
Bevins, N.
Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less
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WE-D-213-02: Preparing for Part 2 of the ABR Diagnostic Physics Exam
DOE Office of Scientific and Technical Information (OSTI.GOV)
Zambelli, J.
Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less
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[What everybody should know about good clinical practices].
Osorio, Lyda
2015-01-01
An increasing number of countries are adopting good clinical practices guidelines as part of the regulation of clinical studies to register pharmaceutical products and other health-related products. Consequently, all parties involved in the research and development of these products should know them, implement them and ensure their compliance. However, good clinical practices guidelines are just one of the initiatives seeking to achieve the highest ethical and scientific standards in health research and in other areas where humans are research subjects. This review defines such practices and their objectives presenting in a practical manner their legal framework in Colombia, and clarifying their application in studies where interventions use no medications or those that are not clinical trials. Finally, the work discusses the challenges to ensure that good clinical practices contribute to the protection of research participants, the education of trustworthy health professionals, and a culture of respect for human beings.
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Impact of Nursing Students' Free-Clinic Experiences on Subsequent Professional Nursing Practice
ERIC Educational Resources Information Center
Bell, Christina Lynn
2017-01-01
Bachelors of Science Nursing students at a small liberal arts college in the upper Midwest volunteer with an instructor at a free clinic as part of their curriculum. This study's purpose was to identify the impact of nursing students' free-clinic experiences on their subsequent professional nursing practice and their ability to attend to: (a)…
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MO-F-204-02: Preparing for Part 2 of the ABR Diagnostic Physics Exam
DOE Office of Scientific and Technical Information (OSTI.GOV)
Szczykutowicz, T.
Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less
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MO-F-204-03: Preparing for Part 3 of the ABR Diagnostic Physics Exam
DOE Office of Scientific and Technical Information (OSTI.GOV)
Zambelli, J.
Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less
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MO-F-204-01: Preparing for Part 1 of the ABR Diagnostic Physics Exam
DOE Office of Scientific and Technical Information (OSTI.GOV)
McKenney, S.
Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less
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MO-F-204-04: Preparing for Parts 2 & 3 of the ABR Nuclear Medicine Physics Exam
DOE Office of Scientific and Technical Information (OSTI.GOV)
MacDougall, R.
Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less
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WE-D-213-00: Preparing for the ABR Diagnostic and Nuclear Medicine Physics Exams
DOE Office of Scientific and Technical Information (OSTI.GOV)
NONE
Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less
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An ethnographic study of nurses' experience with nursing research and its integration in practice.
Dupin, Cécile Marie; Borglin, Gunilla; Debout, Christophe; Rothan-Tondeur, Monique
2014-09-01
To report from a study aimed at illuminating how French Registered Nurses experience and engage in nursing research in clinical practice. Nursing research in France is mainly conducted by nurses working at clinical research units rather than by dedicated nurse researchers. Education, i.e. advanced degrees, in the field of nursing research is still in its infancy and not yet consistent with the international context. Outside France, the general perception is that nursing research is a unified part of professional nursing. Consequently, in-depth knowledge about how nurses in a French clinical context might experience and engage in nursing research is still lacking. The design of this study was influenced by an ethnographic approach as described by the French anthropologists Beaud and Weber. Data, participatory observations, field notes and interviews (n = 6) were collected in a teaching hospital between April-August 2012. The field consisted of a wound-care unit and clinical research units. Collected data were analysed based on Beaud and Weber's description of analysis. Three beliefs were identified: being a unified part of a research team, being an integral part of 'crosswise - across' activities and being part of research activities. Commitment to nursing research was strengthened by patient-related issues. Based on this context, nursing research would likely benefit from the support of a naturalized reciprocity between clinical practice and research. © 2014 John Wiley & Sons Ltd.
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MO-F-204-00: Preparing for the ABR Diagnostic and Nuclear Medical Physics Exams
DOE Office of Scientific and Technical Information (OSTI.GOV)
NONE
Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less
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Evidence-Based Practice for Children with Speech Sound Disorders: Part 1 Narrative Review
ERIC Educational Resources Information Center
Baker, Elise; McLeod, Sharynne
2011-01-01
Purpose: This article provides a comprehensive narrative review of intervention studies for children with speech sound disorders (SSD). Its companion paper (Baker & McLeod, 2011) provides a tutorial and clinical example of how speech-language pathologists (SLPs) can engage in evidence-based practice (EBP) for this clinical population. Method:…
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Davis, Bruce H; Dasgupta, Amar; Kussick, Steven; Han, Jin-Yeong; Estrellado, Annalee
2013-01-01
Flow cytometry and other technologies of cell-based fluorescence assays are as a matter of good laboratory practice required to validate all assays, which when in clinical practice may pass through regulatory review processes using criteria often defined with a soluble analyte in plasma or serum samples in mind. Recently the U.S. Food and Drug Administration (FDA) has entered into a public dialogue in the U.S. regarding their regulatory interest in laboratory developed tests (LDTs) or so-called "home brew" assays performed in clinical laboratories. The absence of well-defined guidelines for validation of cell-based assays using fluorescence detection has thus become a subject of concern for the International Council for Standardization of Haematology (ICSH) and International Clinical Cytometry Society (ICCS). Accordingly, a group of over 40 international experts in the areas of test development, test validation, and clinical practice of a variety of assay types using flow cytometry and/or morphologic image analysis were invited to develop a set of practical guidelines useful to in vitro diagnostic (IVD) innovators, clinical laboratories, regulatory scientists, and laboratory inspectors. The focus of the group was restricted to fluorescence reporter reagents, although some common principles are shared by immunohistochemistry or immunocytochemistry techniques and noted where appropriate. The work product of this two year effort is the content of this special issue of this journal, which is published as 5 separate articles, this being Validation of Cell-based Fluorescence Assays: Practice Guidelines from the ICSH and ICCS - Part II - Preanalytical issues. © 2013 International Clinical Cytometry Society. © 2013 International Clinical Cytometry Society.
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Federal Register 2010, 2011, 2012, 2013, 2014
2013-02-07
... Part II: Lifelong Learning and Self-Assessment Part III: Cognitive Expertise Part IV: Practice...: Licensure and Professional Standing Part II: Lifelong Learning and Self-Assessment Part III: Cognitive...\\ The MOC assesses physicians' commitment to lifelong learning according to the following six core...
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Sargeant, Sally J E; Harrison, Janet
2004-09-01
This paper is the first of a two-part series of articles presenting the role of the clinical librarian (CL) in the UK today. It situates the CL concept historically, and specifically reports the findings from a study in 2002 (Skinner, The Role of the Clinical Librarian in the UK. MSc Dissertation. Loughborough University: Department of Information Science). The impetus for the 2002 study was the awareness of an increase in job advertisements within the NHS for roles seeking to enhance the practice of evidence-based medicine, which included elements of clinical librarianship. Therefore the research was undertaken to establish whether this increase was coincidental, or the beginning of a new professional role for librarians. A content analysis of CL job advertisements, examining job titles and duties was undertaken. Twenty-three advertisements were scrutinized, and these results are presented here. As a complementary investigation, a postal questionnaire was sent to a sample of practising CLs in the UK. Several duties can be classified as core to the role of the CL. However there is a great diversity of duties attached to this core, reflecting an absence of nationally accepted practice. Further work was necessary to assess current practice and how clinical librarianship can continue to grow at local and national levels. This is addressed in Part Two of this series.
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Video observation in HIT development: lessons learned on benefits and challenges.
Høstgaard, Anna Marie; Bertelsen, Pernille
2012-08-22
Experience shows that the precondition for the development of successful health information technologies is a thorough insight into clinical work practice. In contemporary clinical work practice, clinical work and health information technology are integrated, and part of the practice is tacit. When work practice becomes routine, it slips to the background of the conscious awareness and becomes difficult to recognize without the context to support recall. This means that it is difficult to capture with traditional ethnographic research methods or in usability laboratories or clinical set ups. Observation by the use of the video technique within healthcare settings has proven to be capable of providing a thorough insight into the complex clinical work practice and its context - including parts of the tacit practice. The objective of this paper is 1) to argue for the video observation technique to inform and improve health-information-technology development and 2) to share insights and lessons learned on benefits and challenges when using the video observation technique within healthcare settings. A multiple case study including nine case studies conducted by DaCHI researchers 2004-2011 using audio-visual, non-participant video observation for data collection within different healthcare settings. In HIT development, video observation is beneficial for 1) informing and improving system design 2) studying changes in work practice 3) identifying new potentials and 4) documenting current work practices. The video observation technique used within healthcare settings is superior to other ethnographic research methods when it comes to disclosing the complexity in clinical work practice. The insights gained are far more realistic compared to traditional ethnographic studies or usability studies and studies in clinical set ups. Besides, the data generated through video recordings provide a solid basis for dialog between the health care professionals involved. The most important lessons learned are that a well considered methodology and clear formulated objectives are imperative, in order to stay focused during the data rich analysis phase. Additionally, the video observation technique is primarily recommended for studies of specific clinical work practices within delimited clinical settings. Overall, the video observation technique has proven to be capable of improving our understanding of the interwoven relation between clinical work practice and HIT and to inform us about user requirements and needs for HIT, which is a precondition for the development of more successful HIT systems in the future.
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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.
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Clinical examination & record-keeping: Part 2: History taking.
Hadden, A M
2017-12-15
This article is the second part of a BDJ series of Practice papers on the subject of clinical examination and related record keeping. The series is taken from the Faculty of General Dental Practice UK (FGDP[UK]) 2016 Good Practice Guidelines book on this topic, edited by A. M. Hadden. This particular article discusses history taking, where information may be gathered prior to the patient seeing the clinician or, in some cases, this may be carried out chairside by the individual. The information gathered can include a medical history, socio-behavioural history, and patient anxiety levels. It is important to note that throughout this article (and the BDJ series and associated FGDP[UK] book), the specific guidelines will be marked as follows: A: Aspirational, B: Basic, C: Conditional. Further information about this guideline notation system is provided in Part 1 of this series ( 2017; 223: 765-768).
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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
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Barnett, David; Louzao, Raaul; Gambell, Peter; De, Jitakshi; Oldaker, Teri; Hanson, Curtis A
2013-01-01
Flow cytometry and other technologies of cell-based fluorescence assays are as a matter of good laboratory practice required to validate all assays, which when in clinical practice may pass through regulatory review processes using criteria often defined with a soluble analyte in plasma or serum samples in mind. Recently the U.S. Food and Drug Administration (FDA) has entered into a public dialogue in the U.S. regarding their regulatory interest in laboratory developed tests (LDTs) or so-called home brew assays performed in clinical laboratories. The absence of well-defined guidelines for validation of cell-based assays using fluorescence detection has thus become a subject of concern for the International Council for Standardization of Haematology (ICSH) and International Clinical Cytometry Society (ICCS). Accordingly, a group of over 40 international experts in the areas of test development, test validation, and clinical practice of a variety of assay types using flow cytometry and/or morphologic image analysis were invited to develop a set of practical guidelines useful to in vitro diagnostic (IVD) innovators, clinical laboratories, regulatory scientists, and laboratory inspectors. The focus of the group was restricted to fluorescence reporter reagents, although some common principles are shared by immunohistochemistry or immunocytochemistry techniques and noted where appropriate. The work product of this two year effort is the content of this special issue of this journal, which is published as 5 separate articles, this being Validation of Cell-based Fluorescence Assays: Practice Guidelines from the ICSH and ICCS - Part IV - Postanalytic considerations. © 2013 International Clinical Cytometry Society.
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Davis, Bruce H; Wood, Brent; Oldaker, Teri; Barnett, David
2013-01-01
Flow cytometry and other technologies of cell-based fluorescence assays are as a matter of good laboratory practice required to validate all assays, which when in clinical practice may pass through regulatory review processes using criteria often defined with a soluble analyte in plasma or serum samples in mind. Recently the U.S. Food and Drug Administration (FDA) has entered into a public dialogue in the U.S. regarding their regulatory interest in laboratory developed tests (LDTs) or so-called "home brew" assays performed in clinical laboratories. The absence of well-defined guidelines for validation of cell-based assays using fluorescence detection has thus become a subject of concern for the International Council for Standardization of Haematology (ICSH) and International Clinical Cytometry Society (ICCS). Accordingly, a group of over 40 international experts in the areas of test development, test validation, and clinical practice of a variety of assay types using flow cytometry and/or morphologic image analysis were invited to develop a set of practical guidelines useful to in vitro diagnostic (IVD) innovators, clinical laboratories, regulatory scientists, and laboratory inspectors. The focus of the group was restricted to fluorescence reporter reagents, although some common principles are shared by immunohistochemistry or immunocytochemistry techniques and noted where appropriate. The work product of this two year effort is the content of this special issue of this journal, which is published as 5 separate articles, this being Validation of Cell-based Fluorescence Assays: Practice Guidelines from the ICSH and ICCS - Part I - Rationale and aims. © 2013 International Clinical Cytometry Society. © 2013 International Clinical Cytometry Society.
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Defining the Path Forward: Guidance for Laboratory Medicine Guidelines
Jones, Patricia M.; Chin, Alex C.; Christenson, Robert H.
2015-01-01
The National Academy of Clinical Biochemistry (NACB) has developed consensus-based guidelines for the laboratory evaluation and monitoring of patients with specified disorders for two decades. In 1997, the NACB recognized the need to standardize the process of guideline development and promulgated its first Standard Operating Procedure (SOP) for this purpose. In 2010, the American Association of Clinical Chemistry (AACC) and NACB created the Evidence-Based Laboratory Medicine Committee (EBLMC). Among other roles, this group was given responsibility to provide oversight of clinical practice guideline development in accordance with SOP guidance and using currently accepted good practices. In 2011, the U.S. Institute of Medicine (IOM) published two reports of relevance: ‘Clinical Practice Guidelines We Can Trust’ and ‘Finding What Works in Health Care – Standards for Systematic Reviews.’ These reports were created as part of a response to a legislative mandate from the U.S. Congress requesting that steps be taken to implement recommendations from lOM’s report on ‘Knowing What Works in Health Care’ (2008). The latest revision of the laboratory medicine practice guidelines (LMPG) SOP was in part driven by these reports. NACB continues to develop LMPGs at a rate of roughly one per year through standard processes detailed in its 2014 revision of the SOP. This article describes the NACB and EBLMC experience in developing LMPGs with a focus on the evolution and use of the latest SOP. AACC and NACB have established a solid track record in collaboratively working with many clinical societies and professional organizations on clinical practice guideline development. Presently, three LMPG’s are in various stages of development and all with the collaboration of other clinical/professional groups. The practices and tools being used for current LMPGs in progress are also highlighted in the context of the challenges that presently exist for effective clinical practice guideline development in the U.S. PMID:27683491
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Considerations for Providing Ambulatory Pharmacy Services for Pediatric Patients.
Lampkin, Stacie J; Gildon, Brooke; Benavides, Sandra; Walls, Kelly; Briars, Leslie
2018-01-01
Pediatric clinical pharmacists are an integral part of the health care team. By practicing in an ambulatory care clinic, they can reduce the risk of medication errors, improve health outcomes, and enhance patient care. Unfortunately, because of limited data, misconceptions surrounding the role of pharmacists, and reimbursement challenges, there may be difficulty in establishing or expanding pediatric clinical pharmacy services to an ambulatory care setting. The purpose of this paper is to provide an overview of considerations for establishing or expanding pharmacy services in a pediatric ambulatory care clinic. The primer will discuss general and pediatric-specific pharmacy practice information, as well as potential barriers, and recommendations for identifying a practice site, creating a business plan, and integrating these services into a clinic setting.
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Maximising the potential of part-time clinical teachers.
Patston, Philip; Holmes, David; Maalhagh-Fard, Ahmad; Ting, Kang; Ziccardi, Vincent B
2010-12-01
A problem faced by health professions education throughout the world is a lack of full-time clinical teachers. This is particularly serious in dentistry and nursing, but is increasingly also true in medicine. To make up for this shortfall there is a growing reliance on part-time clinical teachers. Part-time clinical teachers are essential for the education of students. However, compared with their full-time counterparts, the part-time teachers are often not adequately prepared for their roles as educators within the context of the clinical curriculum. They might not be trained in the latest educational practices, and may be unprepared for the time needed to excel as teachers and mentors. As part-time teachers take on more responsibility, it is important that they take part in orientation and training sessions to assist them in developing the skills they need to succeed. This will require a significant commitment from the institution as well as the part-time teacher, but is critical for maintaining the academic quality of the clinical training programmes. This also represents an untapped area for research into how to ensure the success of part-time clinical teachers. © Blackwell Publishing Ltd 2010.
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ERIC Educational Resources Information Center
Greenwood, Jennifer; Parsons, Myra
2002-01-01
Focus group evaluations of a training program for nurses leading clinical development units focused on research-based practice found that leadership and strategic skills were developed. However, participants had insufficient time to assimilate knowledge or develop mentoring relationships and needed more help developing research-receptive culture…
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Rodger, Sylvia; Webb, Gillian; Devitt, Lorraine; Gilbert, John; Wrightson, Pat; McMeeken, Joan
2008-01-01
This report describes the outcomes of extensive discussions surrounding clinical education and practice placement issues undertaken by an international group of allied health educators (in audiology, occupational therapy, physiotherapy, and speech pathology) who have met since 2001 as part of Universitas 21 Health Sciences annual meetings. The report outlines key issues associated with clinical education and practice placements from an international perspective and across these four allied health professions. The allied health practice context is described in terms of the range of allied health educational programs in Universitas 21 and recent changes in health and tertiary education sectors in represented countries. Some issues and benefits related to supervision during allied health students' practice placements are addressed. A new approach is proposed through partnership such that frameworks for the provision of practice placements can be created to facilitate student learning and educate and support clinical educators. A set of guidelines that can enhance partnerships and collaborative practice for the benefit of clinical education within complex and changing health/human service and educational environments is proposed.
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Darzins, Susan W; Imms, Christine; Stefano, Marilyn Di; Radia-George, Camilla A
2016-10-01
Evidence supports validity of the Personal Care Participation Assessment and Resource Tool (PC-PART), but clinical utility remains unverified. This study aimed to investigate occupational therapists' perceptions about the PC-PART's clinical utility for inpatient rehabilitation. Using mixed methods, occupational therapists who had used the PC-PART as part of a research study in an inpatient rehabilitation setting completed a questionnaire ( n = 9) and participated in a focus group ( n = 6) to explore their perspectives about its clinical utility. Quantitative data were summarized and qualitative data analyzed using inductive thematic analysis. Quantitative data highlighted both positive and negative aspects of the PC-PART's clinical utility. Five themes emerged from the qualitative data: nature of information gathered; familiarity with the instrument; perceived time and effort; item phrasing, interpretation, and presentation; and external influences on clinical use. The PC-PART was perceived to support gathering of clinically useful information, helpful to intervention and discharge planning. Recommendations for improving some item phrasing, operational definitions, and instructions were identified. Although standardized assessments were valued, use in routine practice was challenging, requiring a knowledge translation strategy.
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Comparative effectiveness research in clinical practice.
Lawrence, William F; Chang, Stephanie; Kane, Robert L; Wilt, Timothy J
2014-08-01
The Agency for Healthcare Research and Quality (AHRQ) has funded systematic reviews of comparative effectiveness research in 17 areas over the last 10 years as part of a federal mandate. These reviews provide a reliable and unbiased source of comprehensive information about the effectiveness and risks of treatment alternatives for patients and clinicians. This article describes comparative effectiveness research, provides an overview of how physicians can use it in clinical practice, and references important contributions made by the Minnesota Evidence-based Practice Center.
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Obbels, Jasmien; Vanbrabant, Koen; Bouckaert, Filip; Verwijk, Esmée; Sienaert, Pascal
2016-06-01
Cognition can be affected by electroconvulsive therapy (ECT). Good clinical practice includes neuropsychological assessment, although this is seldom a part of routine clinical practice. It looks like a substantial part of patients fail to complete cognitive assessments. This constitutes a problem in the generalizability of published clinical research on cognitive side effects. Most studies of ECT-related cognitive adverse effects do not discuss this important issue of so-called cognitive test nonparticipants. Recent findings suggest that cognitive test nonparticipants are more severely ill, and probably more vulnerable to cognitive side effects. To examine the feasibility of a neuropsychological test battery in daily clinical practice, in an adult population referred for ECT. We reviewed the clinical records of 84 patients referred for ECT. Demographic and clinical characteristics of those patients who were able to complete our routine cognitive testing at baseline are compared with those who could not complete the assessment. From 84 ECT patients, 60 (71%) completed a pre-ECT cognitive assessment, whereas 24 (29%) did not. Patients with a unipolar depression, with psychotic symptoms, who started their treatment with a bitemporal electrode placement were more likely to be test noncompleters than test completers. Patients with a unipolar depression, with psychotic features, who are treated with a bitemporal electrode placement, have a higher likelihood of not completing a pre-ECT cognitive assessment. These patients probably represent a subgroup more vulnerable to cognitive side effects.
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Oude Rengerink, Katrien; Thangaratinam, Shakila; Barnfield, Gemma; Suter, Katja; Horvath, Andrea R; Walczak, Jacek; Wełmińska, Anna; Weinbrenner, Susanne; Meyerrose, Berit; Arvanitis, Theodoros N; Onody, Rita; Zanrei, Gianni; Kunz, Regina; Arditi, Chantal; Burnand, Bernard; Gee, Harry; Khan, Khalid S; Mol, Ben W J
2011-01-01
Evidence-based medicine (EBM) improves the quality of health care. Courses on how to teach EBM in practice are available, but knowledge does not automatically imply its application in teaching. We aimed to identify and compare barriers and facilitators for teaching EBM in clinical practice in various European countries. A questionnaire was constructed listing potential barriers and facilitators for EBM teaching in clinical practice. Answers were reported on a 7-point Likert scale ranging from not at all being a barrier to being an insurmountable barrier. The questionnaire was completed by 120 clinical EBM teachers from 11 countries. Lack of time was the strongest barrier for teaching EBM in practice (median 5). Moderate barriers were the lack of requirements for EBM skills and a pyramid hierarchy in health care management structure (median 4). In Germany, Hungary and Poland, reading and understanding articles in English was a higher barrier than in the other countries. Incorporation of teaching EBM in practice faces several barriers to implementation. Teaching EBM in clinical settings is most successful where EBM principles are culturally embedded and form part and parcel of everyday clinical decisions and medical practice.
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ERIC Educational Resources Information Center
Rizq, Rosemary; Target, Mary
2008-01-01
There is a widely acknowledged lack of clarity in psychotherapeutic training about the role of personal therapy in developing practitioner competence. This paper presents part of a wider ongoing qualitative study exploring the role that personal therapy plays in the clinical practice and training of experienced counselling psychologists. Results…
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Evidence-based periodontal therapy: An overview
Vijayalakshmi, R.; Anitha, V.; Ramakrishnan, T.; Sudhakar, Uma
2008-01-01
Dentists need to make clinical decisions based on limited scientific evidence. In clinical practice, a clinician must weigh a myriad of evidences every day. The goal of evidence-based dentistry is to help practitioners provide their patients with optimal care. This is achieved by integrating sound research evidence with personal clinical expertise and patient values to determine the best course of treatment. Periodontology has a rich background of research and scholarship. Therefore, efficient use of this wealth of research data needs to be a part of periodontal practice. Evidence-based periodontology aims to facilitate such an approach and it offers a bridge from science to clinical practice. The clinician must integrate the evidence with patient preference, scientific knowledge, and personal experience. Most important, it allows us to care for our patients. Therefore, evidence-based periodontology is a tool to support decision-making and integrating the best evidence available with clinical practice. PMID:20142947
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Lynch, C D; Llewelyn, J; Ash, P J; Chadwick, B L
2011-05-28
Community-based clinical teaching programmes are now an established feature of most UK dental school training programmes. Appropriately implemented, they enhance the educational achievements and competences achieved by dental students within the earlier part of their developing careers, while helping students to traverse the often-difficult transition between dental school and vocational/foundation training and independent practice. Dental school programmes have often been criticised for 'lagging behind' developments in general dental practice - an important example being the so-called 'business of dentistry', including clinical audit. As readers will be aware, clinical audit is an essential component of UK dental practice, with the aims of improving the quality of clinical care and optimising patient safety. The aim of this paper is to highlight how training in clinical audit has been successfully embedded in the community-based clinical teaching programme at Cardiff.
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McIlvennan, Colleen K; Page, Robert L
Pharmacologic treatment for systolic heart failure, otherwise known as heart failure with reduced ejection fraction, has been established through clinical trials and is formulated into guidelines to standardize the diagnosis and treatment. Since the introduction of angiotensin-converting enzyme inhibitors and vasodilators in the 1980s, many guideline-recommended therapies have emerged over the past 20 years targeting specific neurohormones, aldosterone, and catecholamines to treat heart failure. Part 2 of this series will describe β-blockers, digoxin, and aldosterone antagonists in the context of the mechanism of action in heart failure, investigational trials that showed beneficial effects, and the practical applications for clinical use.
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Sharp, J R
1995-01-01
In Part I of this two-part article, in the December 1994 issue of the journal, the author discussed the manufacturing theories of Peter Drucker in terms of their applicability for the health care field. He concluded that Drucker's four principles and practices of manufacturing--statistical quality control, manufacturing accounting, modular organization, and systems approach--do have application to the health care system. Clinical guidelines, a variation on the Drucker theory, are a specific example of the manufacturing process in health. The performance to date of some guidelines and their implications for the health care reform debate are discussed in Part II of the article.
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Chang, Hui-Ming; Moudgil, Rohit; Scarabelli, Tiziano; Okwuosa, Tochukwu M; Yeh, Edward T H
2017-11-14
Modern cancer therapy has successfully cured many cancers and converted a terminal illness into a chronic disease. Because cancer patients often have coexisting heart diseases, expert advice from cardiologists will improve clinical outcome. In addition, cancer therapy can also cause myocardial damage, induce endothelial dysfunction, and alter cardiac conduction. Thus, it is important for practicing cardiologists to be knowledgeable about the diagnosis, prevention, and management of the cardiovascular complications of cancer therapy. In this first part of a 2-part review, we will review cancer therapy-induced cardiomyopathy and ischemia. This review is based on a MEDLINE search of published data, published clinical guidelines, and best practices in major cancer centers. With the number of cancer survivors expanding quickly, the time has come for cardiologists to work closely with cancer specialists to prevent and treat cancer therapy-induced cardiovascular complications. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Leadership for learning: a literature study of leadership for learning in clinical practice.
Allan, Helen T; Smith, Pamela A; Lorentzon, Maria
2008-07-01
To report a literature study of leadership for learning in clinical practice in the United Kingdom. Background Previous research in the United Kingdom showed that the ward sister was central to creating a positive learning environment for student nurses. Since the 1990s, the ward mentor has emerged as the key to student nurses' learning in the United Kingdom. A literature study of new leadership roles and their influence on student nurse learning (restricted to the United Kingdom) which includes an analysis of ten qualitative interviews with stakeholders in higher education in the United Kingdom undertaken as part of the literature study. Learning in clinical placements is led by practice teaching roles such as mentors, clinical practice facilitators and practice educators rather than new leadership roles. However, workforce changes in clinical placements has restricted the opportunities for trained nurses to role model caring activities for student nurses and university based lecturers are increasingly distant from clinical practice. Leadership for learning in clinical practice poses three unresolved questions for nurse managers, practitioners and educators - what is nursing, what should student nurses learn and from whom? Leadership for student nurse learning has passed to new learning and teaching roles with Trusts and away from nursing managers. This has implications for workforce planning and role modelling within the profession.
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Harrison, Janet; Sargeant, Sally J E
2004-12-01
This article is the second part of a two-part series reporting a study of the role of the Clinical Librarian (CL) in the UK. A qualitative method of semi-structured interviews was used to explore in-depth the role of the CL. The interviews provided a rich source of data and give insight into this new and emerging role as practised in the National Health Service (NHS). Similarities and differences are examined between the CL population and reported within themes, specifically: personal qualities and skills required, training for the CLs, marketing the CL service, working in the clinical environment, monitoring and evaluation and the acceptance of the CL in the NHS. A common understanding of the skills and knowledge required to undertake the CL role was shared by the respondents. However, practice differed as this was often dictated by local circumstances. The study confirmed the need for the CLs to work with clinical colleagues in the clinical setting to enhance patient care. The importance of using best evidence to support patient care is a message that is slowly becoming the norm in the NHS and the CL role in this practice is demonstrated by this study.
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The administration of music therapy training clinics: a descriptive study.
Abbott, Elaine A
2006-01-01
A two-part study was conducted to describe issues and administrative practices related to university and college affiliated music therapy training clinics. First, all 72 AMTA academic directors were surveyed in order to discover (a) which programs had a clinic, and (b) the reasons why other directors did not operate a clinic. Second, 12 survey respondents, who reported that they were involved with a training clinic, participated in in-depth interviews discussing: (a) their motivations for establishing a clinic, (b) the possible effects of a clinic on the community, (c) the individuals and groups involved in clinic operations, d) clinic space and equipment, (e) policy and procedure topics, (f) specific administrative practices related to clients and students, (g) finances, (h) research (i) quality assurance, (j) dual roles, and (k) liability issues. The administrative practices described by the interviewees varied greatly across clinics and provided a wealth of information that could be considered both useful and thought provoking for those interested in operating a music therapy clinic.
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Through the eyes of the student: Best practices in clinical facilitation.
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.
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Nováková, Lucie; Pavlík, Jakub; Chrenková, Lucia; Martinec, Ondřej; Červený, Lukáš
2018-01-05
This review is a Part II of the series aiming to provide comprehensive overview of currently used antiviral drugs and to show modern approaches to their analysis. While in the Part I antivirals against herpes viruses and antivirals against respiratory viruses were addressed, this part concerns antivirals against hepatitis viruses (B and C) and human immunodeficiency virus (HIV). Many novel antivirals against hepatitis C virus (HCV) and HIV have been introduced into the clinical practice over the last decade. The recent broadening portfolio of these groups of antivirals is reflected in increasing number of developed analytical methods required to meet the needs of clinical terrain. Part II summarizes the mechanisms of action of antivirals against hepatitis B virus (HBV), HCV, and HIV, their use in clinical practice, and analytical methods for individual classes. It also provides expert opinion on state of art in the field of bioanalysis of these drugs. Analytical methods reflect novelty of these chemical structures and use by far the most current approaches, such as simple and high-throughput sample preparation and fast separation, often by means of UHPLC-MS/MS. Proper method validation based on requirements of bioanalytical guidelines is an inherent part of the developed methods. Copyright © 2017 Elsevier B.V. All rights reserved.
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Differential diagnosis of common tremor syndromes
Bhidayasiri, R
2005-01-01
Tremor is one of the most common involuntary movement disorders seen in clinical practice. In addition to the detailed history, the differential diagnosis is mainly clinical based on the distinction at rest, postural and intention, activation condition, frequency, and topographical distribution. The causes of tremor are heterogeneous and it can present alone (for example, essential tremor) or as a part of a neurological syndrome (for example, multiple sclerosis). Essential tremor and the tremor of Parkinson's disease are the most common tremors encountered in clinical practice. This article focuses on a practical approach to these different forms of tremor and how to distinguish them clinically. Evidence supporting various strategies used in the differentiation is then presented, followed by a review of formal guidelines or recommendations when they exist. PMID:16344298
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The Vanderbilt Professional Nursing Practice Program, part 3: managing an advancement process.
Steaban, Robin; Fudge, Mitzie; Leutgens, Wendy; Wells, Nancy
2003-11-01
Consistency of performance standards across multiple clinical settings is an essential component of a credible advancement system. Our advancement process incorporates a central committee, composed of nurses from all clinical settings within the institution, to ensure consistency of performance in inpatient, outpatient, and procedural settings. An analysis of nurses advanced during the first 18 months of the program indicates that performance standards are applicable to nurses in all clinical settings. The first article (September 2003) in this 3-part series described the foundation for and the philosophical background of the Vanderbilt Professional Nursing Practice Program (VPNPP), the career advancement program underway at Vanderbilt University Medical Center. Part 2 described the development of the evaluation tools used in the VPNPP, the implementation and management of this new system, program evaluation, and improvements since the program's inception. The purpose of this article is to review the advancement process, review the roles of those involved in the process, and to describe outcomes and lessons learned.
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Chang, Hui-Ming; Okwuosa, Tochukwu M; Scarabelli, Tiziano; Moudgil, Rohit; Yeh, Edward T H
2017-11-14
In this second part of a 2-part review, we will review cancer or cancer therapy-associated systemic and pulmonary hypertension, QT prolongation, arrhythmias, pericardial disease, and radiation-induced cardiotoxicity. This review is based on a MEDLINE search of published data, published clinical guidelines, and best practices in major cancer centers. Newly developed targeted therapy can exert off-target effects causing hypertension, thromboembolism, QT prolongation, and atrial fibrillation. Radiation therapy often accelerates atherosclerosis. Furthermore, radiation can damage the heart valves, the conduction system, and pericardium, which may take years to manifest clinically. Management of pericardial disease in cancer patients also posed clinical challenges. This review highlights the unique opportunity of caring for cancer patients with heart problems caused by cancer or cancer therapy. It is an invitation to action for cardiologists to become familiar with this emerging subspecialty. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Retention and recruitment of general dentists in an adjunct teaching model-A pilot study.
Howe, Brian J; Allareddy, Verasathpurush; Barwacz, Christopher A; Parker, I Reed; Straub-Morarend, Cheryl L; Holmes, David C
2017-01-01
Retention and recruitment of part time clinical adjunct faculty members in dental education is becoming increasingly difficult as dental schools come to rely on this workforce for their increased involvement in clinical education. Contributing factors include full time faculty shortage, aging workforce, practice and student debt, practice and family commitments, and financial compensation. This study attempts to ascertain barriers to teaching so appropriate strategies can be formulated to address this issue. In the spring of 2016 an email survey was sent to current and former adjunct faculty members to ascertain demographics and retention and recruitment strategies. Descriptive analyses were completed for all variables in the sample. Twenty nine of forty six subjects responded to the survey with a response rate of 63%. Subjects over the age of sixty comprised 55% with only 17% being under the age of forty five. Overall family and practice commitments along with compensation were the primary barriers to teaching part time. For new dentists, student loan debt was the primary barrier to teaching. Travel to teach was also a barrier as 70% of respondents drove 200 miles or less to the dental school. The study demonstrated that the aging part time work force is a great concern and new part time clinical adjunct faculty members must be recruited. Barriers to recruitment and retention of faculty must be considered and addressed to sustain this teaching model.
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Howlin, Frances; Halligan, Phil; O'Toole, Sinead
2014-09-01
Equality and disability legislation, coupled with increasing numbers of students with a disability, and inadequate supports in clinical practice, acted as catalysts to explore how best to support undergraduate nursing and midwifery students on clinical placements. Historically, higher education institutions provide reasonable accommodations for theoretical rather than clinical modules for practice placements. This paper describes the development and implementation of a Clinical Needs Assessment designed to identify the necessary supports or reasonable accommodations for nursing and midwifery students with a disability undertaking work placements in clinical practice. The existing literature, and consultation with an expert panel, revealed that needs assessments should be competency based and clearly identify the core skills or elements of practice that the student must attain to achieve proficiency and competence. The five Domains of Competence, advocated by An Bord Altranais, the Nursing and Midwifery Board of Ireland, formed the framework for the Clinical Needs Assessment. A panel of experts generated performance indicators to enable the identification of individualised reasonable accommodations for year 1 nursing and midwifery students in one Irish University. Development and implementation of the Clinical Needs Assessment promoted equality, inclusion and a level playing field for nursing and midwifery students with a disability in clinical practice. Copyright © 2014 Elsevier Ltd. All rights reserved.
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The Ethics of Clinical Care and the Ethics of Clinical Research: Yin and Yang.
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.
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Weinstein, Ronald S; Krupinski, Elizabeth A; Doarn, Charles R
2018-05-01
Telemedicine and telehealth are the practices of medicine at a distance. Performing the equivalent of a complete clinical examination by telemedicine would be unusual. However, components of a more traditional clinical examination are part of the telemedicine workup for specific conditions. Telemedicine clinical examinations are facilitated, and enhanced, through the integration of a class of medical devices referred to as telemedicine peripherals (eg, electronic stethoscopes, tele-ophthalmoscopes, video-otoscopes, and so forth). Direct-to-consumer telehealth is a rapidly expanding segment of the health care service industry. Copyright © 2018 Elsevier Inc. All rights reserved.
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Jefford, Elaine; Fahy, Kathleen; Sundin, Deborah
2011-06-01
What are the strengths and limitations of existing Decision-Making Theories as a basis for guiding best practice clinical decision-making within a framework of midwifery philosophy? Each theory is compared in relation with how well they provide a teachable framework for midwifery clinical reasoning that is consistent with midwifery philosophy. Hypothetico-Deductive Theory, from which medical clinical reasoning is based; intuitive decision-making; Dual Processing Theory; The International Confederation of Midwives Clinical Decision-Making Framework; Australian Nursing and Midwifery Council Midwifery Practice Decisions Flowchart and Midwifery Practice. Best practice midwifery clinical Decision-Making Theory needs to give guidance about: (i) effective use of cognitive reasoning processes; (ii) how to include contextual and emotional factors; (iii) how to include the interests of the baby as an integral part of the woman; (iv) decision-making in partnership with woman; and (v) how to recognize/respond to clinical situations outside the midwife's legal/personal scope of practice. No existing Decision-Making Theory meets the needs of midwifery. Medical clinical reasoning has a good contribution to make in terms of cognitive reasoning processes. Two limitations of medical clinical reasoning are its reductionistic focus and privileging of reason to the exclusion of emotional and contextual factors. Hypothetico-deductive clinical reasoning is a necessary but insufficient condition for best practice clinical decision-making in midwifery. © 2011 Blackwell Publishing Asia Pty Ltd.
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Chambrone, Leandro; Tatakis, Dimitris N
2015-02-01
This paper aims to create a "bridge" between research and practice by developing a practical, extensive, and clinically relevant study that translates evidence-based findings on soft tissue root coverage (RC) of recession-type defects to daily clinical practice. This review is prepared in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement based on the proposed focused questions. A literature search with no restrictions regarding status or the language of publication was performed for MEDLINE and EMBASE databases up to and including June 2013. Systematic reviews (SRs), randomized clinical trials, controlled clinical trials, case series, and case reports evaluating recession areas that were treated by means of RC procedures were considered eligible for inclusion through the three parts of the study (part I, an overview of the base of SRs; part II, an alternative random-effects meta-analyses on mean percentage of RC and sites exhibiting complete RC; and part III, an SR of non-randomized trials exploring other conditions not extensively evaluated by previous SRs). Data on Class I, II, III, and IV recessions, type of histologic attachment achieved with treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions, tooth type and location, long-term effectiveness outcomes, unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes were assessed as well. Of the 2,456 potentially eligible trials, 234 were included. Data on Class I, II, III, and IV gingival recessions, histologic attachment achieved after treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions/biomodification, tooth type and location, long-term effectiveness outcomes and unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes (i.e., esthetic, visual analog scale, complications, hypersensitivity, patients perceptions) were assessed. Subepithelial connective tissue (CT)-based procedures and coronally advanced flap plus acellular dermal matrix grafts, enamel matrix derivative, or collagen matrix led to the best improvements of recession depth, clinical attachment level (CAL) gain, and keratinized tissue (KT). Some conditions, such as smoking and use of magnification, may affect RC outcomes. All RC procedures can provide significant reduction in recession depth and CAL gain for Miller Class I and II recession-type defects. Subepithelial CT graft-based procedures provided the best outcomes for clinical practice because of their superior percentages of mean and complete RC, as well as significant increase of KT.
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Effect of part-time practice on patient outcomes.
Parkerton, Patricia H; Wagner, Edward H; Smith, Dean G; Straley, Hugh L
2003-09-01
Primary care physicians are spending fewer hours in direct patient care, yet it is not known whether reduced hours are associated with differences in patient outcomes. To determine whether patient outcomes vary with physicians' clinic hours. Cross-sectional retrospective design assessing primary care practices in 1998. All 25 outpatient-clinics of a single medical group in western Washington. One hundred ninety-four family practitioners and general internists, 80% of whom were part-time, who provided ambulatory primary care services to specified HMO patient panels. Physician appointment hours ranged from 10 to 35 per week (30% to 100% of full time). Twenty-three measures of individual primary care physician performance collected in an administrative database were aggregated into 4 outcome measures: cancer screening, diabetic management, patient satisfaction, and ambulatory costs. Multivariate regression on each of the 4 outcomes controlled for characteristics of physicians (administrative role, gender, seniority) and patient panels (size, case mix, age, gender). While the effects were small, part-time physicians had significantly higher rates for cancer screening (4% higher, P =.001), diabetic management (3% higher, P =.033), and for patient satisfaction (3% higher, P =.035). After controlling for potential confounders, there was no significant association with patient satisfaction (P =.212) or ambulatory costs (P =.323). Primary care physicians working fewer clinical hours were associated with higher quality performance than were physicians working longer hours, but with patient satisfaction and ambulatory costs similar to those of physicians working longer hours. The trend toward part-time clinical practice by primary care physicians may occur without harm to patient outcomes.
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Ng, Stella L; Bisaillon, Laura; Webster, Fiona
2017-01-01
Qualitative, social science approaches to research have surged in popularity within health professions education (HPE) over the past decade. Institutional ethnography (IE) offers the field another sociological approach to inquiry. Although widely used in nursing and health care research, IE remains relatively uncommon in the HPE research community. This article provides a brief introduction to IE and suggests why HPE researchers may wish to consider it for future studies. Part 1 of this paper presents IE's conceptual grounding in: (i) the entry point to inquiry ('materiality'), (ii) a generous definition of 'work' and (iii) a focus on how 'texts' such as policies, forms and written protocols influence activity. Part 2 of this paper outlines the method's key features through exemplars from our own research. Part 3 discusses the ways in which research that blurs the lines between educational and clinical practice can be both generative for HPE and accomplished using IE. The authors demonstrate the usefulness of IE for studying complex social issues in HPE. It is posited that a key added value of IE is that it goes beyond individual-level explanations of problems and phenomena, yet also closely studies individuals' activities, rather than remaining at an abstract or distant level of analysis. Thereby, IE can result in feasible and meaningful social change at the nexus of health professions education and other social systems such as clinical practice. IE adds to the growing qualitative research toolkit for HPE researchers. It is worth considering because it may enable change through the study of HPE in relation to other social processes, structures and systems, including the clinical practice world. A particular benefit may be found in blending HPE research with research on clinical practice, toward changing practice and policy through IE, given the interrelated nature of these fields. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.
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Code of Federal Regulations, 2011 CFR
2011-10-01
... with a doctorate in psychology) who is practicing as a clinical or counseling psychologist and is... in the State of practice, an individual with a doctorate in psychology and two years of supervised...
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Code of Federal Regulations, 2013 CFR
2013-10-01
... with a doctorate in psychology) who is practicing as a clinical or counseling psychologist and is... in the State of practice, an individual with a doctorate in psychology and two years of supervised...
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Code of Federal Regulations, 2012 CFR
2012-10-01
... with a doctorate in psychology) who is practicing as a clinical or counseling psychologist and is... in the State of practice, an individual with a doctorate in psychology and two years of supervised...
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Code of Federal Regulations, 2014 CFR
2014-10-01
... with a doctorate in psychology) who is practicing as a clinical or counseling psychologist and is... in the State of practice, an individual with a doctorate in psychology and two years of supervised...
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Physician perceptions of the role and value of basic science knowledge in daily clinical practice.
Fischer, Jennifer A; Muller-Weeks, Susan
2012-01-01
The role of basic science education in a clinical setting remains unclear. Research to understand how academic clinicians perceive and use this part of their education can aid curricular development. To assess physician's attitudes toward the value of science knowledge in their clinical practice. Academic physicians from three medical schools completed a questionnaire about the utility of basic science education in core clinical tasks and in practice-based learning and improvement. A total of 109 clinical faculty returned the survey. Overall, 89% of the respondents indicated that basic science education is valuable to their clinical practice. When asked about the utility of basic science information in relation to direct patient care, greater than 50% of the doctors felt they use this when diagnosing and communicating with patients. This rose to greater than 60% when asked about choosing treatment options for their patients. Individuals also responded that basic science knowledge is valuable when developing evidence-based best practices. Specifically, 89% felt that they draw upon this information when training students/residents and 84% use this information when reading journal articles. This study shows that basic science education is perceived by responding academic physicians to be important to their clinical work.
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Clinical supervision: an important part of every nurse's practice.
Bifarin, Oladayo; Stonehouse, David
2017-03-23
Clinical supervision involves a supportive relationship between supervisor and supervisee that facilitates reflective learning and is part of professional socialisation. Clinical supervision can take many different forms and may be adapted to suit local circumstances. A working agreement is required between the parties to the supervision and issues surrounding confidentiality must be understood. High-quality clinical supervision leads to greater job satisfaction and less stress. When it is absent or inadequate, however, the results can be serious and it is particularly important that student nurses are well supported in this way. Further research in this area is necessary.
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Jahanpour, Faezeh; Azodi, Parviz; Azodi, Farzan; Khansir, Ali Akbar
2016-06-01
Clinical training is an integral part of nursing education; however, some studies have shown that it is not always efficient. This study aimed to find out the factors that can impede nursing students' clinical learning. In this qualitative study, data were collected via reflective journal writing. Purposeful sampling was used, and 12 senior nursing students were recruited to the study. The data were analyzed using a content analysis method. Three main categories were derived, including inappropriate communication, ineffective role models, and theory-practice gaps. Students perceived that inappropriate communication between instructors, staff members, and students had the greatest impact on student learning. The competence of clinical instructors and staff is an important factor affecting students' training. The clinical learning environment does not always integrate theory and practice together. Nursing students did not experience effective clinical learning. Having expert instructors and supportive communication are important factors in creating a clinical learning environment.
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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.
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Hudak, Nicholas M; Melcher, Betsy; Strand de Oliveira, Justine
2017-12-01
This study describes clinical preceptors' perceptions of interprofessional practice, the nature and variety of physician assistant (PA) students' interprofessional interactions during clinical training, and factors that facilitate or hinder interprofessional education (IPE) in clinical settings. This qualitative study involved interviews with preceptors that were audio-recorded, transcribed, and then analyzed through an iterative process to identify key conceptual themes. Fourteen preceptors from a variety of clinical settings participated. Four themes were identified: (1) preceptors define interprofessional practice differently; (2) students learn about teams by being a part of teams; (3) preceptors separate students to avoid diluting learning experiences; and (4) preceptors can facilitate IPE by introducing students to members of the team and role modeling team skills. The themes may inform PA educators' efforts to increase IPE in clinical settings through educational interventions with both preceptors and students.
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Radiologic sciences. Faculty needs assessment.
Powers, Kevin J
2005-01-01
A total of 326 programs are represented in the data collected. Based on the average number of full- and part-time faculty members reported per program, this survey represents more than 1500 faculty positions. Based on the forecast of retirement and career change for all faculty members, there will be a turnover of 700 to 800 positions over the next 5 to 10 years. Part-time/adjunct faculty vacancies are expected to create the greatest number of opportunities for technologists to make the transition to education, with approximately one third of current part-time/adjunct educators planning on leaving radiologic sciences education within 5 years. To encourage retention of part-time/adjunct educators, annual evaluations should be modified to recognize the important educational role these instructors play. There is a need to create enthusiasm and interest in education as a career pathway for radiologic technologists. Resources are needed that help radiologic technologists make the transition to teaching. Finally, the retention of educators must be emphasized. Program applicant trends indicate radiologic technology students are older, have prior postsecondary education experience or are making a career change. This data emphasizes the need for educators, both full time and part time, to understand the characteristics and needs of the adult learner. Adult learners bring a wealth of education, experience and life skills that create both opportunities and challenges in the classroom and clinical setting. All categories of respondents indicated that their current salaries were greater than those of program graduates in their firstjob. Of interest is that 1 in 5 (20%) of part-time/adjunct educators indicated the opposite--that program graduates earn more in their firstjob than educators earn. When asked about salaries if working full time in clinical practice, the majority of all groups indicated their salary would be about the same or would decrease. Only 20% of program directors, 21% of full-time educators and 26% of part-time/adjunct educators indicated their salary would be higher in clinical practice. Part-time/adjunct educators reported working the most in clinical practice within the past week to month. Program directors exhibited the greatest separation from clinical practice, with more than half indicating a gap of 2 years or more from practicing in the clinical environment. While academic achievement is common among the educator populations sampled, a very low percentage of these educators are seeking an advanced academic degree. Less than a third of those surveyed indicated that they were pursuing an advanced degree. Becoming involved in research is not a requirement for many current educators, although survey participants expressed an interest in information about how to conduct a research project. A primary motivator for conducting the faculty development needs assessment was to use the data in strategic planning to set priorities for the resources available to the ASRT Education Department. The data will help maximize ASRT support for present and future educators. Services created by the ASRT Education Department will deepen the relationship with this key segment of the professional community.
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ERIC Educational Resources Information Center
Omer, Tagwa
2016-01-01
Nursing and other health professionals are increasingly using simulation as a strategy and a tool for teaching and learning at all levels that need clinical training. Nursing education for decades used simulation as an integral part of nursing education. Recent studies indicated that simulation improves nursing knowledge, clinical practice,…
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ERIC Educational Resources Information Center
Gordon, Michael; Russo, Kate
2009-01-01
This pilot study explored the experiences and understanding of clinical psychology practices and services of children and adolescents attending clinical psychology outpatient appointments. Fifteen young participants took part in the study. A content analysis indicated that young children and adolescents have an appropriate understanding of the…
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Code of Federal Regulations, 2010 CFR
2010-10-01
... with a doctorate in psychology) who is practicing as a clinical or counseling psychologist and is... clinical or counseling experience. (School psychologists are not included.) (iv) Clinical social worker..., vocational or educational counseling, and social services unrelated to mental health will be excluded; if a...
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Defining the Engaging Learning Experience from the Athletic Training Student Perspective
ERIC Educational Resources Information Center
Mazerolle, Stephanie M.; Bowman, Thomas G.; Benes, Sarah S.
2014-01-01
Context: Clinical experiences are an integral part of athletic training education and are where students gain the hands-on, practical knowledge and skills necessary to provide quality patient care in the field. However, some clinical education experiences may not allow athletic training students to become clinically integrated. Objective: To…
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Nursing students' early exposure to clinical practice: an innovation in curriculum development.
Hoyles, A; Pollard, C; Lees, S; Glossop, D
2000-08-01
This paper describes a pilot study addressing issues surrounding the balance and status given to both theory and practice in the foundation part of a pre-registration programme. Contemporary thinking seems to suggest that there is a need to reverse recent trends which have placed an emphasis on theory. To facilitate this a framework for clinical learning was adapted to guide students' early exposure to clinical practice. The focus was to develop the students' observational and reflective skills whilst also providing the students with a frame of reference within which they could explore their theoretical studies. The information and experiences gained as a result of this study have led to the integration of an Orientation Framework to support students' early clinical experiences in a pre-registration programme.
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Do procedural skills workshops during family practice residency work?
MacKenzie, Mark S; Berkowitz, Jonathan
2010-08-01
To determine if participation in a procedural skills workshop during family practice residency affects future use of these skills in postgraduate clinical practice. Survey involving self-assessment of procedural skills experience and competence. British Columbia. Former University of British Columbia family practice residents who trained in Vancouver, BC, including residents who participated in a procedural skills workshop in 2001 or 2003 and residents graduating in 2000 and 2002 who did not participate in the procedural skills workshop. Self-assessed experience and competence in the 6 office-based procedural skills that were taught during the procedural skills workshops in 2001 and 2003. Participation in a procedural skills workshop had no positive effect on future use of these skills in clinical practice. Participation in the workshop was associated with less reported experience (P = .091) in injection of lateral epicondylitis. As with previous Canadian studies, more women than men reported experience and competence in gynecologic procedures. More women than men reported experience (P = .001) and competence (P = .004) in intrauterine device insertion and experience (P = .091) in endometrial aspiration biopsy. More men than women reported competence (P = .052) in injection of trochanteric bursae. A third year of emergency training was correlated with an increase in reported experience (P = .021) in shoulder injection. Participation in a procedural skills workshop during family practice residency did not produce a significant increase in the performance of these skills on the part of participants once they were in clinical practice. The benefit of a skills workshop might be lost when there is no opportunity to practise and perfect these skills. Sex bias in the case of some procedures might represent a needs-based acquisition of skills on the part of practising physicians. Short procedural skills workshops might be better suited to graduated physicians with more clinical experience.
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In defense of clinical conferences in clinical nursing education.
Vezeau, Toni M
2016-01-01
Clinical conferencing has been a consistent feature of clinical education, but the current clinical education environment poses many challenges to its continuance. The paper raises concern regarding the current state of clinical conferencing as part of clinical practice education in nursing. This topic is of great concern, but has there is little direction for clinical educators. The paper reviews the literature on conferencing and recommends avenues for future research. Copyright © 2015 Elsevier Ltd. All rights reserved.
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An investigation of nurse educator's perceptions and experiences of undertaking clinical practice.
Williams, Angela; Taylor, Cathy
2008-11-01
Educational policy (DOH, 1999. Making a difference: strengthening the nursing, midwifery and health visiting contribution to health and healthcare. Department of Health, London; UKCC, 1999. Fitness for Practice. United Kingdom Central Council for Nursing, Midwifery and Health Visiting, London; Nursing and Midwifery Council, 2006. Standards to support learning and assessment in practice. Nursing and Midwifery Council, London) and current nursing literature (Griscti, O., Jacono, B., Jacono, J., 2005. The nurse educator's clinical role. Journal of Advanced Nursing 50 (1), 84-92; Owen, S., Ferguson, K., Baguley, I., 2005. The clinical activity of mental health nurse lecturers. Journal of Psychiatric and Mental Health Nursing 12, 310-316), place increasing emphasis on nurse educators undertaking clinical practice to facilitate their clinical confidence and competence. This study investigated nurse educators' perceptions and experiences of undertaking clinical practice. A qualitative design and descriptive, exploratory approach were used. A purposive sample of 11 nurse educators in one nursing department, took part in two focus group interviews, one with 5 and the other with 6 respondents, to identify and discuss their perceptions and experiences of undertaking clinical practice. A process of thematic content analysis revealed three broad themes relating to the meaning and importance of clinical practice, perceived benefits and barriers which are examined and discussed. The paper concludes that despite policy recommendations, barriers highlighted in this study such as insufficient time, heavy workload and a lack of valuing of the clinical role have been raised over the past few decades. The effect of undertaking clinical practice, particularly on the quality of teaching is argued to be valuable armoury in the battle to secure sufficient resources to support engagement in clinical practice. Financial and organisational commitment; valuing of clinical practice and research evidence are crucial to realising clinical practice for nurse educators. Alternative interpretations of what may constitute the clinical role such as joint research projects and supporting and supervising students are offered, which need to be assessed against clear, specific and realistic aims for the clinical role of the nurse educator.
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Diagnostic and interventional musculoskeletal ultrasound: part 2. Clinical applications.
Smith, Jay; Finnoff, Jonathan T
2009-02-01
Musculoskeletal ultrasound involves the use of high-frequency sound waves to image soft tissues and bony structures in the body for the purposes of diagnosing pathology or guiding real-time interventional procedures. Recently, an increasing number of physicians have integrated musculoskeletal ultrasound into their practices to facilitate patient care. Technological advancements, improved portability, and reduced costs continue to drive the proliferation of ultrasound in clinical medicine. This increased interest creates a need for education pertaining to all aspects of musculoskeletal ultrasound. The primary purpose of this article is to review diagnostic ultrasound technology and its potential clinical applications in the evaluation and treatment of patients with neurological and musculoskeletal disorders. After reviewing this article, physicians should be able to (1) list the advantages and disadvantages of ultrasound compared to other available imaging modalities; (2) describe how ultrasound machines produce images using sound waves; (3) discuss the steps necessary to acquire and optimize an ultrasound image; (4) understand the difference ultrasound appearances of tendons, nerves, muscles, ligaments, blood vessels, and bones; and (5) identify multiple applications for diagnostic and interventional musculoskeletal ultrasound. Part 2 of this 2-part article will focus on the clinical applications of musculoskeletal ultrasound in clinical practice, including the ultrasonographic appearance of normal and abnormal tissues as well as specific diagnostic and interventional applications in major body regions.
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Retention and recruitment of general dentists in an adjunct teaching model—A pilot study
Barwacz, Christopher A.; Parker, I. Reed; Straub-Morarend, Cheryl L.; Holmes, David C.
2017-01-01
Purpose/Objectives Retention and recruitment of part time clinical adjunct faculty members in dental education is becoming increasingly difficult as dental schools come to rely on this workforce for their increased involvement in clinical education. Contributing factors include full time faculty shortage, aging workforce, practice and student debt, practice and family commitments, and financial compensation. This study attempts to ascertain barriers to teaching so appropriate strategies can be formulated to address this issue. Methods In the spring of 2016 an email survey was sent to current and former adjunct faculty members to ascertain demographics and retention and recruitment strategies. Descriptive analyses were completed for all variables in the sample. Results Twenty nine of forty six subjects responded to the survey with a response rate of 63%. Subjects over the age of sixty comprised 55% with only 17% being under the age of forty five. Overall family and practice commitments along with compensation were the primary barriers to teaching part time. For new dentists, student loan debt was the primary barrier to teaching. Travel to teach was also a barrier as 70% of respondents drove 200 miles or less to the dental school. Conclusion The study demonstrated that the aging part time work force is a great concern and new part time clinical adjunct faculty members must be recruited. Barriers to recruitment and retention of faculty must be considered and addressed to sustain this teaching model. PMID:28715479
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The content of the work of clinical nurse specialists described by use of daily activity diaries.
Oddsdóttir, Elín Jakobína; Sveinsdóttir, Herdís
2011-05-01
Evaluate the usefulness of the role of clinical nurse specialists and the content of their work by mapping their activities. The clinical work of advanced practice nursing differs in different countries, and a clear picture is lacking on what exactly advanced practice nurses do. Prospective exploratory study. The setting of the study was the largest hospital in Iceland where over half of the country's active nursing workforce are employed, including the only clinical nurse specialists. Of 19 clinical nurse specialists working at the hospital, 15 participated. Data were collected over seven days with a structured activity diary that lists 65 activities, classified into six roles and three domains. In 17 instances, the 'role activities' and 'domain activities' overlap and form 17 categories of practice. The clinical nurse specialists coded their activities at 15-minutes interval and could code up to four activities simultaneously. Daily, the clinical nurse specialists evaluated their clinical nurse specialist background. The roles that occupied the greatest proportion of the clinical nurse specialists' time were education, expert practice and 'other' activities, while the smallest proportions were in counselling, research and practice development. The domain they worked in most was the institutional domain, followed by the client/family domain and the clinical outcome management domain. All of the clinical nurse specialists reported working on two activities simultaneously, 11 of them on three activities and six on four activities. They self-assessed their background as clinical nurse specialists as being very useful. The activity diary is a useful tool for assessing the content of practice. Clinical nurse specialists spend too much time on activities related to the institution. Nurse managers are advised to provide clinical nurse specialists with ample time to develop the direct practice role in the client/family domain. The development of advanced nursing practice requires that clinical nurse specialists take an active and visible part in direct patient care. © 2011 Blackwell Publishing Ltd.
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Sense and Sensibility When Prescribing 'Off-Label' to Psychiatric Patients.
Baldwin, David S; Tiwari, Nupur; Gordon, Robert
2015-01-01
Pharmacological treatment forms part of much routine psychiatric practice. Many psychotropic drugs and psychotherapies are available for treating patients with mental disorders, but considerable numbers of individuals remain troubled by incapacitating symptoms even after a succession of evidence-based treatments. In this situation, many doctors consider prescribing a psychotropic medication outside the narrow terms of its market authorisation or 'product licence', in an attempt to optimise clinical outcomes and increase the chance of recovery. Despite expressed concerns about potential hazards and increased physician liability, many authorities agree that using a drug outside the narrow terms of its product licence can be an important part of clinical practice. This paper illustrates the nature and extent of the use of licensed drugs for unlicensed applications in psychiatric and other medical settings, indicates potential drawbacks and hazards, and makes recommendations for a suggested process when prescribing 'off-label', as an appropriate part of the overall management of individual patients.
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Orientation, Evaluation, and Integration of Part-Time Nursing Faculty.
Carlson, Joanne S
2015-07-10
This study helps to quantify and describe orientation, evaluation, and integration practices pertaining to part-time clinical nursing faculty teaching in prelicensure nursing education programs. A researcher designed Web-based survey was used to collect information from a convenience sample of part-time clinical nursing faculty teaching in prelicensure nursing programs. Survey questions focused on the amount and type of orientation, evaluation, and integration practices. Descriptive statistics were used to analyze results. Respondents reported on average four hours of orientation, with close to half reporting no more than two hours. Evaluative feedback was received much more often from students than from full-time faculty. Most respondents reported receiving some degree of mentoring and that it was easy to get help from full-time faculty. Respondents reported being most informed about student evaluation procedures, grading, and the steps to take when students are not meeting course objectives, and less informed about changes to ongoing curriculum and policy.
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Learning for clinical leadership.
Cook, Michael J; Leathard, Helen L
2004-11-01
Clinical leadership has been acclaimed widely as a major factor influencing the quality of patient care but research has revealed a paucity of preparation for this significant role. Leadership literature has rarely addressed clinical leadership specifically or referred to the difficulties in characterizing effective clinical leaders. The research informing this paper focused on clinical leadership and identified five attributes of effective clinical leaders: creativity, highlighting, influencing, respecting, and supporting. Effective clinical leaders adopted a transformational leadership style and improved care, through others, by including transformational (soft) knowledge as an integral part of their effective practice repertoire. Phronesis is introduced as practical wisdom that is gained through immersion in relevant experience, and as an essential element of preparation for clinical nursing leadership practice. It is argued, that learning to transform care requires opportunities to work within an environment that engenders and supports aspiring leaders. The paper describes the research process, elucidates the attributes through illustrative examples from the research data, and discusses an emergent educational strategy for the development of these attributes by clinicians in their practice environments. The paper also describes the application of this research through an interdisciplinary programme for staff leading teams in both health and social services sectors.
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Aboushanab, Tamer; AlSanad, Saud
2018-06-08
Cupping therapy is a popular treatment in various countries and regions, including Saudi Arabia. Cupping therapy is regulated in Saudi Arabia by the National Center for Complementary and Alternative Medicine (NCCAM), Ministry of Health. The authors recommend that this quality model for selecting patients in cupping clinics - first version (QMSPCC-1) - be used routinely as part of clinical practice and quality management in cupping clinics. The aim of the quality model is to ensure the safety of patients and to introduce and facilitate quality and auditing processes in cupping therapy clinics. Clinical evaluation of this tool is recommended. Continued development, re-evaluation and reassessment of this tool are important. Copyright © 2018. Published by Elsevier B.V.
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Transfer of knowledge and skills: some implications for nursing and nurse education.
Lauder, W; Reynolds, W; Angus, N
1999-08-01
The construct of transfer has enormous importance to nursing as it begins to highlight potential problems in the transfer of knowledge and skills from the campus to the clinical area, from one part of the clinical area to another (e.g. surgical to medical), and from community to the clinical area. Thus, any adequate conceptualization of transfer must account for problems of practice-practice transfer as well as theory-practice transfer. These potential problems are the concern of educators, students and managers who have a responsibility for agency nurses and bank nurses who may find themselves in different specialities on a regular basis. Transfer has relevance to a whole raft of other issues ranging from the application of theories to nursing practice, through to the validity of claims that courses which develop intellectual skills prepare nurses for lifelong learning.
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Nutritional Support of Medical Practice.
ERIC Educational Resources Information Center
Schneider, Howard A., Ed.; And Others
This book is intended to assemble for the medical practitioner in the developed countries those features of nutritional science which are clearly useful and clinically applicable in day-to-day medical practice. The book contains 32 chapters structured into three parts. After a brief description from the viewpoint of human biology, the first main…
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Research in Counseling and Therapy.
ERIC Educational Resources Information Center
Loesch, Larry C., Ed.; Vacc, Nicholas A., Ed.
There exists in the counseling and therapy professions the paradox of widespread endorsement of research with little use of, or engagement in, research in actual practice. This situation exists in large part because many counselors and therapists are less knowledgeable of research than they are of clinical practice. This collection of digests,…
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78 FR 12264 - Criteria for a Catastrophically Disabled Determination for Purposes of Enrollment
Federal Register 2010, 2011, 2012, 2013, 2014
2013-02-22
..., we would eliminate the Folstein Mini Mental State Examination (MMSE) as a criterion for determining... clinical finding. An examining clinician, in practice, examines the veteran and determines the veteran's... document on February 12, 2013, for publication. List of Subjects in 38 CFR Part 17 Administrative practice...
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Building a Knowledge to Action Program in Stroke Rehabilitation.
Janzen, Shannon; McIntyre, Amanda; Richardson, Marina; Britt, Eileen; Teasell, Robert
2016-09-01
The knowledge to action (KTA) process proposed by Graham et al (2006) is a framework to facilitate the development and application of research evidence into clinical practice. The KTA process consists of the knowledge creation cycle and the action cycle. The Evidence Based Review of Stroke Rehabilitation is a foundational part of the knowledge creation cycle and has helped guide the development of best practice recommendations in stroke. The Rehabilitation Knowledge to Action Project is an audit-feedback process for the clinical implementation of best practice guidelines, which follows the action cycle. The objective of this review was to: (1) contextualize the Evidence Based Review of Stroke Rehabilitation and Rehabilitation Knowledge to Action Project within the KTA model and (2) show how this process led to improved evidence-based practice in stroke rehabilitation. Through this process, a single centre was able to change clinical practice and promote a culture that supports the use of evidence-based practices in stroke rehabilitation.
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Martin, Raul
2018-01-01
Current corneal assessment technologies make the process of corneal evaluation extremely fast and simple, and several devices and technologies show signs that help in identification of different diseases thereby, helping in diagnosis, management, and follow-up of patients. The purpose of this review is to present and update readers on the evaluation of cornea and ocular surface. This first part reviews a description of slit lamp biomicroscopy (SLB), endothelial specular microscopy, confocal microscopy, and ultrasound biomicroscopy examination techniques and the second part describes the corneal topography and tomography, providing up-to-date information on the clinical recommendations of these techniques in eye care practice. Although the SLB is a traditional technique, it is of paramount importance in clinical diagnosis and compulsory when an eye test is conducted in primary or specialist eye care practice. Different techniques allow the early diagnosis of many diseases, especially when clinical signs have not yet become apparent and visible with SLB. These techniques also allow for patient follow-up in several clinical conditions or diseases, facilitating clinical decisions and improving knowledge regarding the corneal anatomy. PMID:29380757
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Cascales, Thomas
2017-04-01
Recent epidemiological studies show that 2% of babies in ordinary paediatric clinics suffer from infantile anorexia. In the first part of this paper we present a case study from our hospital clinical activity. Our framework combines clinical psychoanalytic sessions and perinatal videos. In the second part, we will focus on the concepts of instinct and excitation proposed by Sigmund Freud and the concept of mastery proposed by Anna Freud. In the third part, we will examine these concepts in the light of the case study. The fourth part is devoted to clinical recommendations from our hospital psychoanalytic practice. In conclusion, unlike other clinical settings, the psychoanalytic setting allows for the elaboration of the parental hatred included in the libidinal cathexis. Our psychoanalytic setting (sessions/videos) makes it possible to decontaminate parental intrapsychic elements overloaded with excitement, saturated with hate elements, and rendered sterile by the instinct for mastery. An initial part of the treatment process involves working through the intersubjective elements observed in the video. Copyright © 2016 Institute of Psychoanalysis.
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Li, Qing-na; Huang, Xiu-ling; Gao, Rui; Lu, Fang
2012-08-01
Data management has significant impact on the quality control of clinical studies. Every clinical study should have a data management plan to provide overall work instructions and ensure that all of these tasks are completed according to the Good Clinical Data Management Practice (GCDMP). Meanwhile, the data management plan (DMP) is an auditable document requested by regulatory inspectors and must be written in a manner that is realistic and of high quality. The significance of DMP, the minimum standards and the best practices provided by GCDMP, the main contents of DMP based on electronic data capture (EDC) and some key factors of DMP influencing the quality of clinical study were elaborated in this paper. Specifically, DMP generally consists of 15 parts, namely, the approval page, the protocol summary, role and training, timelines, database design, creation, maintenance and security, data entry, data validation, quality control and quality assurance, the management of external data, serious adverse event data reconciliation, coding, database lock, data management reports, the communication plan and the abbreviated terms. Among them, the following three parts are regarded as the key factors: designing a standardized database of the clinical study, entering data in time and cleansing data efficiently. In the last part of this article, the authors also analyzed the problems in clinical research of traditional Chinese medicine using the EDC system and put forward some suggestions for improvement.
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Owens, Rhoda A
This study explored two-year institution part-time nurse faculty's perceptions of their experiences during their role transitions from nurses in clinical practice to part-time clinical instructors. Part-time nurse faculty enter academia as expert clinicians, but most have little or no training in the pedagogy of effective student learning. A phenomenological study was used to explore the faculty role transition experiences. Findings support the proposition that six participants transitioned from their expert clinician to instructor identities; however, two continue in the process. Critical to this process are relationships with individuals in their environments, past and present experiences, the incentive to learn to be better instructors, and the importance of support and training. A model emerged, Process of Role Transition and Professional Identity Formation for Part-Time Clinical Instructors at Two-Year Institutions, that is potentially useful for administrators in developing individualized orientation and professional development programs.
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Reimagining nursing's place in the history of clinical practice.
Fairman, Julie; D'Antonio, Patricia
2008-10-01
This work posits how medical history might be conceptualized if nurses and nursing history was used as the analytical lens. Nursing is seen not as a separate part or subsection of medical history, but rather one that is deeply embedded in the relationships and social order of clinical practice. Nursing is an analytical category in and of itself. By approaching nursing as such a category, we enlarge "new notions of historical significance" to encompass personal, political, public, and private activities that constitute medical experiences.
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Jacobs, Carmel; Graham, Ian D; Makarski, Julie; Chassé, Michaël; Fergusson, Dean; Hutton, Brian; Clemons, Mark
2014-01-01
Consensus statements and clinical practice guidelines are widely available for enhancing the care of cancer patients. Despite subtle differences in their definition and purpose, these terms are often used interchangeably. We systematically assessed the methodological quality of consensus statements and clinical practice guidelines published in three commonly read, geographically diverse, cancer-specific journals. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. Thirty-four consensus statements and 67 clinical practice guidelines were evaluated. The rigour of development score for consensus statements over the three journals was 32% lower than that of clinical practice guidelines. The editorial independence score was 15% lower for consensus statements than clinical practice guidelines. One journal scored consistently lower than the others over both domains. No journals adhered to all the items related to the transparency of document development. One journal's consensus statements endorsed a product made by the sponsoring pharmaceutical company in 64% of cases. Guidance documents are an essential part of oncology care and should be subjected to a rigorous and validated development process. Consensus statements had lower methodological quality than clinical practice guidelines using AGREE II. At a minimum, journals should ensure that that all consensus statements and clinical practice guidelines adhere to AGREE II criteria. Journals should consider explicitly requiring guidelines to declare pharmaceutical company sponsorship and to identify the sponsor's product to enhance transparency.
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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.
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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
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ERIC Educational Resources Information Center
Austin, Zubin; Dean, Marie Rocchi
2006-01-01
The use of distance education for clinical skills development in the health professions has not been extensively described, due in part to the intensive nature of the relationship between the patient and practitioner. In the context of pharmacy practice, there are specific needs to develop new vehicles for clinical skills education due to growing…
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ERIC Educational Resources Information Center
Bradley, Carolyn; Maschi, Tina; O'Brien, Helen; Morgen, Keith; Ward, Kelly
2012-01-01
The purpose of this study was to describe licensed clinical social workers' (LCSWs) professional motivation to pursue a social work career and the decision to enter clinical practice. It used a probability sample of 245 New Jersey LCSWs and the Social Work Values Survey as part of an anonymous self-administered mail survey. Descriptive analyses…
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Torruco-García, Uri; Ortiz-Montalvo, Armando; Varela-Ruiz, Margarita Elena; Hamui-Sutton, Alicia
2016-01-01
Today´s relevant educational models emphasize that a great part of learning be situated and reflexive; one of those is the Entrusted Professional Activities model. The study objective was to develop a model that integrates Entrusted Professional Activities with a medical school curriculum. From October 2012 a multidisciplinary group met to develop a model with the specialty of obstetrics and gynecology. From two published models of Entrusted Professional Activities and the curriculum of a school of medicine, blocks, units, and daily clinical practice charts were developed. The thematic content of the curriculum was integrated with the appropriate milestones for undergraduate students and the clinical practice needed to achieve it. We wrote a manual with 37 daily clinical practice charts for students (18 of gynecology and 19 of obstetrics) and 37 for teachers. Each chart content was the daily clinical practice, reflection activities, assessment instruments, and bibliography. It is feasible to combine a model of Entrusted Professional Activities with an undergraduate curriculum, which establishes a continuum with postgraduate education.
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The Validity of Projective Techniques and Their Clinical and Research Contributions
ERIC Educational Resources Information Center
Blatt, Sidney J.
1975-01-01
Questions about the limitations and potential contributions of projective techniques in research are considered and issues which limit the contributions of diagnostic assessment and projective techniques in clinical practice are examined. A proposal is made for conceptualizing diagnostic assessment as a more integral part of the therapeutic…
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Clinical reasoning and population health: decision making for an emerging paradigm of health care.
Edwards, Ian; Richardson, Barbara
2008-01-01
Chronic conditions now provide the major disease and disability burden facing humanity. This development has necessitated a reorientation in the practice skills of health care professions away from hospital-based inpatient and outpatient care toward community-based management of patients with chronic conditions. Part of this reorientation toward community-based management of chronic conditions involves practitioners' understanding and adoption of a concept of population health management based on appropriate theoretical models of health care. Drawing on recent studies of expertise in physiotherapy, this article proposes a clinical reasoning and decision-making framework to meet these challenges. The challenge of population and community-based management of chronic conditions also provides an opportunity for physiotherapists to further clarify a professional epistemology of practice that embraces the kinds of knowledge and clinical reasoning processes used in physiotherapy practice. Three case studies related to the management of chronic musculoskeletal pain in different populations are used to exemplify the range of epistemological perspectives that underpin community-based practice. They illustrate the link between conceptualizations of practice problems and knowledge sources that are used as a basis for clinical reasoning and decision making as practitioners are increasingly required to move between the clinic and the community.
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Facilitation of learning: part 2.
Warburton, Tyler; Houghton, Trish; Barry, Debbie
2016-04-27
The previous article in this series of 11, Facilitation of learning: part 1, reviewed learning theories and how they relate to clinical practice. Developing an understanding of these theories is essential for mentors and practice teachers to enable them to deliver evidence-based learning support. This is important given that effective learning support is dependent on an educator who possesses knowledge of their specialist area as well as the relevent tools and methods to support learning. The second domain of the Nursing and Midwifery Council's Standards to Support Learning and Assessment in Practice relates to the facilitation of learning. To fulfil this domain, mentors and practice teachers are required to demonstrate their ability to recognise the needs of learners and provide appropriate support to meet those needs. This article expands on some of the discussions from part 1 of this article and considers these from a practical perspective, in addition to introducing some of the tools that can be used to support learning.
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Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus.
Evers, Andrea W M; Colloca, Luana; Blease, Charlotte; Annoni, Marco; Atlas, Lauren Y; Benedetti, Fabrizio; Bingel, Ulrike; Büchel, Christian; Carvalho, Claudia; Colagiuri, Ben; Crum, Alia J; Enck, Paul; Gaab, Jens; Geers, Andrew L; Howick, Jeremy; Jensen, Karin B; Kirsch, Irving; Meissner, Karin; Napadow, Vitaly; Peerdeman, Kaya J; Raz, Amir; Rief, Winfried; Vase, Lene; Wager, Tor D; Wampold, Bruce E; Weimer, Katja; Wiech, Katja; Kaptchuk, Ted J; Klinger, Regine; Kelley, John M
2018-06-12
Placebo and nocebo effects occur in clinical or laboratory medical contexts after administration of an inert treatment or as part of active treatments and are due to psychobiological mechanisms such as expectancies of the patient. Placebo and nocebo studies have evolved from predominantly methodological research into a far-reaching interdisciplinary field that is unravelling the neurobiological, behavioural and clinical underpinnings of these phenomena in a broad variety of medical conditions. As a consequence, there is an increasing demand from health professionals to develop expert recommendations about evidence-based and ethical use of placebo and nocebo effects for clinical practice. A survey and interdisciplinary expert meeting by invitation was organized as part of the 1st Society for Interdisciplinary Placebo Studies (SIPS) conference in 2017. Twenty-nine internationally recognized placebo researchers participated. There was consensus that maximizing placebo effects and minimizing nocebo effects should lead to better treatment outcomes with fewer side effects. Experts particularly agreed on the importance of informing patients about placebo and nocebo effects and training health professionals in patient-clinician communication to maximize placebo and minimize nocebo effects. The current paper forms a first step towards developing evidence-based and ethical recommendations about the implications of placebo and nocebo research for medical practice, based on the current state of evidence and the consensus of experts. Future research might focus on how to implement these recommendations, including how to optimize conditions for educating patients about placebo and nocebo effects and providing training for the implementation in clinical practice. © 2018 S. Karger AG, Basel.
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Nihat, Akin; de Lusignan, Simon; Thomas, Nicola; Tahir, Mohammad Aumran; Gallagher, Hugh
2016-04-06
This study is a process evaluation of the Quality Improvement in Chronic Kidney Disease (QICKD) study, comparing audit-based education (ABE) and sending clinical guidelines and prompts (G&P) with usual practice, in improving systolic blood pressure control in primary care. This evaluation aimed to explore how far clinical staff in participating practices were aware of the intervention, and why change in practice might have taken place. 4 primary care practices in England: 2 received ABE, and 2 G&P. We purposively selected 1 northern/southern/city and rural practice from each study arm (from a larger pool of 132 practices as part of the QICKD trial). The 4 study practices were purposively sampled, and focus groups conducted with staff from each. All staff members were invited to attend. Focus groups in each of 4 practices, at the mid-study point and at the end. 4 additional trial practices not originally selected for in-depth process evaluation took part in end of trial focus groups, to a total of 12 focus groups. These were recorded, transcribed and analysed using the framework approach. 5 themes emerged: (1) involvement in the study made participants more positive about the CKD register; (2) clinicians did not always explain to patients that they had CKD; (3) while practitioners improved their monitoring of CKD, many were sceptical that it improved care and were more motivated by pay-for-performance measures; (4) the impact of study interventions on practice was generally positive, particularly the interaction with specialists, included in ABE; (5) the study stimulated ideas for future clinical practice. Improving quality in CKD is complex. Lack of awareness of clinical guidelines and scepticism about their validity are barriers to change. While pay-for-performance incentives are the main driver for change, quality improvement interventions can have a complementary influence. 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/
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Saavedra Salinas, Miguel Ángel; Barrera Cruz, Antonio; Cabral Castañeda, Antonio Rafael; Jara Quezada, Luis Javier; Arce-Salinas, C Alejandro; Álvarez Nemegyei, José; Fraga Mouret, Antonio; Orozco Alcalá, Javier; Salazar Páramo, Mario; Cruz Reyes, Claudia Verónica; Andrade Ortega, Lilia; Vera Lastra, Olga Lidia; Mendoza Pinto, Claudia; Sánchez González, Antonio; Cruz Cruz, Polita Del Rocío; Morales Hernández, Sara; Portela Hernández, Margarita; Pérez Cristóbal, Mario; Medina García, Gabriela; Hernández Romero, Noé; Velarde Ochoa, María Del Carmen; Navarro Zarza, José Eduardo; Portillo Díaz, Verónica; Vargas Guerrero, Angélica; Goycochea Robles, María Victoria; García Figueroa, José Luis; Barreira Mercado, Eduardo; Amigo Castañeda, Mary Carmen
2015-01-01
Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus (SLE), rheumatoid arthritis (RA) and antiphospholipid antibody syndrome (APS). Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and grading of recommendations, internal validation by peers, and external validation of the final document. The quality criteria of the AGREE II instrument were followed. The various panels answered the 37 questions related to maternal and fetal care in SLE, RA, and APS, as well as to the use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. We present the recommendations for pregnant women with SLE in this first part. We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with SLE integrate the best available evidence for the treatment and follow-up of patients with these conditions. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
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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.
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Hind, V; Waterhouse, P J; Maguire, A; Tabari, D; Lloyd, J
2009-11-01
The primary dental care outreach (PDCO) course in Newcastle, UK commenced in September 2004 with dental undergraduates attending outreach clinics on a fortnightly rotation over a 2 year continuous placement. To evaluate the PDCO with respect to practical issues and clinical activity. Clinical activity data were collected using data sheets and Access software together with data on patient attendances and Structured Clinical Operative Tests (SCOTs). Comparative clinical data were collected from the same group of students in Child Dental Health (CDH) in the School of Dental Sciences. In 2004/2005, 1683 clinical procedures were undertaken in PDCO and 1362 in CDH. Of the treatment undertaken in PDCO, 37.1% was examination and treatment planning, 17.1% basic intracoronal restorations and 13.1% fissure sealing, the activity representative of day to day in general practice. Completion rates for the five piloted SCOTs in cross infection control, writing a prescription, writing a referral letter, taking a valid consent and taking a radiograph ranged from 74% to 97% in 2004/2006. The practical issues and challenges of delivering a new clinical course broadly related to induction of new PDCO staff, support of staff, establishing effective communication, timetabling logistics, delivery of clinical teaching and quality assurance. Once the practical issues and challenges of setting up a new clinical course have been overcome PDCO has a valuable role to play in preparing undergraduates for their future practising careers.
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Comparison of veterinary drugs and veterinary homeopathy: part 2
Lees, P.; Pelligand, L.; Whiting, M.; Chambers, D.; Toutain, P-L.; Whitehead, M. L.
2017-01-01
Part 2 of this narrative review outlines the theoretical and practical bases for assessing the efficacy and effectiveness of conventional medicines and homeopathic products. Known and postulated mechanisms of action are critically reviewed. The evidence for clinical efficacy of products in both categories, in the form of practitioner experience, meta-analysis and systematic reviews of clinical trial results, is discussed. The review also addresses problems and pitfalls in assessing data, and the ethical and negative aspects of pharmacology and homeopathy in veterinary medicine. PMID:28821700
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Sweeney, Jane K; Heriza, Carolyn B; Blanchard, Yvette
2009-01-01
To describe clinical training models, delineate clinical competencies, and outline a clinical decision-making algorithm for neonatal physical therapy. In these updated practice guidelines, advanced clinical training models, including precepted practicum and residency or fellowship training, are presented to guide practitioners in organizing mentored, competency-based preparation for neonatal care. Clinical competencies in neonatal physical therapy are outlined with advanced clinical proficiencies and knowledge areas specific to each role. An algorithm for decision making on examination, evaluation, intervention, and re-examination processes provides a framework for clinical reasoning. Because of advanced-level competency requirements and the continuous examination, evaluation, and modification of procedures during each patient contact, the intensive care unit is a restricted practice area for physical therapist assistants, physical therapist generalists, and physical therapy students. Accountable, ethical physical therapy for neonates requires advanced, competency-based training with a preceptor in the pediatric subspecialty of neonatology.
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Ethical Issues in Paediatric Practice - Part I: General Principles
Attard-Montalto, S
2001-01-01
Clinical problems with ethical implications pose an ever increasing dilemma in everyday medical practice, and this is particularly the case with ethical issues involving children and those unable to take their own decisions. In this editorial we shall review some of the general principles that guide medical ethical problems. PMID:22368603
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Assessing the Pre-Service Clinical Practice Experiences of Practicing Teachers
ERIC Educational Resources Information Center
Meyer, Steve
2016-01-01
Recent emphasis on teacher effectiveness and accountability has led the education policy, research, and practitioner communities to take a closer look at the effectiveness of teacher preparation programs, motivated in large part by concerns about program quality. Several national- and state-level studies have found new teachers to be underprepared…
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Will a Clinical Approach Make Education Research More Relevant for Practice?
ERIC Educational Resources Information Center
Bulterman-Bos, Jacquelien A.
2008-01-01
The way in which researchers view education differs fundamentally from the way in which teachers view education. These different outlooks are (partly) a consequence of the different work roles of researchers and teachers. This article explores the question of whether it is really inevitable that research and practice each establish different views…
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Building confidence: an exploration of nurses undertaking a postgraduate biological science course.
Van Wissen, Kim; McBride-Henry, Karen
2010-01-01
This study aimed to explore the impact of studying biological science at a postgraduate level and how this impacted on nursing practice. The term biological sciences in this research encompasses elements of physiology, genetics, biochemistry and pathophysiology. A qualitative research study was designed, that involved the dissemination of a pre- and post-course semi-structured questionnaire for a biological science course, as part of a Master of Nursing programme at a New Zealand University, thus exploring the impact of undertaking a postgraduate biological sciences course. The responses were analysed into themes, based on interpretive concepts. The primary themes revealed improvement in confidence as: confidence in communication, confidence in linking nursing theoretical knowledge to practice and confidence in clinical nursing knowledge. This study highlights the need to privilege clinically-derived nursing knowledge, and that confidence in this nursing knowledge and clinical practice can be instilled through employing the model of theory-guided practice.
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Learning Together; part 2: training costs and health gain - a cost analysis.
Cullen, Katherine; Riches, Wendy; Macaulay, Chloe; Spicer, John
2017-01-01
Learning Together is a complex educational intervention aimed at improving health outcomes for children and young people. There is an additional cost as two doctors are seeing patients together for a longer appointment than a standard general practice (GP) appointment. Our approach combines the impact of the training clinics on activity in South London in 2014-15 with health gain, using NICE guidance and standards to allow comparison of training options. Activity data was collected from Training Practices hosting Learning Together. A computer based model was developed to analyse the costs of the Learning Together intervention compared to usual training in a partial economic evaluation. The results of the model were used to value the health gain required to make the intervention cost effective. Data were returned for 363 patients booked into 61 clinics across 16 Training Practices. Learning Together clinics resulted in an increase in costs of £37 per clinic. Threshold analysis illustrated one child with a common illness like constipation needs to be well for two weeks, in one Practice hosting four training clinics for the clinics to be considered cost effective. Learning Together is of minimal training cost. Our threshold analysis produced a rubric that can be used locally to test cost effectiveness at a Practice or Programme level.
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[Artificial intelligence--the knowledge base applied to nephrology].
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.
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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.
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Comparative effectiveness research and its utility in In-clinic practice
Dang, Amit; Kaur, Kirandeep
2016-01-01
One of the important components of patient-centered healthcare is comparative effectiveness research (CER), which aims at generating evidence from the real-life setting. The primary purpose of CER is to provide comparative information to the healthcare providers, patients, and policy makers about the standard of care available. This involves research on clinical questions unanswered by the explanatory trials during the regulatory approval process. Main methods of CER involve randomized controlled trials and observational methods. The limitations of these two methods have been overcome with the help of new statistical methods. After the evidence generation, it is equally important to communicate the results to all the interested organizations. CER is beginning to have its impact in the clinical practice as its results become part of the clinical practice guidelines. CER will have far-reaching scientific and financial impact. CER will make both the treating physician and the patient equally responsible for the treatment offered. PMID:26955571
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Saunders, Hannele
2015-07-01
To describe quantitative and qualitative best evidence as sources for practical interventions usable in daily care delivery in order to integrate best evidence into clinical decision-making at local practice settings. To illustrate the development, implementation and evaluation of a pain management nursing care bundle based on a clinical practice guideline via a real-world clinical exemplar. Successful implementation of evidence-based practice requires consistent integration of best evidence into daily clinical decision-making. Best evidence comprises high-quality knowledge summarised in systematic reviews and translated into guidelines. However, consistent integration of guidelines into care delivery remains challenging, partly due to guidelines not being in a usable form for daily practice or relevant for the local context. A position paper with a clinical exemplar of a nurse-led, evidence-based quality improvement project to design, implement and evaluate a pain management care bundle translated from a national nursing guideline. A pragmatic approach to integrating guidelines into daily practice is presented. Best evidence from a national nursing guideline was translated into a pain management care bundle and integrated into daily practice in 15 medical-surgical (med-surg) units of nine hospitals of a large university hospital system in Finland. Translation of best evidence from guidelines into usable form as care bundles adapted to the local setting may increase implementation and uptake of guidelines and improve quality and consistency of care delivery. A pragmatic approach to translating a nursing guideline into a pain management care bundle to incorporate best evidence into daily practice may help achieve more consistent and equitable integration of guidelines into care delivery, and better quality of pain management and patient outcomes. © 2015 John Wiley & Sons Ltd.
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Perspective: clinical communication education in the United Kingdom: some fresh insights.
Brown, Jo
2012-08-01
Clinical communication education is now part of the core curriculum of every medical school in the United Kingdom and the United States. It has emerged over 30 years because of various societal, political, and policy drivers and is supported by an impressive evidence base.For a variety of reasons, however, clinical communication has become separated from other parts of medical education and tends to be positioned in the early years of the curriculum, when students have limited experience of being in the clinical workplace and working with patients. The teachers of clinical communication, whether medical-school-based or clinically based, may not share learning goals for the subject and this may, therefore, provide a disintegrated learning experience for students.Clinical communication teachers need to inject fresh thinking into the teaching and learning of the subject to unite it with clinical practice in the authentic clinical workplace. Engaging with theories of workplace learning, which aim to overcome the theory/practice gap in vocational education, may be the way forward. The author suggests various ways that this might be achieved-for example, by situating clinical communication education throughout the whole undergraduate curriculum, by integrating the topic of clinical communication with other areas of medical education, by developing coteaching and curriculum design partnerships between medical school and clinical workplace, and by developing a greater range of postgraduate education that offers opportunities for professional development in clinical communication for qualified doctors that is complementary with what is taught in undergraduate education.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Taslakian, Bedros, E-mail: Bedros.Taslakian@nyumc.org; Sridhar, Divya
Interventional radiology (IR) has evolved into a full-fledged clinical specialty with attendant patient care responsibilities. Success in IR now requires development of a full clinical practice, including consultations, inpatient admitting privileges, and an outpatient clinic. In addition to technical excellence and innovation, maintaining a comprehensive practice is imperative for interventional radiologists to compete successfully for patients and referral bases. A structured approach to periprocedural care, including routine follow-up and early identification and management of complications, facilitates efficient and thorough management with an emphasis on quality and patient safety.
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Taslakian, Bedros; Sridhar, Divya
2017-04-01
Interventional radiology (IR) has evolved into a full-fledged clinical specialty with attendant patient care responsibilities. Success in IR now requires development of a full clinical practice, including consultations, inpatient admitting privileges, and an outpatient clinic. In addition to technical excellence and innovation, maintaining a comprehensive practice is imperative for interventional radiologists to compete successfully for patients and referral bases. A structured approach to periprocedural care, including routine follow-up and early identification and management of complications, facilitates efficient and thorough management with an emphasis on quality and patient safety.
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McMenamin, John; Nicholson, Rick; Leech, Ken
2011-12-01
Clinical reminders have been shown to help general practice achieve an increase in some preventive care items, especially if they identify a patient's eligibility for the target item, prompt clinicians at the right time, provide a fast link to management tools and facilitate clinical recording. WRPHO has introduced the Patient Dashboard clinical reminder and monitored its impact on health targets. This paper reports the impact of a computerised colour-coded clinical reminder on achieving agreed health targets in Whanganui regional practices. Patient Dashboard was developed from previous versions in Auckland and Northland and provided to Whanganui regional practices with Primary Health Organisation (PHO) support. The Dashboard was linked with existing and new clinical management tools which automatically updated clinical records. Data from practices was pooled by Whanganui Regional Primary Health Organisation and target achievement rates reported over 15 months. Over the initial 15 months of Patient Dashboard use, recording of smoking status increased from 74% to 82% and of alcohol use from 15% to 47%. Screening for diabetes increased from 62% to 74%, cardiovascular risk assessment from 20% to 43%, cervical screening from 71% to 79%, and breast screening from 60% to 80%. Patient Dashboard was associated with increased performance indicators both for those targets which were part of a PHO programme and for targets without additional support.
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ERIC Educational Resources Information Center
Colbert, Colleen Y.; Ogden, Paul E.; Lowe, Darla; Moffitt, Michael J.
2010-01-01
Systems-based practice (SBP) is rarely taught or evaluated during medical school, yet is one of the required competencies once students enter residency. We believe Texas A&M College of Medicine students learn about systems issues informally, as they care for patients at a free clinic in Temple, TX. The mandatory free clinic rotation is part of…
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Shared decision making as part of value based care: New U.S. policies challenge our readiness.
Spatz, Erica S; Elwyn, Glyn; Moulton, Benjamin W; Volk, Robert J; Frosch, Dominick L
2017-06-01
Shared decision making in the United States is increasingly being recognized as part of value-based care. During the last decade, several state and federal initiatives have linked shared decision making with reimbursement and increased protection from litigation. Additionally, private and public foundations are increasingly funding studies to identify best practices for moving shared decision making from the research world into clinical practice. These shifts offer opportunities and challenges for ensuring effective implementation. Copyright © 2017. Published by Elsevier GmbH.
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What impact do students have on clinical educators and the way they practise?
Waters, Lisa; Lo, Kristin; Maloney, Stephen
2017-07-11
The clinical education setting plays an important part in teaching students about the real world of clinical practice. Traditionally the educational relationship between student and clinical educator has been considered one-way, with students being the ones that benefit. This review focuses on the areas of clinician practice and behaviour that students are reported to influence through clinical placements and as such, determine the overall impact students can have on supervising clinicians. Electronic searches were conducted across MEDLINE, EMBASE, PsychINFO and CINAHL in July 2016. Retrieved articles were filtered to find those which presented data relating to students in the clinical setting. Data was extracted and analysed independently by two authors through thematic analysis. Twenty-eight studies met the inclusion criteria. Results showed that practitioners enjoy the act of teaching. Clinical student presence encourages clinicians to solidify their knowledge base, stimulates learning and causes them to re-evaluate their practice. Practitioner skills were further developed as a results of students. Clinical educator workload and time spent at work increased when a student was present with time management being the predominant challenge practitioners faced. Studies demonstrated that clinicians feel they benefit by students periodically becoming the teacher. Student placements in clinical practice cause an increase in practitioner workload and lengthen their work day. These perceived limitations are outweighed by the many benefits described by supervising clinicians. Providing clinical education can enrich both the practice, and the practitioner, and the aforementioned advantages should be highlighted when offering or considering the expansion of clinical placements.
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ERIC Educational Resources Information Center
Burke, Jay Evan
2017-01-01
Practicum training is an essential part of The Chicago School of Professional Psychology (TCSPP) Marriage and Family Therapy (MFT) Master's degree program, and the cornerstone for preparing students for clinical practice. To characterize the development across clinical competency areas, the current study examined midpoint and final evaluation data…
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Textbook of Child and Adolescent Psychiatry. 3rd Edition.
ERIC Educational Resources Information Center
Wiener, Jerry M.; Dulcan, Mina K.
The third edition of this textbook continues its tradition of integrating clinical wisdom and scientific research to improve patient care and advocacy for children and families. Each of the 56 chapters presents a summary of a core topic, blending clinical experience with evidence-based practices in assessment and treatment. Divided into 10 parts,…
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Values-based practice in mental health and psychiatry.
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.
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Do procedural skills workshops during family practice residency work?
MacKenzie, Mark S.; Berkowitz, Jonathan
2010-01-01
ABSTRACT OBJECTIVE To determine if participation in a procedural skills workshop during family practice residency affects future use of these skills in postgraduate clinical practice. DESIGN Survey involving self-assessment of procedural skills experience and competence. SETTING British Columbia. PARTICIPANTS Former University of British Columbia family practice residents who trained in Vancouver, BC, including residents who participated in a procedural skills workshop in 2001 or 2003 and residents graduating in 2000 and 2002 who did not participate in the procedural skills workshop. MAIN OUTCOME MEASURES Self-assessed experience and competence in the 6 office-based procedural skills that were taught during the procedural skills workshops in 2001 and 2003. RESULTS Participation in a procedural skills workshop had no positive effect on future use of these skills in clinical practice. Participation in the workshop was associated with less reported experience (P = .091) in injection of lateral epicondylitis. As with previous Canadian studies, more women than men reported experience and competence in gynecologic procedures. More women than men reported experience (P = .001) and competence (P = .004) in intrauterine device insertion and experience (P = .091) in endometrial aspiration biopsy. More men than women reported competence (P = .052) in injection of trochanteric bursae. A third year of emergency training was correlated with an increase in reported experience (P = .021) in shoulder injection. CONCLUSION Participation in a procedural skills workshop during family practice residency did not produce a significant increase in the performance of these skills on the part of participants once they were in clinical practice. The benefit of a skills workshop might be lost when there is no opportunity to practise and perfect these skills. Sex bias in the case of some procedures might represent a needs-based acquisition of skills on the part of practising physicians. Short procedural skills workshops might be better suited to graduated physicians with more clinical experience. PMID:20705868
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McLean, Michelle; Johnson, Patricia; Sargeant, Sally; Green, Patricia
2015-01-01
On their journey to "becoming" doctors, medical students encounter a range of health professionals who contribute to their socialisation into clinical practice. Amongst these individuals are registered nurses (RNs) in clinical practice who are often employed by medical schools as clinical tutors. These RNs will encounter medical students on campus and later in the clinical setting. This qualitative study explored RNs' perceptions of their contribution to medical students' developing professional identities in order to provide a greater understanding of this process and ultimately inform future curriculum. This qualitative study took place in 2012 at one Australian medical school as part of a broader study exploring medical students' professional identity development from the perspectives of their teachers and trainers. Eight of the nine RNs involved in teaching procedural skills were interviewed. Recorded interviews were transcribed verbatim. Data were analysed inductively by the research team. Two major themes emerged: RNs as change agents and RNs as facilitators of medical students' transition to the clinical environment. RNs as change agents related to their role modelling good practice, being patient-centred, and by emphasising factors contributing to good teamwork such as recognising and respecting individual professional roles. They facilitated students' transition to the clinical environment often through personal narratives, by offering advice on how to behave and work with members of the healthcare team, and by being a point of contact in the hospital. Based on their descriptions of how they role modelled good practice and how they facilitated students' transition to clinical practice, we believe that RN clinical tutors do have the experience and expertise in clinical practice and a professional approach to patients to contribute to medical students' developing professional identities as future doctors.
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Ohnsorge, Kathrin; Widdershoven, Guy
2011-09-01
In this article, we argue that a critical examination of epistemological and anthropological presuppositions might lead to a more fruitful use of theory in clinical-ethical practice. We differentiate between two views of conceptualizing ethics, referring to Charles Taylors' two epistemological models: 'monological' versus 'dialogical consciousness'. We show that the conception of ethics in the model of 'dialogical consciousness' is radically different from the classical understanding of ethics in the model of 'monological consciousness'. To reach accountable moral judgments, ethics cannot be conceptualized as an individual enterprise, but has to be seen as a practical endeavor embedded in social interactions within which moral understandings are being negotiated. This view has specific implications for the nature and the role of ethical theory. Theory is not created in the individual mind of the ethicist; the use of theory is part of a joint learning process and embedded in a cultural context and social history. Theory is based upon practice, and serves practical purposes. Thus, clinical ethics support is both practical and theoretical. © 2011 Blackwell Publishing Ltd.
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Duhamel, Fabie
2010-02-01
The author's reflections on knowledge transfer/translation highlight the importance of the circular process between science and practice knowledge, leading to the notion of "knowledge exchange." She addresses the dilemmas of translating knowledge into clinical practice by describing her academic contributions to knowledge exchange within Family Systems Nursing (FSN). Teaching and research strategies are offered that address the circularity between science and practice knowledge. The evolution of 20 years of teaching, research, and clinical experience has resulted in the recent creation of a Center of Excellence in Family Nursing at the University of Montreal. The three main objectives of the Center uniquely focus on knowledge exchange by providing (a) a training context for skill development for nurses specializing in FSN, (b) a research milieu for knowledge "creation" and knowledge "in action" studies to further advance the practice of FSN, and (c) a family healing setting to support families who experience difficulty coping with health issues.
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Darrah, Johanna; Loomis, Joan; Manns, Patricia; Norton, Barbara; May, Laura
2006-11-01
The Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada, recently implemented a Master of Physical Therapy (MPT) entry-level degree program. As part of the curriculum design, two models were developed, a Model of Best Practice and the Clinical Decision-Making Model. Both models incorporate four key concepts of the new curriculum: 1) the concept that theory, research, and clinical practice are interdependent and inform each other; 2) the importance of client-centered practice; 3) the terminology and philosophical framework of the World Health Organization's International Classification of Functioning, Disability, and Health; and 4) the importance of evidence-based practice. In this article the general purposes of models for learning are described; the two models developed for the MPT program are described; and examples of their use with curriculum design and teaching are provided. Our experiences with both the development and use of models of practice have been positive. The models have provided both faculty and students with a simple, systematic structured framework to organize teaching and learning in the MPT program.
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Puryer, J; McNally, L; O'Sullivan, D
2015-01-01
UK dental schools are reliant on part-time teachers to deliver the clinical educational component of the course, the majority with a background in general dental practice. Opportunities for promotion are limited, as is the support for obtaining educational qualifications. The aim of this study was to ascertain the views of such teachers at a dental school. An anonymous online survey was used to obtain both qualitative and quantitative views. The response rate was 80%. The school has n = 50 part-time clinical teachers, who have been teaching for, on average ten years, and for three sessions per week. Eighteen percent of teachers are recognised specialists. Forty-six percent of respondents have a formal teaching qualification, mostly at certificate level, and 55% thought it necessary to acquire a formal teaching qualification. Eighty-eight percent were happy with their role as clinical teachers. This study demonstrates that despite the lack of support and prospect of career progression, the majority of part-time clinical teachers at this institution are satisfied with their role.
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Wang, Jing-Jy; Lo, Chi-Hui Kao; Ku, Ya-Lie
2004-11-01
A set of problem solving strategies integrated into nursing process in nursing core courses (PSNP) was developed for students enrolled in a post-RN baccalaureate nursing program (RN-BSN) in a university in Taiwan. The purpose of this study, therefore, was to evaluate the effectiveness of PSNP on students' clinical problem solving abilities. The one-group post-test design with repeated measures was used. In total 114 nursing students with 47 full-time students and 67 part-time students participated in this study. The nursing core courses were undertaken separately in three semesters. After each semester's learning, students would start their clinical practice, and were asked to submit three written nursing process recordings during each clinic. Assignments from the three practices were named post-test I, II, and III sequentially, and provided the data for this study. The overall score of problem solving indicated that score on the post-test III was significantly better than that on post-test I and II, meaning both full-time and part-time students' clinical problem solving abilities improved at the last semester. In conclusion, problem-solving strategies integrated into nursing process designed for future RN-BSN students are recommendable.
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Roberts, Michael C; Blossom, Jennifer B; Evans, Spencer C; Amaro, Christina M; Kanine, Rebecca M
2017-01-01
Evidence-based practice (EBP) has become a central focus in clinical child and adolescent psychology. As originally defined, EBP in psychology is the integration of the best available research evidence, patient characteristics, and clinical expertise. Although evidence-based perspectives have garnered widespread acceptance in recent years, there has also been some confusion and disagreement about the 3-part definition of EBP, particularly the role of research. In this article, we first provide a brief review of the development of EBP in clinical child and adolescent psychology. Next, we outline the following 4 points to help clarify the understanding of EBP: (a) knowledge should not be confused with epistemic processes, (b) research on clinician and client factors is needed for EBP, (c) research on assessment is needed for EBP, and (d) the 3-part conceptualization of EBP can serve as a useful framework to guide research. Based on these principles, we put forth a slightly revised conceptualization of EBP, in which the role of research is expanded and more clearly operationalized. Finally, based on our review of the literature, we offer illustrative examples of specific directions for future research to advance the evidence base for EBP in clinical child and adolescent psychology.
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Reimagining Nursing's Place in the History of Clinical Practice
Fairman, Julie; D'Antonio, Patricia
2008-01-01
This work posits how medical history might be conceptualized if nurses and nursing history was used as the analytical lens. Nursing is seen not as a separate part or subsection of medical history, but rather one that is deeply embedded in the relationships and social order of clinical practice. Nursing is an analytical category in and of itself. By approaching nursing as such a category, we enlarge “new notions of historical significance” to encompass personal, political, public, and private activities that constitute medical experiences. PMID:18375461
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Challenges to laboratory hematology practice: Egypt perspective.
Rizk, S H
2018-05-01
Laboratory hematology is an integral part of all clinical laboratories along the extensive healthcare facilities in Egypt. The aim of this review is to portrait the laboratory hematology practice in Egypt including its unique socioeconomic background, blood disease pattern, education and training, regulatory oversight, and the related challenges. Current practice varies widely between different parts of the healthcare system in terms of the range of tests, applied techniques, workforce experience, and quality of service. The national transfusion service (NBTS) in Egypt has been recently upgraded and standardized according to the World Health Organization (WHO) guidelines. Formal postgraduate education roughly follows the British system. Laboratory hematology specialization is achieved through 2-3 years masters' degree followed by 2-4 years doctorate degree in clinical pathology with training and research in hematology. Improvement of laboratory hematology education is recently undergoing a reform as a part of the modernization of higher education policy and following the standards developed by the National Quality Assurance and Accreditation Agency (NQAAA). Accreditation of medical laboratories is recently progressing with the development of the "Egyptian Accreditation Council" (EGAC) as the sole accreditation body system and training of assessors. Current laboratory system has many challenges, some are related to the inadequate system performance, and others are unique to laboratory hematology issues. The rapid technological advances and therapeutic innovations in hematology practice call for an adapting laboratory system with continuous upgrading. © 2018 John Wiley & Sons Ltd.
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Berthelsen, Connie Bøttcher; Hølge-Hazelton, Bibi
2017-05-01
To report an analysis of the concept of nursing research culture in the context of clinical nursing practice. Nursing research culture should be valued for its contribution to improving patient care and should be considered as a routine hospital activity. However, the demand for efficiency, nurses' barriers to research use and the lack of definition of the concept of nursing research culture make it difficult to establish. Concept analysis. Data were collected through a literature review in PubMed, CINAHL and PsycINFO during March 2016. Walker and Avant's eight-step framework for concept analysis. Five defining attributes of nursing research culture in the context of clinical nursing practice were identified: strong monodisciplinary nursing professionalism, academic thinking and socialization, research use as a part of daily nursing practice, acceptance by colleagues and management and facilitation of resources from management and organization. Although the method of concept analysis has been criticized and heavily debated, the development of nursing research cultures based on the defining attributes and antecedents of the concept will be important to emphasize evidence-based clinical nursing care. Further research should support the development and the implementation of nursing research culture in clinical nursing practice. © 2016 John Wiley & Sons Ltd.
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Aarts, Johanna W M; Faber, Marjan J; Cohlen, Ben J; Van Oers, Anne; Nelen, WillianNe L D M; Kremer, Jan A M
2015-01-01
The Internet is expected to innovate healthcare, in particular patient-centredness of care. Within fertility care, information provision, communication with healthcare providers and support from peers are important components of patient-centred care. An online infertility community added to an in vitro fertilisation or IVF clinic's practice provides tools to healthcare providers to meet these. This study's online infertility community facilitates peer-to-peer support, information provision to patients and patient provider communication within one clinic. Unfortunately, these interventions often fail to become part of clinical routines. The analysis of a first introduction into usual care can provide lessons for the implementation in everyday health practice. The aim was to explore experiences of professionals and patients with the implementation of an infertility community into a clinic's care practice. We performed semi-structured interviews with both professionals and patients to collect these experiences. These interviews were analyzed using the Normalisation Process Model. Assignment of a community manager, multidisciplinary division of tasks, clear instructions to staff in advance and periodical evaluations could contribute to the integration of this online community. Interviews with patients provided insights into the possible impact on daily care. This study provides lessons to healthcare providers on the implementation of an online infertility community into their practice.
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Davies, B R; Leung, A N; Dunne, S M
2013-05-01
Dental schools in the United Kingdom are becoming increasingly reliant on the services of part-time teachers to deliver the clinical educational component of the dental course. Their background is predominantly from general dental practice but the opportunities to progress in the system are limited. The aim of this study was to ascertain the views and perceptions of such teachers at a dental school. An anonymous, non-incentivised online survey was used to obtain both qualitative and quantitative views of the part timers. The department has n = 40 part-time teachers and there was a response rate of 78%. Overall 73% were satisfied with their current teaching position, whereas the remaining 27% of teachers were seeking higher rewards both in terms of recognition and status. This study demonstrated the need for formal teaching skills and training to be made available to part-time clinical teachers. Allied to this is the requirement for a clearly defined and achievable career pathway.
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Policy implementation in practice: the case of national service frameworks in general practice.
Checkland, Kath; Harrison, Stephen
2004-10-01
National Service Frameworks are an integral part of the government's drive to 'modernise' the NHS, intended to standardise both clinical care and the design of the services used to deliver that clinical care. This article uses evidence from qualitative case studies in three general practices to illustrate the difficulties associated with the implementation of such top-down guidelines and models of service. In these studies it was found that, while there had been little explicit activity directed at implementation overall, the National Service Framework for coronary heart disease had in general fared better than that for older people. Gunn's notion of 'perfect implementation' is used to make sense of the findings.
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The diverse landscape of palliative care clinics.
Smith, Alexander K; Thai, Julie N; Bakitas, Marie A; Meier, Diane E; Spragens, Lynn H; Temel, Jennifer S; Weissman, David E; Rabow, Michael W
2013-06-01
Many health care organizations are interested in instituting a palliative care clinic. However, there are insufficient published data regarding existing practices to inform the development of new programs. Our objective was to obtain in-depth information about palliative care clinics. We conducted a cross-sectional survey of 20 outpatient palliative care practices in diverse care settings. The survey included both closed- and open-ended questions regarding practice size, utilization of services, staffing, referrals, services offered, funding, impetus for starting, and challenges. Twenty of 21 (95%) practices responded. Practices self-identified as: hospital-based (n=7), within an oncology division/cancer center (n=5), part of an integrated health system (n=6), and hospice-based (n=2). The majority of referred patients had a cancer diagnosis. Additional common diagnoses included chronic obstructive pulmonary disease, neurologic disorders, and congestive heart failure. All practices ranked "pain management" and "determining goals of care" as the most common reasons for referrals. Twelve practices staffed fewer than 5 half-days of clinic per week, with 7 operating only one half-day per week. Practices were staffed by a mixture of physicians, advanced practice nurses or nurse practitioners, nurses, or social workers. Eighteen practices expected their practice to grow within the next year. Eleven practices noted a staffing shortage and 8 had a wait time of a week or more for a new patient appointment. Only 12 practices provide 24/7 coverage. Billing and institutional support were the most common funding sources. Most practices described starting because inpatient palliative providers perceived poor quality outpatient care in the outpatient setting. The most common challenges included: funding for staffing (11) and being overwhelmed with referrals (8). Once established, outpatient palliative care practices anticipate rapid growth. In this context, outpatient practices must plan for increased staffing and develop a sustainable financial model.
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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.
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Dhaliwal, Rupinder; Cahill, Naomi; Lemieux, Margot; Heyland, Daren K
2014-02-01
Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patient decisions about appropriate healthcare for specific clinical circumstances, and are designed to minimize practice variation, improve costs, and improve clinical outcomes. The Canadian Critical Care Practice Guidelines (CCPGs) were first published in 2003 and most recently updated in 2013. A total of 68 new randomized controlled trials were identified since the last version in 2009, 50 of them published between 2009 and 2013. The remaining articles were trials published before 2009 but were not identified in previous iterations of the CCPGs. For clinical practice guidelines to be useful to practitioners, they need to be up-to-date and be reflective of the current body of evidence. Herein we describe the process by which the CCPGs were updated. This process resulted in 10 new sections or clinical topics. Of the old clinical topics, 3 recommendations were upgraded, 4 were downgraded, and 27 remained the same. To influence decision making at the bedside, these updated guidelines need to be accompanied by active guideline implementation strategies. Optimal implementation strategies should be guided by local contextual factors including barriers and facilitators to best practice recommendations. Moreover, evaluating and monitoring performance, such as participating in the International Nutrition Survey of practice, should be part of any intensive care unit's performance improvement strategy. The active implementation of the updated CCPGs may lead to better nutrition care and improved patient outcomes in the critical care setting.
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Narayanan, Jaishree; Dobrin, Sofia; Choi, Janet; Rubin, Susan; Pham, Anna; Patel, Vimal; Frigerio, Roberta; Maurer, Darryck; Gupta, Payal; Link, Lourdes; Walters, Shaun; Wang, Chi; Ji, Yuan; Maraganore, Demetrius M
2017-01-01
Using the electronic medical record (EMR) to capture structured clinical data at the point of care would be a practical way to support quality improvement and practice-based research in epilepsy. We describe our stepwise process for building structured clinical documentation support tools in the EMR that define best practices in epilepsy, and we describe how we incorporated these toolkits into our clinical workflow. These tools write notes and capture hundreds of fields of data including several score tests: Generalized Anxiety Disorder-7 items, Neurological Disorders Depression Inventory for Epilepsy, Epworth Sleepiness Scale, Quality of Life in Epilepsy-10 items, Montreal Cognitive Assessment/Short Test of Mental Status, and Medical Research Council Prognostic Index. The tools summarize brain imaging, blood laboratory, and electroencephalography results, and document neuromodulation treatments. The tools provide Best Practices Advisories and other clinical decision support when appropriate. The tools prompt enrollment in a DNA biobanking study. We have thus far enrolled 231 patients for initial visits and are starting our first annual follow-up visits and provide a brief description of our cohort. We are sharing these EMR tools and captured data with other epilepsy clinics as part of a Neurology Practice Based Research Network, and are using the tools to conduct pragmatic trials using subgroup-based adaptive designs. © 2016 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.
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Homaifar, Beeta; Matarazzo, Bridget; Wortzel, Hal S
2013-09-01
This column is the second in a series presenting a model for therapeutic risk management of the suicidal patient. As discussed in the first part of the series, the model involves several elements including augmenting clinical risk assessment with structured instruments, stratifying risk in terms of both severity and temporality, and developing and documenting a safety plan. This column explores in more detail how to augment clinical risk assessment with structured instruments. Unstructured clinical interviews have the potential to miss important aspects of suicide risk assessment. By augmenting the free-form clinical interview with structured instruments that demonstrate reliability and validity, a more nuanced and multifaceted approach to suicide risk assessment is achieved. Incorporating structured instruments into practice also serves a medicolegal function, since these instruments may become a living part of the medical record, establishing baseline levels of suicidal thoughts and behaviors and facilitating future clinical determinations regarding safety needs. We describe several instruments used in a multidisciplinary suicide consultation service, each of which has demonstrated relevance to suicide risk assessment and screening, ease of administration, and strong psychometric properties. In addition, we emphasize the importance of viewing suicide risk assessment as an ongoing process rather than as a singular event. Finally, we discuss special considerations in the evolving practice of risk assessment.
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Translation of Nutritional Genomics into Nutrition Practice: The Next Step.
Murgia, Chiara; Adamski, Melissa M
2017-04-06
Genetics is an important piece of every individual health puzzle. The completion of the Human Genome Project sequence has deeply changed the research of life sciences including nutrition. The analysis of the genome is already part of clinical care in oncology, pharmacology, infectious disease and, rare and undiagnosed diseases. The implications of genetic variations in shaping individual nutritional requirements have been recognised and conclusively proven, yet routine use of genetic information in nutrition and dietetics practice is still far from being implemented. This article sets out the path that needs to be taken to build a framework to translate gene-nutrient interaction studies into best-practice guidelines, providing tools that health professionals can use to understand whether genetic variation affects nutritional requirements in their daily clinical practice.
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Translation of Nutritional Genomics into Nutrition Practice: The Next Step
Murgia, Chiara; Adamski, Melissa M.
2017-01-01
Genetics is an important piece of every individual health puzzle. The completion of the Human Genome Project sequence has deeply changed the research of life sciences including nutrition. The analysis of the genome is already part of clinical care in oncology, pharmacology, infectious disease and, rare and undiagnosed diseases. The implications of genetic variations in shaping individual nutritional requirements have been recognised and conclusively proven, yet routine use of genetic information in nutrition and dietetics practice is still far from being implemented. This article sets out the path that needs to be taken to build a framework to translate gene–nutrient interaction studies into best-practice guidelines, providing tools that health professionals can use to understand whether genetic variation affects nutritional requirements in their daily clinical practice. PMID:28383492
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Curran, Mary K
2014-05-01
The American Nurses Association advocates for nursing professional development (NPD) specialists to have an earned graduate degree, as well as educational and clinical expertise. However, many NPD specialists have limited exposure to adult learning theory. Limited exposure to adult learning theory may affect NPD educational practices, learning outcomes, organizational knowledge transfer, and subsequently, the professional development of the nurses they serve and quality of nursing care. An examination of current teaching practices may reveal opportunities for NPD specialists to enhance educational methods to promote learning, learning transfer, and organizational knowledge and excellence. This article, the first in a two-part series, examines best practices of adult learning theories, nursing professional development, curriculum design, and knowledge transfer. Part II details the results of a correlational study that examined the effects of four variables on the use of adult learning theory to guide curriculum development for NPD specialists in hospitals. Copyright 2014, SLACK Incorporated.
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Saavedra Salinas, Miguel Ángel; Barrera Cruz, Antonio; Cabral Castañeda, Antonio Rafael; Jara Quezada, Luis Javier; Arce-Salinas, C Alejandro; Álvarez Nemegyei, José; Fraga Mouret, Antonio; Orozco Alcalá, Javier; Salazar Páramo, Mario; Cruz Reyes, Claudia Verónica; Andrade Ortega, Lilia; Vera Lastra, Olga Lidia; Mendoza Pinto, Claudia; Sánchez González, Antonio; Cruz Cruz, Polita Del Rocío; Morales Hernández, Sara; Portela Hernández, Margarita; Pérez Cristóbal, Mario; Medina García, Gabriela; Hernández Romero, Noé; Velarde Ochoa, María Del Carmen; Navarro Zarza, José Eduardo; Portillo Díaz, Verónica; Vargas Guerrero, Angélica; Goycochea Robles, María Victoria; García Figueroa, José Luis; Barreira Mercado, Eduardo; Amigo Castañeda, Mary Carmen
2015-01-01
Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus, rheumatoid arthritis (RA) and antiphospholipid syndrome (APS). Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and staging of recommendations, internal validation by peers and external validation of the final document. The quality criteria of the AGREE II instrument were followed. The panels answered 37 questions related to maternal and fetal care in lupus erythematosus, RA and APS, as well as for use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. In this second part, the recommendations for pregnant women with RA, APS and the use of antirheumatic drugs during pregnancy and lactation are presented. We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with RA and APS integrate the best available evidence for the treatment and follow-up of patients with these conditions. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
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Mathers, Jonathan; Greenfield, Sheila; Metcalfe, Alison; Cole, Trevor; Flanagan, Sarah; Wilson, Sue
2010-05-01
National and local evaluations of clinical genetics service pilots have experienced difficulty in engaging with GPs. To understand GPs' reluctance to engage with clinical genetics service developments, via an examination of the role of family history in general practice. Qualitative study using semi-structured one-to-one interviews. The West Midlands, UK. Interviews with 21 GPs working in 15 practices, based on a stratified random sample from the Midlands Research Practices Consortium database. Thematic analysis proceeded alongside data generation. Framework grids were constructed for comparative analytical questioning. Interpretation was framed by two explanatory models: a knowledge deficit model, and practice and professional identity model. There is a clear distinction between the routine use and function of family history in GPs' clinical decision making, and contrasting conceptualisations of genetics and 'genetic conditions'. Although genetics is clearly a part of current GP practice, with acknowledgement of genetic components to multifactorial disease, this is distinguished from 'genetic conditions' which are seen as rare, complex single-gene disorders. Importantly, family history takes its place within a broader notion of the 'family doctor' that interviewees identified as a key aspect of their role. In contrast, clinical genetics was not identified as a core component of generalist practice. The likely effectiveness of educational policy interventions aimed at GPs that focus solely on knowledge deficit models, is questionable. There is a need to acknowledge how appropriate practice is constructed by GPs, within the context of accepted generalist roles and related identities.
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Using scenario-based training to promote information literacy among on-call consultant pediatricians
Pettersson, Jonas; Bjorkander, Emil; Bark, Sirpa; Holmgren, Daniel; Wekell, Per
2017-01-01
Background Traditionally, teaching hospital staff to search for medical information relies heavily on educator-defined search methods. In contrast, the authors describe our experiences using real-time scenarios to teach on-call consultant pediatricians information literacy skills as part of a two-year continuing professional development program. Case Presentation Two information-searching workshops were held at Sahlgrenska University Hospital in Gothenburg, Sweden. During the workshops, pediatricians were presented with medical scenarios that were closely related to their clinical practice. Participants were initially encouraged to solve the problems using their own preferred search methods, followed by group discussions led by clinical educators and a medical librarian in which search problems were identified and overcome. The workshops were evaluated using questionnaires to assess participant satisfaction and the extent to which participants intended to implement changes in their clinical practice and reported actual change. Conclusions A scenario-based approach to teaching clinicians how to search for medical information is an attractive alternative to traditional lectures. The relevance of such an approach was supported by a high level of participant engagement during the workshops and high scores for participant satisfaction, intended changes to clinical practice, and reported benefits in actual clinical practice. PMID:28670215
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Pettersson, Jonas; Bjorkander, Emil; Bark, Sirpa; Holmgren, Daniel; Wekell, Per
2017-07-01
Traditionally, teaching hospital staff to search for medical information relies heavily on educator-defined search methods. In contrast, the authors describe our experiences using real-time scenarios to teach on-call consultant pediatricians information literacy skills as part of a two-year continuing professional development program. Two information-searching workshops were held at Sahlgrenska University Hospital in Gothenburg, Sweden. During the workshops, pediatricians were presented with medical scenarios that were closely related to their clinical practice. Participants were initially encouraged to solve the problems using their own preferred search methods, followed by group discussions led by clinical educators and a medical librarian in which search problems were identified and overcome. The workshops were evaluated using questionnaires to assess participant satisfaction and the extent to which participants intended to implement changes in their clinical practice and reported actual change. A scenario-based approach to teaching clinicians how to search for medical information is an attractive alternative to traditional lectures. The relevance of such an approach was supported by a high level of participant engagement during the workshops and high scores for participant satisfaction, intended changes to clinical practice, and reported benefits in actual clinical practice.
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ERIC Educational Resources Information Center
Maloney, Phoebe; Stagnitti, Karen; Schoo, Adrian
2013-01-01
There is a need to maximise rural clinical fieldwork placement to build health workforce capacity. This study investigated allied health professionals' (AHPs) experience of supervising students as part of work-integrated learning in public and private rural health settings. An anonymous postal questionnaire with 30 questions was used to collect…
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How Conceptual Frameworks Influence Discovery and Depictions of Emotions in Clinical Relationships
ERIC Educational Resources Information Center
Duchan, Judith Felson
2011-01-01
Although emotions are often seen as key to maintaining rapport between speech-language pathologists and their clients, they are often neglected in the research and clinical literature. This neglect, it is argued here, comes in part from the inadequacies of prevailing conceptual frameworks used to govern practices. I aim to show how six such…
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Breaking the silence: nurses' understandings of change in clinical practice.
Copnell, Beverley; Bruni, Nina
2006-08-01
This paper reports a study exploring critical care nurses' understandings of change in their practice. In contemporary nursing literature, change in clinical nursing practice is generally understood to be a rational process, synonymous with progress. It is seen as invariably contested, and hence difficult to achieve. It is represented as occurring infrequently. This literature effectively silences clinicians as this discourse of change does not recognize or incorporate their views or practices. This study was informed by a Foucauldian poststructuralist framework. The participants were 12 critical care nurses who engaged in three individual in-depth, focused interviews. The transcripts were deconstructed to reveal participants' discourses of change and the implications of these discourses for nursing work. The data were generated between 1996 and 1998 as part of a study whose in-depth analysis was completed in 2003. Change was revealed as a highly complex phenomenon, closely intertwined with understandings of clinical nursing work. Participants showed difficulty in identifying or recalling clinical changes. Several dichotomies shaped their understandings of change, including change/stasis, formal/informal and dramatic/subtle. Their experiences of change frequently conflicted with prevailing dominant understandings, but they did not openly challenge them. Rather, they employed dichotomies, such as abstract/concrete and other/self, to enable them to work with these conflicts. As a result, they engaged in practices such as naming other nurses as 'irrational'. The data provide new understandings of change in clinical nursing practice, some of which challenge many widely held views (for example, that such change is a rare occurrence). It is argued that a lack of open challenge by clinical nurses contributes to their silencing, promotes disharmony amongst nurses and, hence, works against a collaborative approach to decisions about clinical practice.
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Cunningham, Nicola; Pham, Tony; Kennedy, Briohny; Gillard, Alexander; Ibrahim, Joseph
2017-05-29
To explore whether subscribers reported clinical practice changes as a result of reading the Clinical Communiqué (CC). Secondarily, to compare the characteristics of subscribers who self-reported changes to clinical practice with those who did not, and to explore subscribers' perceptions of the educational value of the CC. Online cross-sectional survey between 21 July 2015 and 18 August 2015 by subscribers of the CC (response rate=29.9%, 1008/3373), conducted by a team from Monash University, Australia. Change in clinical practice as a result of reading the CC. 53.0% of respondents reported that their practice had changed after reading the CC. Respondents also found that the CC raised awareness (96.5%) and provided ideas about improving patient safety and care (94.1%) leading them to discuss cases with their colleagues (79.6%) and review their practice (75.7%). Multivariate analysis indicated that working in a residential aged care facility (p<0.05) and having taken part in an inquest (p<0.05) were significantly associated with practice change. The design and content of the CC has generated a positive impact on the healthcare community. It is presented in a format that appears to be accessible and acceptable to readers and achieves its goals of promoting safer clinical care through greater awareness of the medico-legal context of practice. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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ERIC Educational Resources Information Center
Libler, Rebecca
2010-01-01
The Indiana State University Professional Development Schools (ISU PDS) Partnership sprang from the convergence of two strong needs: (1) the need for real life practice in the way of extended clinical experiences for teacher education students in schools of practice; and (2) the need on the part of the schools in the community to have access to…
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Laboratory-supported influenza surveillance in Victorian sentinel general practices.
Kelly, H; Murphy, A; Leong, W; Leydon, J; Tresise, P; Gerrard, M; Chibo, D; Birch, C; Andrews, R; Catton, M
2000-12-01
Laboratory-supported influenza surveillance is important as part of pandemic preparedness, for identifying and isolating candidate vaccine strains, for supporting trials of anti-influenza drugs and for refining the influenza surveillance case definition in practice. This study describes the implementation of laboratory-supported influenza surveillance in Victorian sentinel general practices and provides an estimate of the proportion of patients with an influenza-like illness proven to have influenza. During 1998 and 1999, 25 sentinel general practices contributed clinical surveillance data and 16 metropolitan practices participated in laboratory surveillance. Serological, virus-antigen detection, virus culture and multiplex polymerase chain reaction procedures were used to establish the diagnosis of influenza. Two laboratories at major teaching hospitals in Melbourne provided additional data on influenza virus identification. General practice sentinel surveillance and laboratory identification of influenza provided similar data on the pattern of influenza in the community between May and September. The clinical suspicion of influenza was confirmed in 49 to 54 per cent of cases seen in general practice.
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Otterman, Nicoline; Veerbeek, Janne; Schiemanck, Sven; van der Wees, Philip; Nollet, Frans; Kwakkel, Gert
2017-07-01
To select relevant and feasible instruments for the revision of the Dutch clinical practice guideline for physical therapy in patients with stroke. In this implementation study a comprehensive proposal for ICF categories and matching instruments was developed, based on reliability and validity. Relevant instruments were then selected in a consensus round by 11 knowledge brokers who were responsible for the implementation of the selected instruments. The feasibility of the selected instruments was tested by 36 physical therapists at different work settings within stroke services. Finally, instruments that were deemed relevant and feasible were included in the revised guideline. A total of 28 instruments were recommended for inclusion in the revised guideline. Nineteen instruments were retained from the previous guideline. Ten new instruments were tested in clinical practice, seven of which were found feasible. Two more instruments were added after critical appraisal of the set of the measurement instruments. The revised guideline contains 28 relevant and feasible instrument selected and tested in clinical practice by physical therapists. Further education and implementation is needed to integrate instruments in clinical practice. Further research is proposed for developing and implementing a core set of measurement instruments to be used at fixed time points to establish data registries that allow for continuous improvement of rehabilitation for stroke patients. Implications for Rehabilitation The revised Dutch Stroke Physical Therapy Guideline recommends a total of 28 instruments, that are relevant and feasible for clinical practice of physical therapist in the different settings of stroke rehabilitation. The selection of instrument in daily practice should be part of the clinical reasoning process of PTs and be tailored to individual patients' needs and the degree of priority of the affected ICF category. Suggested education strategies for further integration of instruments in of the daily practice of PTs in Stroke Rehabilitation are: 'Training on the job' and 'peer assessment in clinical situations'.
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Development of the Champlain primary care cardiovascular disease prevention and management guideline
Montoya, Lorraine; Liddy, Clare; Hogg, William; Papadakis, Sophia; Dojeiji, Laurie; Russell, Grant; Akbari, Ayub; Pipe, Andrew; Higginson, Lyall
2011-01-01
Abstract Problem addressed A well documented gap remains between evidence and practice for clinical practice guidelines in cardiovascular disease (CVD) care. Objective of program As part of the Champlain CVD Prevention Strategy, practitioners in the Champlain District of Ontario launched a large quality-improvement initiative that focused on increasing the uptake in primary care practice settings of clinical guidelines for heart disease, stroke, diabetes, and CVD risk factors. Program description The Champlain Primary Care CVD Prevention and Management Guideline is a desktop resource for primary care clinicians working in the Champlain District. The guideline was developed by more than 45 local experts to summarize the latest evidence-based strategies for CVD prevention and management, as well as to increase awareness of local community-based programs and services. Conclusion Evidence suggests that tailored strategies are important when implementing specific practice guidelines. This article describes the process of creating an integrated clinical guideline for improvement in the delivery of cardiovascular care. PMID:21673196
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Practice innovation: the need for nimble data platforms to implement precision oncology care.
Elfiky, Aymen; Zhang, Dongyang; Krishnan Nair, Hari K
2015-01-01
Given the drive toward personalized, value-based, and coordinated cancer care delivery, modern knowledge-based practice is being shaped within the context of an increasingly technology-driven healthcare landscape. The ultimate promise of 'precision medicine' is predicated on taking advantage of the range of new capabilities for integrating disease- and individual-specific data to define new taxonomies as part of a systems-based knowledge network. Specifically, with cancer being a constantly evolving complex disease process, proper care of an individual will require the ability to seamlessly integrate multi-dimensional 'omic' and clinical data. Importantly, however, the challenges of curating knowledge from multiple dynamic data sources and translating to practice at the point-of-care highlight parallel needs. As patients, caregivers, and their environments become more proactive in clinical care and management, practical success of precision medicine is equally dependent on the development of proper infrastructures for evolving data integration, platforms for knowledge representation in a clinically-relevant context, and implementation within a provider's work-life and workflow.
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Application of The APA Practice Guidelines on Suicide to Clinical Practice.
Jacobs, Douglas G; Brewer, Margaret L
2006-06-01
This article presents charts from The American Psychiatric Association Practice Guideline for the Assessment and Treatment of Patients with Suicidal Behaviors, part of the Practice Guidelines for the Treatment of Psychiatric Disorders Compendium, and a summary of the assessment information in a format that can be used in routine clinical practice. Four steps in the assessment process are presented: the use of a thorough psychiatric examination to obtain information about the patient's current presentation, history, diagnosis, and to recognize suicide risk factors therein; the necessity of asking very specific questions about suicidal ideation, intent, plans, and attempts; the process of making an estimation of the patient's level of suicide risk is explained; and the use of modifiable risk and protective factors as the basis for treatment planning is demonstrated. Case reports are used to clarify use of each step in this process.
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Mcnaughton, Susan; Barrow, Mark; Bagg, Warwick; Frielick, Stanley
2016-01-01
Practice-based learning integrates the cognitive, psychomotor, and affective domains and is influenced by students' beliefs, values, and attitudes. Concept mapping has been shown to effectively demonstrate students' changing concepts and knowledge structures. This article discusses how concept mapping was modified to capture students' perceptions of the connections between the domains of thinking and knowing, emotions, behavior, attitudes, values, and beliefs and the specific experiences related to these, over a period of eight months of practice-based clinical learning. The findings demonstrate that while some limitations exist, modified concept mapping is a manageable way to gather rich data about students' perceptions of their clinical practice experiences. These findings also highlight the strong integrating influence of beliefs and values on other areas of practice, suggesting that these need to be attended to as part of a student's educational program.
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Mcnaughton, Susan; Barrow, Mark; Bagg, Warwick; Frielick, Stanley
2016-01-01
Practice-based learning integrates the cognitive, psychomotor, and affective domains and is influenced by students’ beliefs, values, and attitudes. Concept mapping has been shown to effectively demonstrate students’ changing concepts and knowledge structures. This article discusses how concept mapping was modified to capture students’ perceptions of the connections between the domains of thinking and knowing, emotions, behavior, attitudes, values, and beliefs and the specific experiences related to these, over a period of eight months of practice-based clinical learning. The findings demonstrate that while some limitations exist, modified concept mapping is a manageable way to gather rich data about students’ perceptions of their clinical practice experiences. These findings also highlight the strong integrating influence of beliefs and values on other areas of practice, suggesting that these need to be attended to as part of a student's educational program. PMID:29349311
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Learning and teaching clinical communication in the clinical workplace.
Brown, Jo; Dearnaley, Jo
2016-08-01
Clinical communication teaching and learning has become increasingly separate from the clinical workplace over the last 20 years in the UK, and in many medical schools is front-loaded to the early years of the curriculum. Many reasons exist to explain this separation, including the increasing use of simulation. However, learning by simulation alone is not ideal, and the literature now points towards a new direction that blends simulation with authentic experiences in the clinical workplace to aid the transition to clinical life. This article presents a practical example of collaboration between a London medical school and a hospital trust to provide an integrated clinical communication learning experience for students by situating teaching on the clinical wards for senior medical students. Clinical communication teaching and learning has become increasingly separate from the clinical workplace We outline a new teaching initiative, the 'Communication on the wards' pilot project, that blends clinical communication teaching with ward-based learning in an authentic environment, with patients, medical students and teachers working together. This teaching initiative was a practical attempt to bridge the theory-practice gap in clinical communication education, and to place learning in the clinical workplace for students. As such, it was enjoyed by all those who took part, and may be the way forward for clinical communication teaching and learning in the future. © 2015 John Wiley & Sons Ltd.
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Clinical application of plasma thermograms. Utility, practical approaches and considerations.
Garbett, Nichola C; Mekmaysy, Chongkham S; DeLeeuw, Lynn; Chaires, Jonathan B
2015-04-01
Differential scanning calorimetry (DSC) studies of blood plasma are part of an emerging area of the clinical application of DSC to biofluid analysis. DSC analysis of plasma from healthy individuals and patients with various diseases has revealed changes in the thermal profiles of the major plasma proteins associated with the clinical status of the patient. The sensitivity of DSC to the concentration of proteins, their interactions with other proteins or ligands, or their covalent modification underlies the potential utility of DSC analysis. A growing body of literature has demonstrated the versatility and performance of clinical DSC analysis across a range of biofluids and in a number of disease settings. The principles, practice and challenges of DSC analysis of plasma are described in this article. Copyright © 2014 Elsevier Inc. All rights reserved.
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Clinical application of plasma thermograms. Utility, practical approaches and considerations
Garbett, Nichola C.; Mekmaysy, Chongkham S.; DeLeeuw, Lynn; Chaires, Jonathan B.
2014-01-01
Differential scanning calorimetry (DSC) studies of blood plasma are part of an emerging area of the clinical application of DSC to biofluid analysis. DSC analysis of plasma from healthy individuals and patients with various diseases has revealed changes in the thermal profiles of the major plasma proteins associated with the clinical status of the patient. The sensitivity of DSC to the concentration of proteins, their interactions with other proteins or ligands, or their covalent modifications underlies the potential utility of DSC analysis. A growing body of literature has demonstrated the versatility and performance of clinical DSC analysis across a range of biofluids and in a number of disease settings. The principles, practice and challenges of DSC analysis of plasma are described in this article. PMID:25448297
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Guidelines for randomised controlled trials investigating Chinese herbal medicine.
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.
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Bioethics of Clinical Applications of Stem Cells.
Petrini, Carlo
2017-04-12
The clinical applications of stem cells pose a multitude of problems, including safety, efficacy, information and consent, the right to unproven treatments, the "right to try", costs, access, sustainability, scientific scrupulousness, patents and regulatory aspects, to name but a few. This article does not address individual issues, but rather introduces and discusses some of the possible approaches to solving the problems. The first part compares the consequentialist and deontological approaches, offering an overview of "top-down" and "bottom-up" models and proposing the principles of personalism as applied in clinical settings. The second part of the article suggests practical frameworks for organising the ethical issues, focusing in particular on the medical indications, patient preferences, quality of life, and contextual features.
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Bridging the gap: strategies to integrate classroom and clinical learning.
Flood, Lisa Sue; Robinia, Kristi
2014-08-01
Nursing students often feel their classroom (didactic) learning and clinical (practice) experiences are disconnected which can lead to a rejection of academe and dissatisfaction with the profession. This classroom/clinical divide may be exacerbated because of the increased use of part-time clinical faculty, who are often isolated from their didactic peers. If clinical faculty, either novice or experienced, are disconnected from didactic faculty, is it any wonder students feel their learning is fragmented? The purpose of this paper is to discuss strategies to help bridge the gap between didactic and clinical learning. Specific integration strategies for faculty are presented using examples from a baccalaureate adult nursing didactic course and its related clinical course. The role of a clinical coordinator in facilitating course integration and support for part-time clinical faculty is described. Ideas for using technology to enhance learning and suggestions to promote socialization to decrease faculty isolation are also discussed. Copyright © 2014 Elsevier Ltd. All rights reserved.
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The Jewish child, adolescent, and family.
Rube, David M; Kibel, Rabbi Nechemiah
2004-01-01
This brief review addresses the history, beliefs, and practices of Jewish families that have implications for clinical management of the problems and disorders of children and adolescents. It focuses primarily on the problems of the Orthodox family due, in part, to the limitations of space. There remains, however, little doubt that the clinician must be aware of the impact that Jewish heritage may have on the clinical issues at hand. This impact is significant whether the worldview of the family is characterized by strict Orthodoxy or is primarily that of an ethnic identification with less concern for belief and practice.
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Pros and cons of using apps in clinical practice.
Moore, Sally; Anderson, John; Cox, Susanne
2012-10-01
There is a lack of research on the use of smartphone apps among nurses in the UK, but the number of healthcare-related apps is increasing and it is likely that nurses will want to include them in practice. It will, therefore, be necessary to assess their effectiveness, appropriateness and efficacy to ensure they enhance patient care. This article looks at the literature on the subject and suggests some issues managers should consider before allowing the use of apps in their clinical areas. It also invites readers to take part in a survey on the use of apps in nursing.
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Wisdom in clinical reasoning and medical practice.
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.
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Exploring a pedagogical approach to integrating research, practice and teaching.
Newton, Jennifer M; McKenna, Lisa G; Gilmour, Carole; Fawcett, Jacqueline
2010-01-01
Application of evidence is accepted as an important component of clinical practice. Teaching research to undergraduate students has been reported internationally as a challenge, particularly for nurse educators. In this paper, reported is a strategy designed to enhance research learning for undergraduate midwifery students at one university, which formed part of a larger, international investigation into women's responses to caesarean birth. Following theory classes and briefings, students worked with their clinical educators in practice to interview women using existing tools, and were engaged in qualitative data analysis. A number of challenges were encountered throughout the process, both for the educators and students. However, the teaching approach provided benefits for students in learning about midwifery research. Recommended as essential is for continued development of pedagogical approaches that make research tangible for students. Furthermore, provision of support for clinical staff working with students is important for success of such approaches.
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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.
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Rashotte, Judy; Thomas, Margot; Grégoire, Diane; Ledoux, Sheila
2008-06-01
This study examined the impact of a 2-part unit-based multiple intervention on the use by pediatric critical care nurses of best practice guidelines for pressure-ulcer prevention. A total of 23 nurses participated in a repeated-measures design pre- and post-intervention to address 2 questions: Is there a difference in nurses' evidence-based practices following implementation of an educational intervention only versus implementation of both an educational and an innovative intervention? Are the changes sustained 6 months after completion of the intervention? A significant change occurred in the implementation of 2 of 11 recommended practices following both interventions: assessment of risk of pressure ulcers using an age-appropriate tool (p < or = 0.001), and the documentation of same (p < or = 0.001). These changes may have been sustained. The findings bring to light the real challenges encountered when attempting to implement and evaluate multiple knowledge translation strategies associated with complex best practice guidelines in clinical practice.
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Marketing occupational health care.
Norris, M J; Harris, J C
1981-01-01
A very basic part of marketing success is determining areas of your business in which you have a competitive advantage. In drafting a marketing plan for the Denver Clinic, the competitive advantages group practices have in the area of occupational health were quickly realized. This competitive edge is presented along with the Denver Clinic's marketing strategies and plans to capitalize on occupational healthcare advantages.
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Clinical-academic partnerships research: converting the rhetoric into reality.
Happell, Brenda
2005-09-01
An increasing recognition of the importance of research-based practice to the nursing profession has led to a number of strategies designed to increase the utilization and conduct of nursing research. The transfer of nursing education from hospitals to universities occurred partly in response to the identified theory-practice gap. Subsequently, a significant investment in joint clinical-academic positions and clinical professorial positions has been made with the intention of bridging the gap between the tertiary sector and the clinical field. Anecdotal evidence suggests that neither strategy has achieved the desired degree of success. The available literature suggests that nurses do not tend to become involved in the conduct of research, nor do they readily utilise research findings in their practice. It is hypothesized in this paper that this reflects the strong cultural differences between the clinical and academic worlds in nursing. The aim of this paper is to discuss the impact of these cultural differences and describe specific principals that could contribute to significant cultural change and the bridging of the academic-clinician divide.
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Pretty, Iain A; Maupomé, Gerardo
2004-04-01
Dentists are involved in diagnosing disease in every aspect of their clinical practice. A range of tests, systems, guides and equipment--which can be generally referred to as diagnostic procedures--are available to aid in diagnostic decision making. In this era of evidence-based dentistry, and given the increasing demand for diagnostic accuracy and properly targeted health care, it is important to assess the value of such diagnostic procedures. Doing so allows dentists to weight appropriately the information these procedures supply, to purchase new equipment if it proves more reliable than existing equipment or even to discard a commonly used procedure if it is shown to be unreliable. This article, the first in a 6-part series, defines several concepts used to express the usefulness of diagnostic procedures, including reliability and validity, and describes some of their operating characteristics (statistical measures of performance), in particular, specificity and sensitivity. Subsequent articles in the series will discuss the value of diagnostic procedures used in daily dental practice and will compare today's most innovative procedures with established methods.
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Diagnostic and interventional musculoskeletal ultrasound: part 1. Fundamentals.
Smith, Jay; Finnoff, Jonathan T
2009-01-01
Musculoskeletal ultrasound involves the use of high-frequency sound waves to image soft tissues and bony structures in the body for the purposes of diagnosing pathology or guiding real-time interventional procedures. Recently, an increasing number of physicians have integrated musculoskeletal ultrasound into their practices to facilitate patient care. Technological advancements, improved portability, and reduced costs continue to drive the proliferation of ultrasound in clinical medicine. This increased interest creates a need for education pertaining to all aspects of musculoskeletal ultrasound. The primary purpose of this article is to review diagnostic ultrasound technology and its potential clinical applications in the evaluation and treatment of patients with neurologic and musculoskeletal disorders. After reviewing this article, physicians should be able to (1) list the advantages and disadvantages of ultrasound compared with other available imaging modalities, (2) describe how ultrasound machines produce images using sound waves, (3) discuss the steps necessary to acquire and optimize an ultrasound image, (4) understand the different ultrasound appearances of tendons, nerves, muscles, ligaments, blood vessels, and bones, and (5) identify multiple applications for diagnostic and interventional musculoskeletal ultrasound in musculoskeletal practice. Part 1 of this 2-part article reviews the fundamentals of clinical ultrasonographic imaging, including relevant physics, equipment, training, image optimization, and scanning principles for diagnostic and interventional purposes.
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Systems and complexity thinking in general practice: part 1 - clinical application.
Sturmberg, Joachim P
2007-03-01
Many problems encountered in general practice cannot be sufficiently explained within the Newtonian reductionist paradigm. Systems and complexity thinking - already widely adopted in most nonmedical disciplines - describes and explores the contextual nature of questions posed in medicine, and in general practice in particular. This article briefly describes the framework underpinning systems and complexity sciences. A case study illustrates how systems and complexity thinking can help to better understand the contextual nature of patient presentations, and how different approaches will lead to different outcomes.
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Clinical neuropsychology in Israel: history, training, practice and future challenges.
Vakil, Eli; Hoofien, Dan
2016-11-01
This is an invited paper for a special issue on international perspectives on training and practice in clinical neuropsychology. We provide a review of the status of clinical neuropsychology in Israel, including the history of neuropsychological, educational, and accreditation requirements to become a clinical neuropsychologist and to practice clinical neuropsychology. The information is based primarily on the personal knowledge of the authors who have been practicing clinical neuropsychology for over three decades and hold various administrative and academic positions in this field. Second, we conducted three ad hoc surveys among clinical and rehabilitation psychologists; heads of academic programs for rehabilitation and neuropsychology; and heads of accredited service providers. Third, we present a literature review of publications by clinical neuropsychologists in Israel. Most of the clinical neuropsychologists are graduates of either rehabilitation or clinical training programs. The vast majority of neuropsychologists are affiliated with rehabilitation psychology. The training programs (2-3 years of graduate school) provide solid therapeutic and diagnostic skills to the students. Seventy-five percent of the participants in this survey are employed at least part-time by public or state-funded institutions. Israeli neuropsychologists are heavily involved in case management, including vocational counseling, and rehabilitation psychotherapy. Conclusions and future goals: Although clinical neuropsychologists in Israel are well educated and valued by all health professionals, there are still several challenges that must be addressed in order to further advance the field and the profession. These included the need for Hebrew-language standardized and normalized neuropsychological tests and the application of evidence-based interventions in neuropsychological rehabilitation.
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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.…
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Practice, supervision, consultancy and appraisal: a continuum of learning.
Launer, John
2003-01-01
I examine four different kinds of learning conversation: reflective practice, clinical supervision, work consultancy and performance appraisal. I propose that there is a close and reciprocal relationship between these kinds of conversation, and that they represent different aspects of a unified field, or continuum. I argue that appraisal should be seen as part of this learning continuum rather than as form of monitoring. PMID:14601347
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Identifying and applying psychological theory to setting and achieving rehabilitation goals.
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.
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McElhinney, Evelyn
2010-11-01
The aim of the study was to identify the factors that influence nurse practitioners ability to practice physical examination skills in the clinical area. The changing health care needs of the population require new ways of working for many health professionals. Physical examination (core skills of inspection, palpation, percussion and auscultation) of patients is a fairly new role for nurses in secondary care in the United Kingdom. However, implementing new roles in the clinical area can be challenging for the practitioners involved, and several factors have been identified which are seen to help or hinder their success. A Delphi study was undertaken using blind copy email over six weeks in 2008. The participants included a purposive sample of 21 nurses from 10 clinical areas who had completed a degree level module in physical examination as part of a nurse practitioner pathway. This study generated valuable opinion of factors that can help or hinder the ability of nurses to practice physical examination in the clinical area. The results highlight the importance of individual self-confidence, role clarity, effective educational preparation and support from other disciplines to the nurse practitioners ability to carry out this new role. Several factors reported by the participants concur and add to factors reported in previous studies of new role implementation. There appears to be a continued need for clear job descriptions, role clarity, authority and autonomy to practice for nurse practitioners undertaking physical examination. Physical examination knowledge and skills are part of the role of nurse practitioners. This study highlights several factors which need to be addressed to ensure practitioners are able to carry out this new role on return to the clinical area. © 2010 Blackwell Publishing Ltd.
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Chmielowska, Ewa; Filipczyk-Cisarż, Emilia; Krzemieniecki, Krzysztof; Leśniewski-Kmak, Krzysztof; Litwiniuk, Maria M.; Wieruszewska-Kowalczyk, Karolina; Kosno-Kruszewska, Elżbieta
2014-01-01
Aim of the study This paper presents the second part of the GoPractice project involving oncologists from seven Polish provinces. The aim of this part of the project was to assess the knowledge of oncologists on indications for granulocyte colony-stimulating factor (G-CSF) secondary prophylaxis (SP) of febrile neutropenia (FN) and FN management based on current therapeutic guidelines (Polish Society of Clinical Oncology [PTOK] and European Organisation for Research and Treatment of Cancer [EORTC]). Material and methods The project involved 169 oncologists from 7 regions working in large specialist oncological centers, university hospitals, regional and city hospitals, specialist outpatient clinics and oncological wards in small, local hospitals. The participants completed a questionnaire based on 7 prepared clinical cases of patients with different tumor types and patient characteristics, receiving chemotherapy (CT) with different levels of FN risk. Participants answered questions related to FN risk assessment and G-CSF use as secondary prophylaxis (SP) and for the management of FN. After completing the questionnaire, the participants proceeded to an educational module in which they were provided with an analysis of correct diagnostic and therapeutic procedures according to the PTOK and EORTC guidelines. Results and Conclusions Indications for G-CSF SP were generally well recognized: in nearly 90% of responses, oncologists assessed correctly indications/lack of indications for secondary prophylaxis, in accordance with guideline recommendations and Experts’ opinion. However, the use of daily G-CSFs was often recommended by the study participants for the management of FN. This clinical practice is contradictory to PTOK and EORTC recommendations and may unnecessarily increase treatment costs. Changing this clinical approach may be achieved through regular training to improve guideline adherence. PMID:25784842
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2013-12-10
This major final rule with comment period addresses changes to the physician fee schedule, clinical laboratory fee schedule, and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule with comment period also includes a discussion in the Supplementary Information regarding various programs. (See the Table of Contents for a listing of the specific issues addressed in the final rule with comment period.)
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The appropriateness of appropriate: smuggling values into clinical practice.
MacDonald, Mary Ellen; Murray, Mary Ann
2007-12-01
The word appropriate has become an institutional given, part of the clinical jargon used in discussions with and about patients and families. The authors unpack appropriate, arguing that this seemingly innocuous word has implications for clinical practice. They begin with the theoretical and historical question What does appropriate "do" in clinical discourse? The answer is both grammatical and moral, rooted in the 19th-century distinction between normal and pathological and the 20th-century medicalization of behaviour. The examination references rhetorical theory and the history of statistics and psychology, and it uses pediatric health care as an example. The authors argue that the use of the word appropriate facilitates the smuggling of values into clinical encounters, which can marginalize patients and compromise therapeutic relationships. In uncovering the discursive (moral) elements of appropriate, they challenge readers to critically reflect on how they speak to and about patients and families.
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Carey, Matthew C; Chick, Anna; Kent, Bridie; Latour, Jos M
2018-06-01
Peer-assisted leaning relates to the acquisition of knowledge and skills through shared learning of matched equals. The concept has been explored within the field of nurse education across a range of learning environments, but its impact in practice is still relatively unknown. This paper reports on findings when observing paediatric undergraduate nursing students who engage in PAL within the clinical practice setting. The aim of this paper is to report the findings of a study undertaken to explore peer-assisted learning in undergraduate nursing students, studying children's health, in the clinical practice setting. A qualitative ethnographic study using non-participant observations. A range of inpatient paediatric clinical settings across two teaching hospitals. First, second and third year paediatric student nurses enrolled on a Bachelor of Nursing Programme. Non-participant observations were used to observe a range of interactions between the participants when engaging in peer-assisted learning within the same clinical area. A total of 67 h of raw data collected across all observations was analysed using framework analysis to draw together key themes. Of the 20 identified students across two hospitals, 17 agreed to take part in the study. Findings were aggregated into three key themes; 1. Peers as facilitators to develop learning when engaging in peer-assisted learning, 2. Working together to develop clinical practice and deliver care, 3. Positive support and interaction from peers to enhance networking and develop working structure. Peer-assisted learning in undergraduate children's nursing students stimulates students in becoming engaged in their learning experiences in clinical practice and enhance collaborative support within the working environment. The benefits of peer-assisted learning in current clinical practice settings can be challenging. Therefore, education and practice need to be aware of the benefits and their contribution towards future strategies and models of learning. Copyright © 2018 Elsevier Ltd. All rights reserved.
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Individualizing therapy, customizing clinical science.
Evans, I M
1996-06-01
The focus of this paper is to propose that the question of standardized versus individualized therapy is part of a more general debate regarding the nature of inquiry, the use of empirical knowledge in practice, and the evaluation of professional activities-what collectively might be called clinical science. Exclusive reliance on traditional experimental research design, with its demand for procedural standardization, promotes a model of clinical behavior therapy as a technology. Such a perspective runs counter to the development of the special relationship between theory (generality) and practice (specificity) that represents one of behavior therapy's unique contributions and long term legacies. If behavior therapists treating individual clients are to adapt general principles to individual need, there must be a broader view of relevant sources of individual differences.
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Nester, C J; Graham, A; Martinez-Santos, A; Williams, A E; McAdam, J; Newton, V; Sweeney, D; Walker, D
2018-01-01
A national survey recently provided the first description of foot orthotic provision in the United Kingdom. This article aims to profile and compare the foot orthoses practice of podiatrists, orthotists and physiotherapists within the current provision. Quantitative data were collected from podiatrists, orthotists and physiotherapists via an online questionnaire. The topics, questions and answers were developed through a series of pilot phases. The professions were targeted through electronic and printed materials advertising the survey. Data were captured over a 10 month period in 2016. Differences between professions were investigated using Chi squared and Fischer's exact tests, and regression analysis was used to predict the likelihood of each aspect of practice in each of the three professions. Responses from 357 podiatrists, 93 orthotists and 49 physiotherapists were included in the analysis. The results reveal statistically significant differences in employment and clinical arrangements, the clinical populations treated, and the nature and volume of foot orthoses caseload. Podiatrists, orthotists and physiotherapists provide foot orthoses to important clinical populations in both a prevention and treatment capacity. Their working context, scope of practice and mix of clinical caseload differs significantly, although there are areas of overlap. Addressing variations in practice could align this collective workforce to national allied health policy.
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Towards a Formative Assessment of Classroom Competencies (FACCs) for postgraduate medical trainees.
Gray, Christopher S; Hildreth, Anthony J; Fisher, Catherine; Brown, Andrew; Jones, Anita; Turner, Ruth; Boobis, Leslie
2008-12-17
An assumption of clinical competency is no longer acceptable or feasible in routine clinical practice. We sought to determine the feasibility, practicability and efficacy of undertaking a formal assessment of clinical competency for all postgraduate medical trainees in a large NHS foundation trust. FY1 doctors were asked to complete a questionnaire to determine prior experience and self reported confidence in performing the GMC core competencies. From this a consensus panel of key partners considered and developed an 8 station Objective Structured Clinical Examination (OSCE) circuit to assess clinical competencies in all training grade medical staff... The OSCE was then administered to all training grade doctors as part of their NHS trust induction process. 106 (87.6% of all trainees) participated in the assessment during the first 14 days of appointment. Candidates achieved high median raw percentage scores for the majority of stations however analysis of pre defined critical errors and omissions identified important areas for concern. Performance of newly qualified FY1 doctor was significantly better than other grades for the arterial blood gas estimation and nasogastric tube insertion stations. Delivering a formal classroom assessment of clinical competencies to all trainees as part of the induction process was both feasible and useful. The assessment identified areas of concern for future training and also served to reassure as to the proficiency of trainees in undertaking the majority of core competencies.
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Nicholas, Johann; Shaw, Catriona; Pitcher, David; Dawnay, Anne
2013-01-01
The UK Renal Association clinical practice guidelines include clinical performance measures for biochemical variables in dialysis patients. The UK Renal Registry (UKRR) annually audits dialysis centre performance against these measures as part of its role in promoting continuous quality improvement. Cross sectional performance analyses were undertaken to compare dialysis centre achievement of clinical audit measures for prevalent haemodialysis (HD) and peritoneal dialysis (PD) cohorts in 2012. The biochemical variables studied were phosphate, adjusted calcium, parathyroid hormone, bicarbonate and total cholesterol. In addition, longitudinal analyses were performed (2002-2012) to show changes in achievement of clinical performance measures over time. Fifty-six percent of HD and 61% of PD patients achieved a phosphate within the range recommended by the RA clinical practice guidelines. Seventy-seven percent of HD and 78% of PD patients had adjusted calcium between 2.2-2.5 mmol/L. Fifty-eight percent of HD and 65% of PD patients had parathyroid hormone between 16-72 pmol/L. Fifty-nine percent of HD and 80% of PD patients achieved the audit measure for bicarbonate. There was significant inter-centre variation for all variables studied. The UKRR consistently demonstrates significant inter-centre variation in achievement of biochemical clinical audit measures. Understanding the causes of this variation is an important part of improving the care of dialysis patients in the UK.
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Pruthi, Rishi; Pitcher, David; Dawnay, Anne
2012-01-01
The UK Renal Association clinical practice guidelines include clinical performance measures for biochemical variables in dialysis patients. The UK Renal Registry (UKRR) annually audits dialysis centre performance against these measures as part of its role in promoting continuous quality improvement. Cross sectional performance analyses were undertaken to compare dialysis centre achievement of clinical audit measures for prevalent haemodialysis (HD) and peritoneal dialysis (PD) cohorts in 2010. The biochemical variables studied were phosphate, adjusted calcium, parathyroid hormone, bicarbonate and total cholesterol. In addition longitudinal analyses were performed (2000-2010) to show changes in achievement of clinical performance measures over time. Fifty-six percent of HD and 69% of PD patients achieved a phosphate within the range recommended by the RA clinical practice guidelines. Seventy-five percent of HD and 76% of PD patients had adjusted calcium between 2.2-2.5 mmol/L. Twenty-eight percent of HD and 31% of PD patients had parathyroid hormone between 16- 32 pmol/L. Sixty percent of HD and 80% of PD patients achieved the audit measure for bicarbonate. There was significant inter-centre variation for all variables studied. The UKRR consistently demonstrates significant inter-centre variation in achievement of biochemical clinical audit measures. Understanding the causes of this variation is an important part of improving the care of dialysis patients in the UK. Copyright © 2012 S. Karger AG, Basel.
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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.
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Quantifying Physician Teaching Productivity Using Clinical Relative Value Units
Yeh, Michael M; Cahill, Daniel F
1999-01-01
OBJECTIVE To design and test a customizable system for calculating physician teaching productivity based on clinical relative value units (RVUs). SETTING/PARTICIPANTS A 550-bed community teaching hospital with 11 part-time faculty general internists. DESIGN Academic year 1997–98 educational activities were analyzed with an RVU-based system using teaching value multipliers (TVMs). The TVM is the ratio of the value of a unit of time spent teaching to the equivalent time spent in clinical practice. We assigned TVMs to teaching tasks based on their educational value and complexity. The RVUs of a teaching activity would be equal to its TVM multiplied by its duration and by the regional median clinical RVU production rate. MEASUREMENTS The faculty members' total annual RVUs for teaching were calculated and compared with the RVUs they would have earned had they spent the same proportion of time in clinical practice. MAIN RESULTS For the same proportion of time, the faculty physicians would have generated 29,806 RVUs through teaching or 27,137 RVUs through clinical practice (Absolute difference = 2,669 RVUs; Relative excess = 9.8%). CONCLUSIONS We describe an easily customizable method of quantifying physician teaching productivity in terms of clinical RVUs. This system allows equitable recognition of physician efforts in both the educational and clinical arenas. PMID:10571707
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The FAMULATUR PLUS as an innovative approach for teaching physical examination skills.
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.
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The FAMULATUR PLUS as an innovative approach for teaching physical examination skills
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
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Struksnes, Solveig; Engelien, Ragna Ingeborg
2016-01-01
Education institution and practice field have a joint responsibility with regard to facilitating a learning environment for the nursing students that provides learning outcomes in accordance with the National Curriculum. Using simulated patient situations is about ensuring a safe learning environment where mistakes are not putting real patients' lives in danger. To compare nursing students' experiences with a skills training situation immediately after the training and after their ten weeks clinical placement in nursing homes. Quantitative, cross-sectional and evaluative. Full- and part-time students in their first year of a Bachelor of Nursing degree. The students answered a questionnaire on two different occasions, immediately after skills training and after internship in a nursing home. Being a "patient" and a "nurse" in simulation was experienced as useful to clinical practice. Students with previous experience had a significantly higher perception of mastering the procedure after the internship, while unexperienced fellow students did not report any significant increase with regard to a sense of coping during their clinical practice. The findings raise questions if there are aspects with the education institution or the practice field that should be improved to help facilitate a better learning process for students without any previous experience. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Cobb, K. A.; Brown, G. A.; Hammond, R. H.; Mossop, L. H.
2015-01-01
Introduction Outcomes-based education has been the core of the curriculum strategy of the Nottingham School of Veterinary Medicine and Science (SVMS) since its inception in 2006. As part of the ongoing curriculum evaluation, the first two graduating cohorts were invited to provide an appraisal of their preparation by the SVMS curriculum for their role in clinical practice. This paper provides brief accounts of the SVMS curriculum model, the development of the evaluation instrument and the findings of the alumni survey. Materials and Methods The evaluation instrument contained 25 attributes expected of SVMS graduates. Alumni rated their preparation for practice in relation to each attribute. Results The four highest rated characteristics were compassion for animals and the application of ethics to animal welfare; communication skills; recognising own limitations and seeking help and advice where needed and clinical examination skills. The four lowest rated were clinical case management and therapeutic strategies; dealing with veterinary public health and zoonotic issues; knowledge of current veterinary legislation and dealing with emergency and critical care cases. Free text responses were in line with these quantitative findings. Conclusion The results indicate that this sample of SVMS graduates were satisfied with their undergraduate education and felt well prepared for their role in clinical practice. PMID:26392910
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The need for national medical licensing examination in Saudi Arabia
Bajammal, Sohail; Zaini, Rania; Abuznadah, Wesam; Al-Rukban, Mohammad; Aly, Syed Moyn; Boker, Abdulaziz; Al-Zalabani, Abdulmohsen; Al-Omran, Mohammad; Al-Habib, Amro; Al-Sheikh, Mona; Al-Sultan, Mohammad; Fida, Nadia; Alzahrani, Khalid; Hamad, Bashir; Al Shehri, Mohammad; Abdulrahman, Khalid Bin; Al-Damegh, Saleh; Al-Nozha, Mansour M; Donnon, Tyrone
2008-01-01
Background Medical education in Saudi Arabia is facing multiple challenges, including the rapid increase in the number of medical schools over a short period of time, the influx of foreign medical graduates to work in Saudi Arabia, the award of scholarships to hundreds of students to study medicine in various countries, and the absence of published national guidelines for minimal acceptable competencies of a medical graduate. Discussion We are arguing for the need for a Saudi national medical licensing examination that consists of two parts: Part I (Written) which tests the basic science and clinical knowledge and Part II (Objective Structured Clinical Examination) which tests the clinical skills and attitudes. We propose this examination to be mandated as a licensure requirement for practicing medicine in Saudi Arabia. Conclusion The driving and hindering forces as well as the strengths and weaknesses of implementing the licensing examination are discussed in details in this debate. PMID:19032779
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Price, David; Howard, Michelle; Hilts, Linda; Dolovich, Lisa; McCarthy, Lisa; Walsh, Allyn E; Dykeman, Lynn
2009-09-01
The new family health teams (FHTs) in Ontario were designed to enable interprofessional collaborative practice in primary care; however, many health professionals have not been trained in an interprofessional environment. To provide health professional learners with an interprofessional practice experience in primary care that models teamwork and collaborative practice skills. The 2 academic teaching units of the FHT at McMaster University in Hamilton, Ont, employ 6 types of health professionals and provide learning environments for family medicine residents and students in a variety of health care professions. Learners engage in formal interprofessional education activities and mixed professional and learner clinical consultations. They are immersed in an established interprofessional practice environment, where all team members are valued and contribute collaboratively to patient care and clinic administration. Other contributors to the success of the program include the physical layout of the clinics, the electronic medical record communications system, and support from leadership for the additional clinical time commitment of delivering interprofessional education. This academic FHT has developed a program of interprofessional education based partly on planned activities and logistic enablers, and largely on immersing learners in a culture of long-standing interprofessional collaboration.
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Pulford, Justin; Siba, Peter M; Mueller, Ivo; Hetzel, Manuel W
2014-12-03
This paper aims to assess the sensitivity and specificity of exit interviews as a measure of malaria case management practice as compared to direct observation. The malaria case management of 1654 febrile patients attending 110 health facilities from across Papua New Guinea was directly observed by a trained research officer as part of a repeat cross sectional survey. Patient recall of 5 forms of clinical advice and 5 forms of clinical action were then assessed at service exit and statistical analyses on matched observation/exit interview data conducted. The sensitivity of exit interviews with respect to clinical advice ranged from 36.2% to 96.4% and specificity from 53.5% to 98.6%. With respect to clinical actions, sensitivity of the exit interviews ranged from 83.9% to 98.3% and specificity from 70.6% to 98.1%. The exit interview appears to be a valid measure of objective malaria case management practices such as the completion of a diagnostic test or the provision of antimalarial medication, but may be a less valid measure of low frequency, subjective practices such as the provision of malaria prevention advice.
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2012-01-01
Background Students may encounter difficulties when they have to apply clinical skills trained in their pre-clinical studies in clerkships. Early clinical exposure in the pre-clinical phase has been recommended to reduce these transition problems. The aim of this study is to explore differences in students' experiences during the first clerkships between students exclusively trained in a skills laboratory and peers for whom part of their skills training was substituted by early clinical experiences (ECE). Methods Thirty pre-clinical students trained clinical skills exclusively in a skills laboratory; 30 peers received part of their skills training in PHC centers. Within half a year after commencing their clerkships all 60 students shared their experiences in focus group discussions (FGDs). Verbatim transcripts of FGDs were analyzed using Atlas-Ti software. Results Clerkship students who had participated in ECE in PHC centers felt better prepared to perform their clinical skills during the first clerkships than peers who had only practiced in a skills laboratory. ECE in PHC centers impacted positively in particular on students’ confidence, clinical reasoning, and interpersonal communication. Conclusion In the Indonesian setting ECE in PHC centers reduce difficulties commonly encountered by medical students in the first clerkships. PMID:22640419
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Influences on final year medical students' attitudes to general practice as a career.
Parker, Johanna E; Hudson, Ben; Wilkinson, Tim J
2014-03-01
General practice is under-represented in student career choices. This study aimed to identify and explore factors that influence the attitudes of final year medical students to general practice as a career. This qualitative study used semi-structured interviews of focus groups of final year undergraduate medical students at the University of Otago, Christchurch, New Zealand. Thematic analysis and grounded theory were used to interpret the data. General practitioners (GPs) play a key role in influencing medical students' attitudes to general practice as a career. Students identified their general practice placement during medical school training and personal contact with their own GP as principal factors. The media portrayal of general practice and the attitudes of friends and family were also influential. Students were positively influenced when they were made to feel part of the team, involved with consultations, allowed to carry out practical procedures under supervision, and witnessed what they perceived as good medical practice during clinical placements. Positive experiences often occurred later in training, when students felt more confident of their clinical abilities. While students reported occasional negative comments about general practice by some hospital doctors, these had a lesser role in influencing their perceptions of general practice compared with their own experiences, both as students and patients. GPs have a strong influence, positively and negatively, on the attitudes of medical students to general practice as a career. Effective influences include being made to feel welcome, involved, valued, and given legitimate roles during clinical placements.
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The case for introducing pre-registered confirmatory pharmacological pre-clinical studies.
Kiwanuka, Olivia; Bellander, Bo-Michael; Hånell, Anders
2018-05-01
When evaluating the design of pre-clinical studies in the field of traumatic brain injury, we found substantial differences compared to phase III clinical trials, which in part may explain the difficulties in translating promising experimental drugs into approved treatments. By using network analysis, we also found cases where a large proportion of the studies evaluating a pre-clinical treatment was performed by inter-related researchers, which is potentially problematic. Subjecting all pre-clinical trials to the rigor of a phase III clinical trial is, however, likely not practically achievable. Instead, we repeat the call for a distinction to be made between exploratory and confirmatory pre-clinical studies.
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Psychosocial factors in sports injury rehabilitation and return to play.
Podlog, Leslie; Heil, John; Schulte, Stefanie
2014-11-01
This article discusses the principles and practices that guide psychological intervention with injury, and encourages a psychological approach to injury for clinicians. Part 1 reviews the research literature, and serves as a foundation for the review of clinical practices in part 2. Examination of the research literature highlights 4 areas: (1) psychological factors influencing rehabilitation, (2) social factors affecting rehabilitation, (3) performance concerns among returning athletes, and (4) tools/inventories for assessing psychological readiness to return. A synopsis of an injury intervention plan is provided, and the influence of pain and fear in the rehabilitation process is described. Copyright © 2014 Elsevier Inc. All rights reserved.
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Bioethics of Clinical Applications of Stem Cells
Petrini, Carlo
2017-01-01
The clinical applications of stem cells pose a multitude of problems, including safety, efficacy, information and consent, the right to unproven treatments, the “right to try”, costs, access, sustainability, scientific scrupulousness, patents and regulatory aspects, to name but a few. This article does not address individual issues, but rather introduces and discusses some of the possible approaches to solving the problems. The first part compares the consequentialist and deontological approaches, offering an overview of “top–down” and “bottom–up” models and proposing the principles of personalism as applied in clinical settings. The second part of the article suggests practical frameworks for organising the ethical issues, focusing in particular on the medical indications, patient preferences, quality of life, and contextual features. PMID:28417921
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... condition damages parts of the brain that control reasoning, personality, social skills, speech, and language. Personality changes, ... Clearinghouse: Paget's Disease of Bone: An Endocrine Society Clinical Practice Guideline Genetic Testing (1 link) Genetic Testing ...
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A profitable hygiene system: not an undervalued practice resource, part 2.
Doherty, Hugh; Davis, Karen; Miller, Kimberly
2009-02-01
In this 2-part article, we have addressed the correct methods to use in selecting the right hygienist and the importance of creating a purposeful vision for your dental hygiene department. We have touched on the role of having the doctor discuss practice expectations, and the qualities and traits a dental hygienist should possess. Finally we have briefly reviewed some ideas regarding hygienist compensation as well as the integration of the new technologies to help you build a successful, productive, and profitable dental hygiene department. Many of today's practice owners have invested hundreds of thousands of dollars in updated facilities and state-of-the-art technology. They have invested in management and leadership courses, developed their business acumen, and have worked to insure that their clinical assistants' skills stay sharp. However, when it comes to dental hygiene, too many practices still operate a 1980s-style "prophylaxis mindset palace." The time has come for more dentists to embrace up-to-date dental hygiene practice standards.
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Practice-based evidence study design for comparative effectiveness research.
Horn, Susan D; Gassaway, Julie
2007-10-01
To describe a new, rigorous, comprehensive practice-based evidence for clinical practice improvement (PBE-CPI) study methodology, and compare its features, advantages, and disadvantages to those of randomized controlled trials and sophisticated statistical methods for comparative effectiveness research. PBE-CPI incorporates natural variation within data from routine clinical practice to determine what works, for whom, when, and at what cost. It uses the knowledge of front-line caregivers, who develop study questions and define variables as part of a transdisciplinary team. Its comprehensive measurement framework provides a basis for analyses of significant bivariate and multivariate associations between treatments and outcomes, controlling for patient differences, such as severity of illness. PBE-CPI studies can uncover better practices more quickly than randomized controlled trials or sophisticated statistical methods, while achieving many of the same advantages. We present examples of actionable findings from PBE-CPI studies in postacute care settings related to comparative effectiveness of medications, nutritional support approaches, incontinence products, physical therapy activities, and other services. Outcomes improved when practices associated with better outcomes in PBE-CPI analyses were adopted in practice.
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On the night shift: advanced nurse practice in emergency medicine.
Jenkins, Jennifer
2016-05-01
Advanced nurse practitioners in the author's emergency department (ED) work autonomously and as part of a team to assess, diagnose and treat patients with unexplained and undiagnosed illnesses and injuries over a 24-hour cycle of care. The complexity of the role in EDs is often not fully understood, and expectations can vary between trusts and between different clinical areas within trusts. This article describes one night shift in the author's ED to explain the complexity of advanced nurse practitioners' roles in this environment. The article focuses on autonomous decision-making skills and the use of advanced clinical skills in the context of evidence-based practice.
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NASA Astrophysics Data System (ADS)
Sosa, M.; Grundel, L.; Simini, F.
2016-04-01
Logical reasoning is part of medical practice since its origins. Modern Medicine has included information-intensive tools to refine diagnostics and treatment protocols. We are introducing formal logic teaching in Medical School prior to Clinical Internship, to foster medical practice. Two simple examples (Acute Myocardial Infarction and Diabetes Mellitus) are given in terms of formal logic expression and truth tables. Flowcharts of both diagnostic processes help understand the procedures and to validate them logically. The particularity of medical information is that it is often accompanied by “missing data” which suggests to adapt formal logic to a “three state” logic in the future. Medical Education must include formal logic to understand complex protocols and best practices, prone to mutual interactions.
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Primary Care Physicians Practicing Preventive Medicine in the Outpatient Setting
Snipelisky, David; Carter, Kimberly; Sundsted, Karna; Burton, M. Caroline
2016-01-01
Background: Preventive care is an important part of primary care medicine, yet much variation in its practice exists. The aim of this study is to assess physicians’ perspectives of practicing preventive medicine and evaluate which topics are deemed most important. Methods: All primary care medicine providers at two separate academic medical centers (Mayo Clinic, MN and Mayo Clinic, FL) were surveyed via an E-mail questionnaire assessing physicians’ perception of the role of preventive medicine during both acute/routine and yearly visits, physicians’ perception of patients’ response to preventive medicine topics, and which preventive medicine topics are commonly practiced. Results: Of 445 providers meeting inclusion criteria, a total of 183 (41.1%) responded. Providers were more likely to engage patients in preventive medicine during yearly visits more so than acute visits (3.82 vs. 4.72, range 1–5 Likert Scale), yet providers were very likely to partake in such practices during both visits. Providers perceived that patients received the practice of preventive medicine very well (4.13 on 1–5 Likert Scale). No significant difference between provider practice and patient perception was noted between the two sites, although there was some variation based on clinical experience of the provider. Providers were found to most commonly practice topics recommended by the United States Preventive Services Task Force. Conclusions: Our study found a high predisposition to practicing preventive medicine. Providers seem to practice according to published evidence-based medicine recommendations. PMID:26941906
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Massaquoi, Lamin Daddy; Edwards, Nancy Christine
2015-12-10
Clinicians regularly assess, diagnose and manage illnesses which are directly or indirectly linked to environmental exposures. Yet, various studies have identified gaps in environmental assessment in routine clinical practice. This review assessed clinicians' environmental health practices, attitudes and beliefs, and competencies and training. Relevant articles were sought using a systematic search strategy using five databases, grey literature and a hand search. Search strategies and protocols were developed using tailored mesh terms and keywords. 43 out of 11,291 articles were eligible for inclusion. Clinicians' attitudes and beliefs towards environmental health and routine clinical practice were generally positive, with most clinicians believing that environmental hazards affect human health. However, with the exception of tobacco smoke exposure, environmental health assessment was infrequently part of routine clinical practice. Clinicians' self-competence in environmental assessment was reported to be inadequate. Major challenges were the time required to complete an assessment, inadequate training and concerns about negative patients' responses. Clinicians have strong positive attitudes and beliefs about the importance of environmental health assessments. However, more concerted and robust strategies will be needed to support clinicians in assuming their assessment and counselling roles related to a wider range of environmental hazards.
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Stieber, Jane C; Nelson, Travis; Huebner, Colleen E
2015-04-01
Photography and electronic media are indispensable tools for dental education and clinical practice. Although previous research has focused on privacy issues and general strategies to protect patient privacy when sharing clinical photographs for educational purposes, there are no published recommendations for developing a functional, privacy-compliant institutional framework for the capture, storage, transfer, and use of clinical photographs and other electronic media. The aims of this study were to research patient rights relating to electronic media and propose a framework for the use of patient media in education and clinical care. After a review of the relevant literature and consultation with the University of Washington's director of privacy and compliance and assistant attorney general, the researchers developed a privacy-compliant framework to ensure appropriate capture, storage, transfer, and use of clinical photography and electronic media. A four-part framework was created to guide the use of patient media that reflects considerations of patient autonomy and privacy, informed consent, capture and storage of media, and its transfer, use, and display. The best practices proposed for capture, storage, transfer, and use of clinical photographs and electronic media adhere to the health care code of ethics (based on patient autonomy, nonmaleficence, beneficence, justice, and veracity), which is most effectively upheld by a practical framework designed to protect patients and limit institutional liability. Educators have the opportunity and duty to convey these principles to students who will become the next generation of dentists, researchers, and educators.
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Academic training and clinical placement problems to achieve nursing competency
RAHMATI SHARGHI, NARJES; ALAMI, ALI; KHOSRAVAN, SHAHLA; MANSOORIAN, MOHAMMAD REZA; EKRAMI, ALI
2015-01-01
Introduction: High quality of care is one of the requirements of nursing which depends on the nursing competency. In this connection, the aim of this research was to determine the problems related to the academic training (nursing' educational program) and clinical practice to achieve competency from the viewpoint of nurses, faculty members, and nursing students. Methods: the study was an analytical cross-sectional one. The sample consisted of the academic staff, the third and the fourth year nursing students and nurses in practice. The instrument of the study was a two-part researcher-made questionnaire with 22 questions in the theoretical- clinical realm to assess problems related to the theoretical and clinical teaching in nursing, and 23 questions to assess the clinical functions. The questionnaire was validated in terms of both face and content validity. Its reliability, using Cronbach's Alpha coefficient, was 0.72 in the theoretical-clinical and 0.73 in the clinical realm. Both descriptive and analytical statistics were used to analyze the data, using SPSS software. Results: The results of this study indicated that from the participants’ viewpoints, the most important problems in the academic education for nursea to acquire competency were as follows: lack of academic research the clinical period (88.9%), no application of theoretical aspects of the nursing process in practice (85.6%), insufficient knowledgeable and professional educators (81.1%), the use of traditional routine-oriented methods on the wards (75.6%); also insufficient time for performance based on knowledge in relation to the nurse's workload (86.5%), weakness and usefulness of scientific function encouragement systems in clinic (85.2%), and learnt theoretical subjects not coming into practice in clinical fields after graduation (75.6%). Conclusion: Efforts to reduce the gap between the theoretical and practical (clinical function) knowledge in educational and work environment are required to improve the training of qualified nurses. PMID:25587550
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Sharp, J R
1994-12-01
Drucker writes that the emerging theory of manufacturing includes four principles and practices: statistical quality control, manufacturing accounting, modular organization, and systems approach. SQC is a rigorous, scientific method of identifying variation in the quality and productivity of a given production process, with an emphasis on improvement. The new manufacturing economics intends to integrate the production strategy with the business strategy in order to account for the biggest portions of costs that the old methods did not assess: time and automation. Production operations that are both standardized and flexible will allow the organization to keep up with changes in design, technology, and the market. The return on innovation in this environment is predicated on a modular arrangement of flexible steps in the process. Finally, the systems approach sees the entire process as being integrated in converting goods or services into economic satisfaction. There is now a major restructuring of the U.S. health care industry, and the incorporation of these four theories into health care reform would appear to be essential. This two-part article will address two problems: Will Drucker's theories relate to health care (Part I)? Will the "new manufacturing" in health care (practice guidelines) demonstrate cost, quality, and access changes that reform demands (Part II)?
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The changing landscape of care: does ethics education have a new role to play in health practice?
Wintrup, Julie
2015-05-08
In the UK, higher education and health care providers share responsibility for educating the workforce. The challenges facing health practice also face health education and as educators we are implicated, by the way we design curricula and through students' experiences and their stories. This paper asks whether ethics education has a new role to play, in a context of major organisational change, a global and national austerity agenda and the ramifications of disturbing reports of failures in care. It asks: how would it be different if equal amounts of attention were given to the conditions in which health decisions are made, if the ethics of organisational and policy decisions were examined, and if guiding collaborations with patients and others who use services informed ethics education and its processes? This is in three parts. In part one an example from an inspection report is used to question the ways in which clinical events are decontextualised and constructed for different purposes. Ramifications of a decision are reflected upon and a case made for different kinds of allegiances to be developed. In part two I go on to broaden the scope of ethics education and make a case for beginning with the messy realities of practice rather than with overarching moral theories. The importance of power in ethical practice is introduced, and in part three the need for greater political and personal awareness is proposed as a condition of moral agency. This paper proposes that ethics education has a new contribution to make, in supporting and promoting ethical practice - as it is defined in and by the everyday actions and decisions of practitioners and people who need health services. Ethics education that promotes moral agency, rather than problem solving approaches, would explore not only clinical problems, but also the difficult and contested arenas in which they occur. It would seek multiple perspectives and would begin with places and people, and their priorities. It would support students to locate their practice in imperfect global contexts, and to understand how individual and collective forms of power can influence healthcare quality.
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National Service Frameworks and UK general practitioners: street-level bureaucrats at work?
Checkland, Kath
2004-11-01
This paper argues that the past decade has seen significant changes in the nature of medical work in general practice in the UK. Increasing pressure to use normative clinical guidelines and the move towards explicit quantitative measures of performance together have the potential to alter the way in which health care is delivered to patients. Whilst it is possible to view these developments from the well-established sociological perspectives of deprofessionalisation and proletarianisation, this paper takes a view of general practice as work, and uses the ideas of Lipsky to analyse practice-level responses to some of these changes. In addition to evidence-based clinical guidelines, National Service Frameworks, introduced by the UK government in 1997, also specify detailed models of service provision that health care providers are expected to follow. As part of a larger study examining the impact of National Service Frameworks in general practice, the response of three practices to the first four NSFs were explored. The failure of NSFs to make a significant impact is compared to the practices' positive responses to purely clinical guidelines such as those developed by the British Hypertension Society. Lipsky's concept of public service workers as 'street-level bureaucrats' is discussed and used as a framework within which to view these findings.
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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.
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Evidence-based medicine for neurosurgeons: introduction and methodology.
Linskey, Mark E
2006-01-01
Evidence-based medicine is a tool of considerable value for medicine and neurosurgery that provides a secure base for clinical practice and practice improvement, but is not without inherent drawbacks, weaknesses and limitations. EBM finds answers to only those questions open to its techniques, and the best available evidence can be a far cry from scientific truth. With the support and backing of governmental agencies, professional medical societies, the AAMC, the ACGME, and the ABMS, EBM is likely here to stay. The fact that: (1) EBM philosophy and critical appraisal techniques have become fully integrated into the training and culture of our younger colleagues, (2) that maintenance of certification will require individuals to demonstrate personal evidence based practice based on tracking and critical analysis of personal practice outcomes as part of the performance-based learning and improvement competency, and (3) that the progressively growing national healthcare expenditures will necessitate increasing basis of reimbursement and funding based on evidence-based effectiveness and guidelines, all point to the likelihood that complete immersion of neurosurgical practice in EBM is inevitable. This article thoroughly explores the history of EBM in medicine in general and in neurosurgery in particular. Emphasis is placed on identifying the legislative and regulatory motive forces at work behind its promulgation and the role that organized medicine has taken to facilitate and foster its acceptance and implementation. An accounting of resources open to neurosurgeons, and a detailed description EBM clinical decision-making methodology is presented. Special emphasis is placed on outlining the methodology as well as the limitations of meta-analyses, randomized clinic trials, and clinical practice parameter guidelines. Commonly perceived objections, as well as substantive problems and limitations of EBM assumptions, tools, and approaches both for individual clinical practice and health policy design and implementation are explored in detail.
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Boyd, Scott D.; Natkunam, Yasodha; Allen, John R.; Warnke, Roger A.
2012-01-01
Determining the immunophenotype of hematologic malignancies is now an indispensible part of diagnostic classification, and can help to guide therapy, or to predict clinical outcome. Diagnostic workup should be guided by morphologic findings and evaluate clinically important markers, but ideally should avoid the use of overly-broad panels of immunostains that can reveal incidental findings of uncertain significance and give rise to increased costs. Here, we outline our approach to diagnosis of B cell neoplasms, combining histologic and clinical data with tailored panels of immunophenotyping reagents, in the context of the 2008 World Health Organization classification. We present data from cases seen at our institution from 2004-8 using this approach, to provide a practical reference for findings seen in daily diagnostic practice. PMID:22820658
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Röijezon, Ulrik; Clark, Nicholas C; Treleaven, Julia
2015-06-01
Impaired proprioception has been reported as a feature in a number of musculoskeletal disorders of various body parts, from the cervical spine to the ankle. Proprioception deficits can occur as a result of traumatic damage, e.g., to ligaments and muscles, but can also occur in association with painful disorders of a gradual-onset nature. Muscle fatigue can also adversely affect proprioception and this has implications for both symptomatic and asymptomatic individuals. Due to the importance of proprioception for sensorimotor control, specific methods for assessment and training of proprioception have been developed for both the spine and the extremities. The aim of this first part of a two part series on proprioception in musculoskeletal rehabilitation is to present a theory based overview of the role of proprioception in sensorimotor control, assessment, causes and findings of altered proprioception in musculoskeletal disorders and general principles of interventions targeting proprioception. An understanding of the basic science of proprioception, consequences of disturbances and theories behind assessment and interventions is vital for the clinical management of musculoskeletal disorders. Part one of this series supplies a theoretical base for part two which is more practically and clinically orientated, covering specific examples of methods for clinical assessment and interventions to improve proprioception in the spine and the extremities. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Potential facilitators and barriers to adopting standard treatment guidelines in clinical practice.
Sharma, Sangeeta; Pandit, Ajay; Tabassum, Fauzia
2017-04-18
Purpose The purpose of this paper is to assess medicines information sources accessed by clinicians, if sources differed in theory and practice and to find out the barriers and facilitators to effective guideline adoption. Design/methodology/approach In all, 183 doctors were surveyed. Barriers and facilitators were classified as: communication; potential adopters; innovation; organization characteristics and environmental/social/economic context. Findings Most of the clinicians accessed multiple information sources including standard treatment guidelines, but also consulted seniors/colleagues in practice. The top three factors influencing clinical practice guideline adoption were innovation characteristics, environmental context and individual characteristics. The respondents differed in the following areas: concerns about flexibility offered by the guideline; denying patients' individuality; professional autonomy; insights into gaps in current practice and evidence-based practice; changing practices with little or no benefit. Barriers included negative staff attitudes/beliefs, guideline integration into organizational structures/processes, time/resource constraints. Fearing third parties (government and insurance companies) restricting medicines reimbursement and poor liability protection offered by the guidelines emerged as the barriers. Facilitators include aligning organizational structures/processes with the innovation; providing leadership support to guide diffusion; increasing awareness and enabling early innovation during pre/in-service training, with regular feedback on outcomes and use. Practical implications Guideline adoption in clinical practice is partly within doctors' control. There are other key prevailing factors in the local context such as environmental, social context, professional and organizational culture affecting its adoption. Organizational policy and accreditation standards necessitating adherence can serve as a driver. Originality/value This survey among clinicians, despite limitations, gives helpful insights. While favourable attitudes may be helpful, clinical adoption could be improved more effectively by targeting barriers.
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A Completed Cycle Audit of Psychiatric Discharge Summaries.
Najim, Hellme; Jaffar, Khalid
2015-09-01
Patients discharge summaries are important as they record a vital miles stone in patients' care. Their accurate record improves patients' care and clarifies communication between different health professionals. 60 Discharge summaries from different consultant psychiatrists' case load were audited. The results were analysed and presented with recommendations to improve them a format was suggested. A reaudit of 62 discharge summaries was carried out by the same team after three years in the same catchment area but the practice has changed to inpatient and community. Improvement in most of the areas audited occur in the reaudit which indicates the usefulness of audit in improving clinical practice which a pivotal part of clinical governance. This completed audit cycle has proven that clinical practice has been reviewed and methods of improving it have been implemented. It has been noted that more items were reviewed and added to the second cycle which should be condoned. Discharge summaries are important clinical documents in secondary and primary care communications. They are helpful for secondary care staff as they good references for people in out of hours services and Accident and Emergency. Good quality discharge summaries improve patients care and make it easy to manage clinical risk.
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The role of clinician emotion in clinical reasoning: Balancing the analytical process.
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.
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Using family paradigms to improve evidence-based practice.
Hidecker, Mary Jo Cooley; Jones, Rebecca S; Imig, David R; Villarruel, Francisco A
2009-08-01
Evidence-based practice (EBP) describes clinical decision making using research, clinical experience, and client values. For family-centered practices, the client's family is integral to this process. This article proposes that using family paradigms, a family science framework, may help elicit and understand client/family values within family-centered EBP. This article describes the family paradigms framework: 4 classic paradigms of "closed," "random," "open," and "synchronous." Its applicability to family-centered EBP is proposed using augmentative and alternative communication examples. A family-centered approach to EBP requires families to be an integral part of clinical decision making, but some families may need assistance in enumerating their views and values. Family paradigms (which consider how a family uses its resources of time, space, energy, and material in the pursuit of its goals of control, affect, meaning, and content) may be a way to elicit family values and preferences relevant to clinical decisions. Family and client values can be incorporated throughout the EBP steps. Considering family paradigms may increase awareness and understanding of how families' views of their goals and resources affect clinical decisions. Further research is needed into both the processes and effectiveness of using family paradigms to conduct family-centered EBP.
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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.
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The dynamic development of gender variability.
Fausto-Sterling, Anne
2012-01-01
We diagram and discuss theories of gender identity development espoused by the clinical groups represented in this special issue. We contend that theories of origin relate importantly to clinical practice, and argue that the existing clinical theories are under-developed. Therefore, we develop a dynamic systems framework for gender identity development. Specifically, we suggest that critical aspects of presymbolic gender embodiment occur during infancy as part of the synchronous interplay of caregiver-infant dyads. By 18 months, a transition to symbolic representation and the beginning of an internalization of a sense of gender can be detected and consolidation is quite evident by 3 years of age. We conclude by suggesting empirical studies that could expand and test this framework. With the belief that better, more explicit developmental theory can improve clinical practice, we urge that clinicians take a dynamic developmental view of gender identity formation into account.
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Evidence-based dental practice: part I. Formulating clinical questions and searching for answers.
Adeyemo, W L; Akinwande, J A; Bamgbose, B O
2007-01-01
Evidence-based dentistry (EBD) is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences. Evidence-based care is now regarded as the "gold standard" in health care delivery worldwide. EBD involves tracking down the available evidence, assessing its validity and relevance, and then using the "best" evidence to inform decisions regarding care. Although, the concept of evidence-based dentistry is not new, however, anecdotal evidence suggests that the awareness of this concept among Nigerian dental practitioners is low. This first of three articles on evidence-based dental practice discusses the historical background of evidence-based medicine/evidence-based dentistry, how to formulate clear clinical questions and how to track down (search) the available evidence in the literature databases.
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Grove, Amy; Clarke, Aileen; Currie, Graeme
2018-05-31
The uptake and use of clinical guidelines is often insufficient to change clinical behaviour and reduce variation in practice. As a consequence of diverse organisational contexts, the simple provision of guidelines cannot ensure fidelity or guarantee their use when making decisions. Implementation research in surgery has focused on understanding what evidence exists for clinical practice decisions but limits understanding to the technical, educational and accessibility issues. This research aims to identify where, when and how evidence and knowledge are used in orthopaedic decision-making and how variation in these factors contributes to different approaches to implementation of clinical guidance in practice. We used in-depth case studies to examine guideline implementation in real-life surgical practice. We conducted comparative case studies in three English National Health Service hospitals over a 12-month period. Each in-depth case study consisted of a mix of qualitative methods including interviews, observations and document analysis. Data included field notes from observations of day-to-day practice, 64 interviews with NHS surgeons and staff and the collection of 121 supplementary documents. Case studies identified 17 sources of knowledge and evidence which influenced clinical decisions in elective orthopaedic surgery. A comparative analysis across cases revealed that each hospital had distinct approaches to decision-making. Decision-making is described as occurring as a result of how 17 types of knowledge and evidence were privileged and of how they interacted and changed in context. Guideline implementation was contingent and mediated through four distinct contextual levels. Implementation could be assessed for individual surgeons, groups of surgeons or the organisation as a whole, but it could also differ between these levels. Differences in how evidence and knowledge were used contributed to variations in practice from guidelines. A range of complex and competing sources of evidence and knowledge exists which influence the working practices of healthcare professionals. The dynamic selection, combination and use of each type of knowledge and evidence influence the implementation and use of clinical guidance in practice. Clinical guidelines are a fundamental part of practice, but represent only one type of evidence influencing clinical decisions. In the orthopaedic speciality, other distinct sources of evidence and knowledge are selected and used which impact on how guidelines are implemented. New approaches to guideline implementation need to appreciate and incorporate this diverse range of knowledge and evidence which influences clinical decisions and to take account of the changing contexts in which decisions are made.
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What makes British general practitioners take part in a quality improvement scheme?
Spooner, A; Chapple, A; Roland, M
2001-07-01
To understand the reasons for the apparent success of a quality improvement scheme designed to produce widespread changes in chronic disease management in primary care. Purposeful sample of 36 primary care staff, managers and specialists. Qualitative analysis of 27 interviews in East Kent Health Authority area, where, over a three-year period, more than three-quarters of general practitioners (GPs) and enrolled in a quality improvement programme which required them to meet challenging chronic disease management targets (PRImary Care Clinical Effectiveness--PRICCE). Major changes in clinical practice appeared to have taken place as a result of participation in PRICCE. The scheme was significantly dependent on leadership from the health authority and on local professional support. Factors that motivated GPs to take part in the project included: a desire to improve patient care; financial incentives; maintenance of professional autonomy in how to reach the targets; maintenance of professional pride; and peer pressure. Good teamworking was essential to successful completion of the project and often improved as a result of taking part. The scheme included a combination of interventions known to be effective in producing professional behavioural change. When managerial vision is aligned to professional values, and combined with a range of interventions known to influence professional behaviour including financial incentives, substantial changes in clinical practice can result. Lessons are drawn for future quality improvement programmes in the National Health Service.
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Butcher, J D; Zukowski, C W; Brannen, S J; Fieseler, C; O'Connor, F G; Farrish, S; Lillegard, W A
1996-12-01
Sports medicine has matured as a focused discipline within primary care with the number of primary care sports medicine physicians growing annually. The practices of these physicians range from "part-time" sports medicine as a part of a broader practice in their primary specialty, to functioning as a full-time team physician for a university or college. Managed care organizations are increasingly incorporating primary care sports medicine providers into their organizations. The optimal role of these providers in a managed care system has not been described. A descriptive analysis was made of patient contacts in a referral-based, free-standing primary care sports medicine clinic associated with a large managed care system. This study describes patient information including demographic data, referral source, primary diagnosis, specialized diagnostic testing, and subsequent specialty consultation. A total of 1857 patient contacts were analyzed. New patients were referred from a full range of physicians both primary care (family practice, internal medicine, pediatrics, and emergency physicians) and other specialists, with family practice clinic providers (physicians, physician assistants, and nurse practitioners) accounting for the largest percentage of new referrals. The majority of patient visits were for orthopedic injuries (95.4%); the most frequently involved injury sites were: knee (26.5%), shoulder (18.2%), back (14.3%), and ankle (10%). The most common types of injury were: tendinitis (21.3%), chronic anterior knee pain (10.6%), and ligament sprains (9.9%). Specialized testing was requested for 8% of all patients. The majority of patients were treated at the Ft Belvoir Sports Medicine Clinic by primary care sports medicine physicians without further specialty referral. Primary care sports medicine physicians offer an intermediate level of care for patients while maintaining a practice in their primary care specialty. This dual practice is ideal in the managed care setting. This study demonstrates the complementary nature of primary care sports medicine and orthopedics, with the primary care sports medicine physician reducing the demand on orthopedists for nonsurgical treatment. This study also demonstrates the need for revision in the orthopedic curriculum for primary care physicians.
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Cleary, Timothy J; Durning, Steven J; Artino, Anthony R
2016-11-01
Helping medical educators obtain and use assessment data to assist medical students, residents, and physicians in reducing diagnostic errors and other forms of ineffective clinical practice is of critical importance. Self-Regulated Learning-Microanalytic Assessment and Training is an assessment-to-intervention framework designed to address this need by generating data about trainees' strategic processes (e.g., focusing on clinical task procedures), regulatory processes (e.g., planning how to do a task), and motivational processes (e.g., increasing confidence for performing a task) as they perform clinical activities. In this article, the authors review several studies that have used an innovative assessment approach, called self-regulated learning (SRL) microanalysis, to generate data about how trainees regulate their thinking and actions during clinical reasoning tasks. Across the studies, initial findings revealed that medical students often do not exhibit strategic thinking and action during clinical reasoning practice tasks even though some regulatory processes (e.g., planning) are predictive of important medical education outcomes. Further, trainees' motivation beliefs, strategic thinking, and self-evaluative judgments tend to shift rapidly during clinical skills practice and may also vary across different parts of a patient encounter. Collectively, these findings underscore the value of dynamically assessing trainees' SRL as they complete clinical tasks. The findings also set the stage for exploring how medical educators can best use SRL microanalytic assessment data to guide remedial practices and the provision of feedback to trainees. Implications and future research directions for connecting assessments to intervention in medical education are discussed.
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Stevens, Lesley Ann; Levin, Adeera
2004-01-01
Chronic Kidney disease (CKD) has been identified as a public health epidemic, fueled in part by improved outcomes of both diabetic and cardiac patient populations, as well as by the increasing recognition that it is possible to identify CKD at earlier stages. The estimated 8 to 10 million Americans that have CKD, with its concomitant morbidity and mortality, have the potential to overwhelm the current system of specialty practice medicine and health care resources. How can clinicians, clinician scientists, and health care administrators translate research findings into clinical practice in an effective manner to improve the care of this burgeoning patient group? The challenge of translating research into clinical care requires identification of that which we do and do not know, communication of knowledge between those who do and do not know, and efficient collection of information for systematic evaluation. This article will describe the challenges of translating current research findings into clinical practice. There is a need to identify the complexity of CKD disease processes and issues associated with delivery of care and to describe the difficulties in the dissemination of new knowledge to physicians. Because of the propensity of CKD to affect identifiable groups of patients, we will discuss the potential challenges of these strategies given the racial, ethnic, and cultural diversity in North America. A potential solution to these challenges is a new paradigm of "process-based medicine" that integrates clinical and basic science research findings with multidisciplinary and shared care models of health care delivery. In this context, attention to advances in information technology, the cognitive processes that underlie physician learning, and the findings of outcome research may ensure true integration of clinical research and clinical practice.
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Orlando, Lori A.; Buchanan, Adam H.; Hahn, Susan E.; Christianson, Carol A.; Powell, Karen P.; Skinner, Celette Sugg; Chesnut, Blair; Blach, Colette; Due, Barbara; Ginsburg, Geoffrey S.; Henrich, Vincent C.
2016-01-01
INTRODUCTION Family health history is a strong predictor of disease risk. To reduce the morbidity and mortality of many chronic diseases, risk-stratified evidence-based guidelines strongly encourage the collection and synthesis of family health history to guide selection of primary prevention strategies. However, the collection and synthesis of such information is not well integrated into clinical practice. To address barriers to collection and use of family health histories, the Genomedical Connection developed and validated MeTree, a Web-based, patient-facing family health history collection and clinical decision support tool. MeTree is designed for integration into primary care practices as part of the genomic medicine model for primary care. METHODS We describe the guiding principles, operational characteristics, algorithm development, and coding used to develop MeTree. Validation was performed through stakeholder cognitive interviewing, a genetic counseling pilot program, and clinical practice pilot programs in 2 community-based primary care clinics. RESULTS Stakeholder feedback resulted in changes to MeTree’s interface and changes to the phrasing of clinical decision support documents. The pilot studies resulted in the identification and correction of coding errors and the reformatting of clinical decision support documents. MeTree’s strengths in comparison with other tools are its seamless integration into clinical practice and its provision of action-oriented recommendations guided by providers’ needs. LIMITATIONS The tool was validated in a small cohort. CONCLUSION MeTree can be integrated into primary care practices to help providers collect and synthesize family health history information from patients with the goal of improving adherence to risk-stratified evidence-based guidelines. PMID:24044145
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Thue, Geir; Jevnaker, Marianne; Gulstad, Guri Andersen; Sandberg, Sverre
2011-09-01
Virtually all the general practices in Norway participate in the Norwegian Quality Improvement of Laboratory Services in Primary Care, NOKLUS. In order to assess and develop NOKLUS's services, it was decided to carry out an investigation in the largest participating group, general practices. In autumn 2008 a questionnaire was sent to all Norwegian general practices asking for feedback on different aspects of NOKLUS's main services: contact with medical laboratory technologists, sending of control materials, use and maintenance of practice-specific laboratory binders, courses, and testing of laboratory equipment. In addition, attitudes were elicited towards possible new services directed at assessing other technical equipment and clinical use of tests. Responses were received from 1290 of 1552 practices (83%). The great majority thought that the frequency of sending out control material should continue as at present, and they were pleased with the feedback reports and follow-up by the laboratory technologists in the counties. Even after many years of practical experience, there is still a need to update laboratory knowledge through visits to practices, courses, and written information. Practices also wanted quality assurance of blood pressure meters and spirometers, and many doctors wanted feedback on their use of laboratory tests. Services regarding quality assurance of point-of-care tests, guidance, and courses should be continued. Quality assurance of other technical equipment and of the doctor's clinical use of laboratory tests should be established as part of comprehensive quality assurance.
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Mearin, F; Ciriza, C; Mínguez, M; Rey, E; Mascort, J J; Peña, E; Cañones, P; Júdez, J
In this Clinical practice guide, an analysis is made of the diagnosis and treatment of adult patients with constipation and abdominal discomfort, under the spectrum of irritable bowel syndrome and functional constipation. These have an important personal, health and social impact, affecting the quality of life of these patients. In irritable bowel syndrome with a predominance of constipation, this is the predominant change in bowel movements, with recurrent abdominal pain, bloating and frequent abdominal distension. Constipation is characterised by infrequent or difficulty in bowel movements, associated with excessive straining during bowel movement or sensation of incomplete evacuation. There is often no underling cause, with an intestinal functional disorder being considered. They have many clinical and pathophysiological similarities, with a similar response of the constipation to common drugs. The fundamental difference is the presence or absence of pain, but not in a way evaluable way; "all or nothing". The severity depends on the intensity of bowel symptoms and other factors, a combination of gastrointestinal and extra-intestinal symptoms, level of involvement, forms of perception, and behaviour. The Rome criteria diagnose functional bowel disorders. This guide is adapted to the Rome criteria IV (May 2016) and in this first part an analysis is made of the alarm criteria, diagnostic tests, and the criteria for referral between Primary Care and Digestive Disease specialists. In the second part, a review will be made of the therapeutic alternatives available (exercise, diet, drug therapies, neurostimulation of sacral roots, or surgery), making practical recommendations for each one of them. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.
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Mearin, F; Ciriza, C; Mínguez, M; Rey, E; Mascort, J J; Peña, E; Cañones, P; Júdez, J
2017-01-01
In this Clinical practice guide, an analysis is made of the diagnosis and treatment of adult patients with constipation and abdominal discomfort, under the spectrum of irritable bowel syndrome and functional constipation. These have an important personal, health and social impact, affecting the quality of life of these patients. In irritable bowel syndrome with a predominance of constipation, this is the predominant change in bowel movements, with recurrent abdominal pain, bloating and frequent abdominal distension. Constipation is characterised by infrequent or difficulty in bowel movements, associated with excessive straining during bowel movement or sensation of incomplete evacuation. There is often no underling cause, with an intestinal functional disorder being considered. They have many clinical and pathophysiological similarities, with a similar response of the constipation to common drugs. The fundamental difference is the presence or absence of pain, but not in a way evaluable way; "all or nothing". The severity depends on the intensity of bowel symptoms and other factors, a combination of gastrointestinal and extra-intestinal symptoms, level of involvement, forms of perception, and behaviour. The Rome criteria diagnose functional bowel disorders. This guide is adapted to the Rome criteria IV (May 2016) and in this first part an analysis is made of the alarm criteria, diagnostic tests, and the criteria for referral between Primary Care and Digestive Disease specialists. In the second part, a review will be made of the therapeutic alternatives available (exercise, diet, drug therapies, neurostimulation of sacral roots, or surgery), making practical recommendations for each one of them. Copyright © 2016. Publicado por Elsevier España, S.L.U.
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Liu, Yu-Qi; Liu, Meng-Yu; Li, Chun; Shi, Nan-Nan; Wang, Yue-Xi; Wang, Li-Ying; Zhao, Xue-Yao; Kou, Shuang; Han, Xue-Jie; Wang, Yan-Ping
2017-09-01
This study is to assess the Guidelines for Diagnosis and Treatment of Common Diseases of Otolaryngology in Traditional Chinese Medicine in clinical application and provide evidence for further guideline revision. The assessment was divided into applicability assessment and practicability assessment. The applicability assessment based on questionnaire survey and the traditional Chinese medicine (TCM) practitioners were asked to independently fill the Questionnaire for Applicability Assessment on the Guidelines for Diagnosis and Treatment in Traditional Chinese Medicine. The practicability assessment was based on prospective case investigation and analysis method and the TCM practitioners-in-charge filled the Case Investigation Questionnaire for Practicability Assessment on the Guidelines for Diagnosis and Treatment in Traditional Chinese Medicine. The data were analyzed in descriptive statistics. 151 questionnaires were investigated for applicability assessment and 1 016 patients were included for practicability assessment. The results showed that 88.74% of them were familiar with the guidelines and 45.70% used them. The guidelines quality and related items were similar in applicability assessment and practicability assessment, and scored highly as more than 85.00% except the "recuperating and prevention". The results suggested that the quality of Guidelines for Diagnosis and Treatment of Common Diseases of Otolaryngology in Traditional Chinese Medicine was high and could better guide the clinical practice. The "recuperating and prevention" part should be improved and the evidence data should be included in future guideline revision, so that the clinical utilization rate could be increased. Copyright© by the Chinese Pharmaceutical Association.
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Development of a university-based emergency department network: lessons learned.
Pimentel, Laura; Hirshon, Jon Mark; Barrueto, Fermin; Browne, Brian J
2012-10-01
As part of the growth of emergency medical care in our state, our university-based emergency medicine practice developed a network of affiliated emergency department (ED) practices. The original practices were academic and based on a faculty practice model; more recent network development incorporated a community practice model less focused on academics. This article discusses the growth of that network, with a focus on the recent addition of a county-wide two-hospital emergency medicine practice. During the transition of the two EDs from a contract management group to the university network, six critical areas in need of restructuring were identified: 1) departmental leadership, 2) recruitment and retention of clinical staff members, 3) staffing strategies, 4) relationships with key constituents, 5) clinical operations, supplies, and equipment, and 6) compensation structure. The impact of changes was measured by comparison of core measures, efficiency metrics, patient volumes, admissions, and transfers to the academic medical center before and after the implementation of our practice model. Our review and modification of these components significantly improved the quality and efficiency of care at the community hospital system. The consistent presence of board certified emergency physicians optimized utilization of clinical resources in the community hospital and the academic health system. This dynamic led to a mutually beneficial merger of these major state healthcare systems. Copyright © 2012 Elsevier Inc. All rights reserved.
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The laboratory diagnosis of testosterone deficiency.
Paduch, Darius A; Brannigan, Robert E; Fuchs, Eugene F; Kim, Edward D; Marmar, Joel L; Sandlow, Jay I
2014-05-01
The evaluation and treatment of hypogonadal men has become an important part of urologic practice. Fatigue, loss of libido, and erectile dysfunction are commonly reported, but nonspecific symptoms and laboratory verification of low testosterone (T) are an important part of evaluation in addition to a detailed history and physical examination. Significant intraindividual fluctuations in serum T levels, biologic variation of T action on end organs, the wide range of T levels in human serum samples, and technical limitations of currently available assays have led to poor reliability of T measurements in the clinical laboratory setting. There is no universally accepted threshold of T concentration that distinguishes eugonadal from hypogonadal men; thus, laboratory results have to be interpreted in the appropriate clinical setting. This review focuses on clinical, biological, and technological challenges that affect serum T measurements to educate clinicians regarding technological advances and limitations of the currently available laboratory methods to diagnose hypogonadism. A collaborative effort led by the American Urological Association between practicing clinicians, patient advocacy groups, government regulatory agencies, industry, and professional societies is underway to provide optimized assay platforms and evidence-based normal assay ranges to guide clinical decision making. Until such standardization is commonplace in clinical laboratories, the decision to treat should be based on the presence of signs and symptoms in addition to serum T measurements. Rigid interpretation of T ranges should not dictate clinical decision making or define coverage of treatment by third party payers. Copyright © 2014 Elsevier Inc. All rights reserved.
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Altshuler, Lisa; Kachur, Elizabeth; Krinshpun, Shifra; Sullivan, Deborah
2008-11-01
In 2003, the Maimonides Infants & Children's Hospital received a Title VII Residency Training in Primary Care grant to integrate genetic-specific competencies into postgraduate pediatrics education. As part of that endeavor, mandatory yearly genetics objective structured clinical exams (OSCEs) were instituted for third-year residents. This article reports on the first three years of experience with this innovative educational tool.After an overview of genetic concepts, dysmorphology, and communication styles, residents complete a five-station OSCE and receive feedback from standardized patients and from the faculty who observe them. After this clinical exercise, the residents participate in a small-group debriefing session to share strategies for effective communication and clinical case management and to discuss the ethical issues that arise with these genetic cases.In three years, 60 residents have completed the genetics OSCE program. Evaluation data demonstrate that the program has been effective in both introducing genetic-specific challenges and assessing residents' clinical skills. It has helped trainees self-identify both strengths and further training needs. Pre- and postsurveys among the trainees show increased comfort levels in performing 5 of 12 genetic-related clinical tasks.We conclude that genetics OSCEs are an enriching educational tool. Merely providing trainees and practicing physicians with the latest scientific information is unlikely to prepare them for counseling patients about complex genetic issues. Developing proficiency requires focused practice and effective feedback.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.
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Sy, Michael Palapal
2017-11-01
For the past more than 50 years, the World Health Organisation has acknowledged through empirical findings that health workers that learn together work together effectively to provide the best care for their patients. This study aimed to: (1) describe the perceived extent of interprofessional education (IPE) experience among Filipino occupational therapists (OTs), physical therapists (PTs), and speech-language-pathologists (SLPs); (2) identify their attitudes towards interprofessional collaboration (IPC); and (3) compare their attitudes towards IPC according to: prior IPE experience, classification of IPE experience, profession, years of practice, and practice setting. Using a cross-sectional survey design, a two-part questionnaire was sent to Filipino OTs, PTs, and SLPs working in the Philippines via an online survey application. The first part of the survey contained eight items of demographic information and the second part contained the 14-item Attitudes Towards Health Care Teams Scale (ATHCTS). Findings revealed that among the Filipino OT, PT and SLP respondents (n = 189), 70.9% had prior experience on IPE. Moreover, the three most commonly used IPE teaching-learning strategies were case discussion (clinical setting), small group discussion, didactics, and case discussion (community setting), while the use of didactics and case discussion (community setting) yielded more agreeable attitudes towards IPC. Among the 14 items in the ATHCTS, 11 were rated with agreeability and three items with neutrality. For professional variables, only the practice setting variable yielded a statistically significant finding confirming those working in the academia to be more agreeable towards IPC compared to other settings. However, years of practice and professional background variables both yielded no statistically significant difference implying no association between years of practice and attitude towards IPC and a homogenous composition among respondents, respectively. The results of this research are to springboard IPE initiatives within Philippine higher education institutions to enable evidence-based IPC approaches in clinical practice.
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Practical Considerations for Clinical PET/MR Imaging.
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.
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Practical Considerations for Clinical PET/MR Imaging.
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.
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Lelorain, Sophie; Sultan, Serge; Zenasni, Franck; Catu-Pinault, Annie; Jaury, Philippe; Boujut, Emilie; Rigal, Laurent
2013-03-01
Clinical empathy, i.e. the ability of physicians to adopt patient perspective, is an essential component of care, which depends in part on empathic concern, i.e. compassionate emotions felt for others. However, too much empathic concern can be challenging for physicians. Aim of this study was to examine physician practice characteristics that could explain clinical empathy beyond empathic concern. We were also interested in testing whether professional reflective activities, such as Balint group attendance or clinical supervision, might make clinical empathy less dependent on empathic concern. A total of 295 French general practitioners (response rate of 37%) completed self-reported questionnaires on empathic concern and clinical empathy, using the Toronto empathy questionnaire (TEQ) and the Jefferson scale of physician empathy (JSPE), respectively. We also recorded information on their professional practice: professional experience, duration of consultations, and participation in Balint groups or being a clinical supervisor. Hierarchical regression analyses were carried out with clinical empathy as dependent variable. Empathic concern was an important component of clinical empathy variance. The physician practice characteristics 'consultation length' and 'being a Balint attendee or a supervisor,' but not 'clinical experience' made a significant and unique contribution to clinical empathy beyond that of empathic concern. Participating to one reflective activity (either Balint group attendance or clinical supervision) made clinical empathy less dependent on empathic concern. Working conditions such as having enough consultation time and having the opportunity to attend a professional reflective activity support the maintenance of clinical empathy without the burden of too much empathic concern.
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Tilson, Julie K; Mickan, Sharon
2014-06-25
There is a need for theoretically grounded and evidence-based interventions that enhance the use of research evidence in physical therapist practice. This paper and its companion paper introduce the Physical therapist-driven Education for Actionable Knowledge translation (PEAK) program, an educational program designed to promote physical therapists' integration of research evidence into clinical decision-making. The pedagogical foundations for the PEAK educational program include Albert Bandura's social cognitive theory and Malcolm Knowles's adult learning theory. Additionally, two complementary frameworks of knowledge translation, the Promoting Action on Research Implementation in Health Services (PARiHS) and Knowledge to Action (KTA) Cycle, were used to inform the organizational elements of the program. Finally, the program design was influenced by evidence from previous attempts to facilitate the use of research in practice at the individual and organizational levels. The 6-month PEAK program consisted of four consecutive and interdependent components. First, leadership support was secured and electronic resources were acquired and distributed to participants. Next, a two-day training workshop consisting of didactic and small group activities was conducted that addressed the five steps of evidence based practice. For five months following the workshop, participants worked in small groups to review and synthesize literature around a group-selected area of common clinical interest. Each group contributed to the generation of a "Best Practices List" - a list of locally generated, evidence-based, actionable behaviors relevant to the groups' clinical practice. Ultimately, participants agreed to implement the Best Practices List in their clinical practice. This, first of two companion papers, describes the underlying pedagogical theories, knowledge translation frameworks, and research evidence used to derive the PEAK program - an educational program designed to promote the use of research evidence to inform physical therapist practice. The four components of the program are described in detail. The companion paper reports the results of a mixed methods feasibility analysis of this complex educational intervention.
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Borlase, Jeanette; Abelson-Mitchell, Nadine
2008-01-01
The concern of academics and clinicians about the alleged dichotomy between theoretical concepts and the practice of nursing has been the catalyst for the development of a pocket-sized aid for nurses, known as the Knowledge Underpinning Practice Orientation Dial (KUPOD [N]/The Dial). A mixed method approach was used incorporating a questionnaire and a focus group of educators. The Dial was introduced, as part of a module, undertaken by a cohort of second-year Diploma in Nursing (Adult Branch) students. Twenty-eight students returned the questionnaire (response rate=85%). Results revealed that the Dial was easy to use in a variety of situations and locations. Respondents used the Dial within clinical and classroom settings and for self directed study. They reported that it was a practical and effective aid to learning, assisting in correlating theory and practice. It supported reflection and enhanced confidence in the clinical area, indicating that this economically produced tool helps to bridge the theory-practice gap. The Dial is now being introduced as a learning resource to a wider range of students.
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Donot, Pierre Emmanuel
2009-01-01
JACIE, a European certification program for stem cell transplantation, has now been recognized by the French Health Authorities. It can be considered as an evaluation of professional practice, an activity that can be promoted by health centres. The present article has two aims: firstly, it describes the structure of the certification standard based on the relative structure of each of its components; secondly, it reports on the experience acquired by the Léon-Bérard cancer centre (Lyon-France) during the certification of its own stem cell transplantation program. The JACIE manual written in English is divided into three parts corresponding to the three processes identified. Part B describes the clinical haematopoietic stem cell transplantation program. Part C is dedicated to the collection of haematopoietic stem cells from blood and marrow. Finally, part D applies to the cell therapy laboratory in charge of cell preservation and the preparation of grafts for re-infusion. After the application has been submitted to the JACIE board, a date is set for an inspection visit. The cell therapy laboratory at Léon-Bérard cancer centre has already participated to a certified transplantation project of the Edouard-Herriot Hospital (Lyon public hospitals) [parts C and D of the certification]. The executive board proposed that the clinical haematology unit of the cancer centre also applied for JACIE certification. A multidisciplinary work group-combining document writing skills and a real capacity to convince and motivate clinical staff was formed. Secondly, a comprehensive collection of existing documents was issued and the clinical pathway of the patients was formalized so that no step of the graft process would be omitted. A physician from another hospital also tested the evaluation process with the organisation of a mock visit. He confirmed that everything was in good way and provided recommendations to improve the program. This huge preparation provided invaluable learning opportunities to the participants. After the final visit by JACIE inspectors, the cancer centre received four-year certification. The challenge is now to maintain this momentum for the next certifications and to better take into account the ethical and juridical constraints of haematopoietic stem cell transplantation.
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Outcomes From Pediatric Gastroenterology Maintenance of Certification Using Web-based Modules.
Sheu, Josephine; Chun, Stanford; O'Day, Emily; Cheung, Sara; Cruz, Rusvelda; Lightdale, Jenifer R; Fishman, Douglas S; Bousvaros, Athos; Huang, Jeannie S
2017-05-01
Beginning in 2013, the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) sponsored and developed subspecialty field-specific quality improvement (QI) activities to provide Part 4 Maintenance of Certification (MOC) credit for ongoing certification of pediatric gastroenterologists by the American Board of Pediatrics. Each activity was a Web-based module that measured clinical practice data repeatedly over at least 3 months as participants implemented rapid cycle change. Here, we examine existing variations in clinical practice among participating pediatric gastroenterologists and determine whether completion of Web-based MOC activities improves patient care processes and outcomes. We performed a cross-sectional and prospective analysis of physician and parent-reported clinical practice data abstracted from Web-based MOC modules on the topics of upper endoscopy, colonoscopy, and informed consent collected from pediatric gastroenterologists from North America from 2013 to 2016. Among 134 participating pediatric gastroenterologists, 56% practitioners practiced at an academic institution and most (94%) were NASPGHAN members. Participating physicians reported data from 6300 procedures. At baseline, notable practice variation across measured activities was demonstrated. Much of the rapid cycle changes implemented by participants involved individual behaviors, rather than system/team-based improvement activities. Participants demonstrated significant improvements on most targeted process and quality care outcomes. Pediatric gastroenterologists and parents reported baseline practice variation, and improvement in care processes and outcomes measured during NASPGHAN-sponsored Web-based MOC QI activities. Subspecialty-oriented Web-based MOC QI activities can reveal targets for reducing unwarranted variation in clinical pediatric practice, and can effectively improve care and patient outcomes.
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Horst, Jeremy A.; Clark, Matthew D.; Lee, Andrew H.
2009-01-01
Dentists are self-selected for visual and kinesthetic learning preferences. Watching another practitioner perform treatment can be incredibly didactic, both before and after learning the procedure. This missing part of dental education has the capacity to play a tremendous role in dental education for all levels of practitioner. Dental students in their clinical years begin to realize the meaning of dentistry as a practice, a set of skills that are never perfected. Abundant evidence demonstrates that cycling between observation and practice enhances procedural learning and retention, yet this mechanism is vastly underused in dental education. Collaborative treatment paradigms, wherein the able student assists a more experienced practitioner, can create mentorship. Learning potentially esoteric information or subtle nuances of clinical acumen is facilitated by the contextual framework of the clinical environment and is strengthened by emotional attachments through interpersonal interactions. In this article, we explore the evidence surrounding mentorship and clinical observation both before and after students are given the responsibilities of patient care, which together recapitulate clinical apprenticeship. Finally, we present examples of how apprenticeship can be brought back to dental education, including evaluation of a clinical assisting program that we implemented and explanation of a hypothetical faculty-student practice partnership model. PMID:19648563
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Casper, Mary L
2013-04-01
This article considers the career of speech-language pathologists practicing in long-term care/skilled nursing facility settings. The range of conditions that lead to communication, cognition, and/or swallowing disorders that are evaluated and treated by the speech-language pathologist in the long-term care setting are examined. Various methodologies for reimbursement are discussed, including the Medicare Physicians' Fee Schedule associated with Medicare Part B and the Prospective Payment System associated with Medicare Part A. Suggestions for effective clinical service delivery are reviewed, along with best practices for interdisciplinary team communication. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Professionalism--a required CLS/CLT curricular component.
Latshaw, Sandra; Honeycutt, Karen
2010-01-01
Determine the impact of requiring Clinical Laboratory Science (CLS) students to participate in approved professionalism activities as part of a mandatory management course. Quasi-experimental, case study reporting qualitative results of 25 CLS students. During the admission interview, students complete a written response to questions about their perceptions related to professionalism. During the clinical educational year, students are required to complete approved professionalism activities as part of a management course. At the end of the course, students write a reflective paper focusing on their professional activities and how these experiences will influence their future professional practice. Overall themes of student reflections are provided. University of Nebraska Medical Center (UNMC) CLS Program in Omaha. After participating in a mandatory professionalism curricular component requiring active student participation in professional activities, student reflective writings provide evidence this is one successful approach to nurture professional identity within future Clinical Laboratory Science/Clinical Laboratory Technician (CLS/CLT) practitioners.
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Determining problems experienced by student nurses in their work with clinical educators in Turkey.
Elcigil, Ayfer; Yildirim Sari, Hatice
2007-07-01
Clinical education is considered an indispensable and vital part of nursing education. Educators have an important role in the successful completion of a student's clinical education. The clinical educator's approach, experience and knowledge have an influence on the students. Students encounter certain problems during their clinical practice under the supervision of educators. This study was conducted to determine the nature of the problems student nurses encounter during clinical training in Turkey. The focus-group interviews were used for this study. Three groups of 8, a total group of 24, composed of students completing their third year were included in the interviews. The students in this study had completed their practical training in the departments of internal medicine, surgery, pediatrics, psychiatry and public health. Among the problems mostly encountered by students, as established by the study, were inadequate assessment by the clinical educator, judgment, negative feedback, communication problems, inadequate guidance and overload. At the end of the research, recommendations were that educators should offer information in the direction of student expectations, increase their positive feedback and lighten the academic workload of these students.
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Adelson, Stewart L
2011-10-01
The American Academy of Child and Adolescent Psychiatry (AACAP) is preparing a publication, Practice Parameter on Gay, Lesbian or Bisexual Sexual Orientation, Gender-Nonconformity, and Gender Discordance in Children and Adolescents. This article discusses the development of the part of the parameter related to gender nonconformity and gender discordance and describes the practice parameter preparation process,rationale, key scientific evidence, and methodology. Also discussed are terminology considerations, related clinical issues and practice skills, and overall organization of information including influences on gender development, gender role behavior, gender nonconformity and gender discordance, and their relationship to the development of sexual orientation.
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Design Recommendations for Pharmacogenomics Clinical Decision Support Systems
Khelifi, Maher; Tarczy-Hornoch, Peter; Devine, Emily B.; Pratt, Wanda
2017-01-01
The use of pharmacogenomics (PGx) in clinical practice still faces challenges to fully adopt genetic information in targeting drug therapy. To incorporate genetics into clinical practice, many support the use of Pharmacogenomics Clinical Decision Support Systems (PGx-CDS) for medication prescriptions. This support was fueled by new guidelines to incorporate genetics for optimizing drug dosage and reducing adverse events. In addition, the complexity of PGx led to exploring CDS outside the paradigm of the basic CDS tools embedded in commercial electronic health records. Therefore, designing the right CDS is key to unleashing the full potential of pharmacogenomics and making it a part of clinicians’ daily workflow. In this work, we 1) identify challenges and barriers of the implementation of PGx-CDS in clinical settings, 2) develop a new design approach to CDS with functional characteristics that can improve the adoption of pharmacogenomics guidelines and thus patient safety, and 3) create design guidelines and recommendations for such PGx-CDS tools. PMID:28815136
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How clinical observation enhances recruitment and selection.
Sutherland, Clare
2012-11-01
A survey of nurse managers in Derby Hospitals NHS Foundation Trust in 2010 found 51 practitioners working at an advanced clinical level, but there were variations in titles, pay bands, clinical skills and academic qualifications. This prompted the introduction of a local framework to support the development of the advanced nurse practitioner (ANP) role and a review of the interview process to enable managers to assess applicants' skills, competencies and knowledge. The process is now used in practice, with candidates' clinical skills now observed as part of the ANP selection process. This article describes how the new process works.
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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.
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Enhancing reflective practice through online learning: impact on clinical practice
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
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McCulloh, Russell J; Fouquet, Sarah D; Herigon, Joshua; Biondi, Eric A; Kennedy, Brandan; Kerns, Ellen; DePorre, Adrienne; Markham, Jessica L; Chan, Y Raymond; Nelson, Krista; Newland, Jason G
2018-06-07
Implementing evidence-based practices requires a multi-faceted approach. Electronic clinical decision support (ECDS) tools may encourage evidence-based practice adoption. However, data regarding the role of mobile ECDS tools in pediatrics is scant. Our objective is to describe the development, distribution, and usage patterns of a smartphone-based ECDS tool within a national practice standardization project. We developed a smartphone-based ECDS tool for use in the American Academy of Pediatrics, Value in Inpatient Pediatrics Network project entitled "Reducing Excessive Variation in the Infant Sepsis Evaluation (REVISE)." The mobile application (app), PedsGuide, was developed using evidence-based recommendations created by an interdisciplinary panel. App workflow and content were aligned with clinical benchmarks; app interface was adjusted after usability heuristic review. Usage patterns were measured using Google Analytics. Overall, 3805 users across the United States downloaded PedsGuide from December 1, 2016, to July 31, 2017, leading to 14 256 use sessions (average 3.75 sessions per user). Users engaged in 60 442 screen views, including 37 424 (61.8%) screen views that displayed content related to the REVISE clinical practice benchmarks, including hospital admission appropriateness (26.8%), length of hospitalization (14.6%), and diagnostic testing recommendations (17.0%). Median user touch depth was 5 [IQR 5]. We observed rapid dissemination and in-depth engagement with PedsGuide, demonstrating feasibility for using smartphone-based ECDS tools within national practice improvement projects. ECDS tools may prove valuable in future national practice standardization initiatives. Work should next focus on developing robust analytics to determine ECDS tools' impact on medical decision making, clinical practice, and health outcomes.
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Basu, Sanjay; Landon, Bruce E; Song, Zirui; Bitton, Asaf; Phillips, Russell S
2015-02-01
Primary care practice transformations require tools for policymakers and practice managers to understand the financial implications of workforce and reimbursement changes. To create a simulation model to understand how practice utilization, revenues, and expenses may change in the context of workforce and financing changes. We created a simulation model estimating clinic-level utilization, revenues, and expenses using user-specified or public input data detailing practice staffing levels, salaries and overhead expenditures, patient characteristics, clinic workload, and reimbursements. We assessed whether the model could accurately estimate clinic utilization, revenues, and expenses across the nation using labor compensation, medical expenditure, and reimbursements databases, as well as cost and revenue data from independent practices of varying size. We demonstrated the model's utility in a simulation of how utilization, revenue, and expenses would change after hiring a nurse practitioner (NP) compared with hiring a part-time physician. Modeled practice utilization and revenue closely matched independent national utilization and reimbursement data, disaggregated by patient age, sex, race/ethnicity, insurance status, and ICD diagnostic group; the model was able to estimate independent revenue and cost estimates, with highest accuracy among larger practices. A demonstration analysis revealed that hiring an NP to work independently with a subset of patients diagnosed with diabetes or hypertension could increase net revenues, if NP visits involve limited MD consultation or if NP reimbursement rates increase. A model of utilization, revenue, and expenses in primary care practices may help policymakers and managers understand the implications of workforce and financing changes.
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Cintolo-Gonzalez, Jessica A; Bedada, Alemayehu Ginbo; Morris, Jon; Azzie, Georges
2016-01-01
There is a growing need to address the global burden of surgical disease along with increasing interest in international surgical practice, necessitating an understanding of the challenges and issues that arise on a systems level when practicing abroad. This elective is a month-long rotation in which senior surgical residents participate in patient care as part of a surgical team in the main tertiary and teaching hospital in Gaborone, the capital city of Botswana. Clinical experience is combined with formal readings and educational sessions, with the attending surgeon supervising the program to develop a systems-based curriculum that contextualizes the clinical experience. A formal debriefing and written reflections by the residents at the conclusion of the rotation are used to qualitatively assess resident development and insight into systems-based international surgical practice. Princess Marina Hospital, Gaborone, Botswana. General surgery residents in their fourth clinical year of training. Our elective met important requirements outlined in the literature for foreign practice, including adequate supervision of the American trainees and care to not detract from local trainees' educational experience. Residents' debriefing and written reflections demonstrated an increased understanding of systems-based practice and awareness of issues important to successful international surgical practice and collaboration. Our global surgery elective with a focus on systems-based practice sensitizes residents to the challenges and issues they must be aware of when practicing internationally. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
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A commitment to high-value care education from the internal medicine community.
Smith, Cynthia D; Levinson, Wendy S
2015-05-05
The Alliance for Academic Internal Medicine, American Board of Internal Medicine (ABIM), ABIM Foundation, and American College of Physicians are collaborating to enhance the education of physicians in high-value care (HVC) and make its practice an essential competency in undergraduate and postgraduate education by 2017. This article serves as the organizations' formal commitment to providing a foundation of HVC education on which others may build. The 5 key targets for HVC education are experiential learning and curriculum, environment and culture, clinical support, regulatory requirements, and sustainability. The goal is to train future health care professionals for whom HVC is part of normal practice, thus providing patients with improved clinical outcomes at a lower cost.
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Collaborative communication: learning from advanced clinical practice patient consultations.
Barratt, Julian
2018-04-28
Advanced nurse practitioners, and nurses aspiring to this role, are required to understand how to communicate effectively and on a collaborative basis with patients and carers during consultations, with the aim of enhancing patient outcomes such as improved patient satisfaction, ability to self-manage healthcare needs and adherence to care plans. This article explores collaborative communication in consultations and how best to achieve this, using the author's doctoral observational research based on the findings of a mixed methods observational study of communication in advanced clinical practice patient consultations. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.
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[The realization way and lean management about medical consumable material in clinical use].
Shang, Changhao; Cheng, Junpei; Xu, Hailin; Wang, Xiaoguang
2015-01-01
The medical consumable material management is an important part of logistic support in the management of hospital, but the hospital has many weak links in the management of supplies. This paper aims to explore the common problems (especially in clinical use) existing in the management of medical consumables and years of management experience in Changhai hospital's practice, then discusses lean management from the perspective of lean management
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The medical genetics workforce: an analysis of clinical geneticist subgroups.
Cooksey, Judith A; Forte, Gaetano; Flanagan, Patricia A; Benkendorf, Judith; Blitzer, Miriam G
2006-10-01
Clinical geneticists with a Doctor of Medicine degree face challenges to meet the growing population demand for genetic services. This study was designed to assist the profession with workforce planning by identifying clinically relevant subgroups of geneticists and describing their professional characteristics and clinical practices. Geneticists' patient care productivity is compared across subgroups and other medical specialists. Part of a comprehensive national study of genetic services and the health workforce, this study uses data from a 2003 survey of geneticists certified by the American Board of Medical Genetics. This study includes 610 clinical geneticists who spend at least 5% of their time in direct patient-care services. An iterative approach was used to identify five subgroups based on the types of new patients seen. We conducted a descriptive analysis of subgroups by demographic, training, professional, and practice characteristics. The subgroups include general (36%), pediatric (28%), reproductive (15%), metabolic (14%), and adult (7%) geneticists. Clinically relevant variations across subgroups were noted in training, professional, and practice parameters. Subgroups vary across patient care hours (median, 15-33 hours/week) and total weekly work hours (52-60 hours). New patient visits (mean, 222-900/year) are higher than follow-up patient visits (mean, 155-405) for all subgroups except metabolic geneticists. Although many geneticists practice as generalist geneticists, this study provides an evidence base for distinguishing clinically relevant subgroups of geneticists. Geneticists provide similar numbers of new patient visits and far fewer follow-up visits than other medical specialists. These findings are relevant to geneticist workforce planning.
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Inquimbert, Camille; Tramini, Paul; Alsina, Ivan; Valcarcel, Jean; Giraudeau, Nicolas
2017-10-01
The purpose of this study was to identify the major sources of perceived stress and their relation to a student satisfaction questionnaire about the curriculum and the pedagogy among French dental students. All dental students ( n = 178) from years 4 to 6 at the University of Montpellier (France) participated in this exploratory survey. In spring 2016, a 3-part questionnaire was distributed during clinical sessions: the first part asked about sociodemographic and living conditions, the second part aimed to assess the students' perceived stress (Dental Environmental Stress questionnaire), and the third part was a satisfaction questionnaire exploring the clinical organization and the teaching methodologies (Student Course Experience Questionnaire). A Spearman's correlation test and a principal component analysis were used to assess the relation between the variables of the questionnaire. The response rate was 99.4%. The most stressful items were "the number of tasks to be performed during clinical practice," "the waiting time before opinion from teachers," and "the administrative part and computer problems." Fifty-four percent of the students claimed to be satisfied with their studies, showing a score of seven or higher. There was a negative correlation between the level of student satisfaction and the level of perceived stress. Although most of the students were globally satisfied with their curriculum, this study highlighted dysfunctions in the clinical education with a level of stress correlated with the student's dissatisfaction. Most of all, students found that examinations were too stressful and that the clinical requested task quotas were overestimated.
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Evidence, education and practice.
Kaste, Markku
2006-01-01
Stroke causes greater loss of quality-adjusted life years than any other disease and is also one of the most expensive disorders. The burden of stroke will increase in the future due to change in the age structure of populations. We have a vast body of evidence on how to prevent stroke and how to treat stroke patients. Good examples are treatment of hypertension, antithrombotic agents and carotid surgery in stroke prevention, thrombolysis in ischaemic stroke and stroke unit care for all stroke patients. We only have to translate scientific evidence into daily practice. If some pieces are missing, it is our duty to generate them through research. While taking part in randomized clinical trials (RCTs), the discipline, an essential part of RCTs, will improve the daily care of all stroke patients. Besides RCTs there are many other sources of scientific evidence for stroke management, one of which is the European Stroke Initiative (EUSI). The mission of the EUSI is to improve and optimize stroke management in Europe through education and by offering best practice guidelines. Also national and international societies and organizations play an important role in providing education. The human factor is one obstacle to more successful stroke management because to be more effective we must change our own clinical routine. We can make a difference by applying available evidence to our daily practice. Copyright (c) 2006 S. Karger AG, Basel.
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A Course Model for Teaching Research Evaluation in Colleges of Pharmacy.
ERIC Educational Resources Information Center
Draugalis, JoLaine R.; Slack, Marion K.
1992-01-01
A University of Arizona undergraduate pharmacy course designed to develop student skills in evaluation of research has five parts: introduction to the scientific method; statistical techniques/data analysis review; research design; fundamentals of clinical studies; and practical applications. Prerequisites include biostatistics and drug…
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General medicine and surgery for dental practitioners. Part 5--Psychiatry.
Brown, S; Greenwood, M; Meechan, J G
2010-07-10
There are a significant number of patients in society who have some form of psychiatric disorder. It is important that dental practitioners have an awareness of the more common psychiatric disorders and their potential implications as they are likely to encounter them in clinical practice.
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Development of professional expertise in optometry.
Faucher, Caroline
2011-04-01
Development of professional expertise is the gradual transition from novice to expert within a profession. Studies on expertise in the profession of optometry have never been published. However, many studies have been performed in other health professions (e.g., nursing, medicine, physical therapy, occupational therapy). This report is an overview of the development of professional expertise that will highlight some applications for optometry. A 5-level scale of professional expertise development, divided into 2 parts, is described. The first part is the progression of students during their professional studies (novice, intermediate, competent). The second part is the professional development occurring during the practice years (advanced, expert). Personal and collective efforts are required to foster the progression toward expertise. Great interest for the profession, motivation, and deliberate practice are individual attitudes that help this progression. The "optometric community of practice," by means of university (professional) training, continuing education, and collaboration between colleagues, also contributes to this process. Professional development is an integral part of the Optometric Oath. Each clinical case is a potential learning experience contributing to one's professional development. Optometrists' attitudes are predominant factors in the progression from one level to another. Copyright © 2011 American Optometric Association. Published by Elsevier Inc. All rights reserved.
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A comparative review of clinical governance arrangements in the UK.
Pridmore, Julia Ann; Gammon, John
This article provides a comparative review of the interpretation and implementation of clinical governance frameworks within the four home countries of the UK--England, Northern Ireland, Scotland and Wales. Clinical governance has become one of most significant and important concepts in modern health care. The article considers the policy background and the many definitions of clinical governance, but specifically compares the various strategic and operational approaches to delivery of clinical governance in different parts of the UK. It is suggested that these variations in approach, by each of the four UK countries, can lead to confusion for healthcare professionals in trying to understand, implement and monitor elements of clinical governance in practice.
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Pheochromocytoma in Urologic Practice
Waingankar, Nikhil; Bratslavsky, Gennady; Jimenez, Camilo; Russo, Paul; Kutikov, Alexander
2016-01-01
Context Pheochromocytoma is regularly encountered in urological practice and requires a thoughtful and careful clinical approach. Objective To review clinical aspects of management of pheochromocytoma in urologic practice. Evidence Acquisition A systematic review of English-language literature was performed through year 2015 using the Medline database. Manuscripts were selected with consensus of the coauthors and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. Evidence Synthesis Findings and recommendations of the evaluated manuscripts are discussed with an emphasis on the description of presentation, diagnosis, evaluation, and perioperative care. Conclusion In addition to surgical expertise, appropriate management of pheochromocytoma in urologic practice requires nuanced understanding of pathophysiology, genetics, and endocrinological principles. When skillfully managed, the vast majority of patients with pheochromocytoma should expect an excellent prognosis. Patient Summary In this article we review the clinical approach to patients with pheochromocytoma, a tumor that stems from the innermost part of the adrenal gland and that often secretes excessive amounts of powerful hormones such as noradrenaline and adrenaline. Significant expertise is required to appropriately manage patients with these tumors. Take Home Message In addition to surgical expertise, appropriate management of pheochromocytoma in urologic practice requires nuanced understanding of pathophysiology, genetics, and endocrinological principles. When skillfully managed, vast majority of patients with pheochromocytoma should expect an excellent prognosis. PMID:28078330
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Romero, Lisa M.; Middleton, Dawn; Mueller, Trisha; Avellino, Lia; Hallum-Montes, Rachel
2015-01-01
Purpose The purposes of the study were to describe baseline data in the implementation of evidence-based clinical practices among health center partners as part of a community-wide teen pregnancy prevention initiative and to identify opportunities for health center improvement. Methods Health center partner baseline data were collected in the first year (2011) and before program implementation of a 5-year community-wide teen pregnancy prevention initiative. A needs assessment on health center capacity and implementation of evidence-based clinical practices was administered with 51 health centers partners in 10 communities in the United States with high rates of teen pregnancy. Results Health centers reported inconsistent implementation of evidence-based clinical practices in providing reproductive health services to adolescents. Approximately 94.1% offered same-day appointments, 91.1% had infrastructure to reduce cost barriers, 90.2% offered after-school appointments, and 80.4% prescribed hormonal contraception without prerequisite examinations or testing. Approximately three quarters provided visual and audio privacy in examination rooms (76.5%) and counseling areas (74.5%). Fewer offered a wide range of contraceptive methods (67.8%) and took a sexual health history at every visit (54.9%). Only 45.1% reported Quick Start initiation of hormonal contraception, emergency contraception (43.1%), or intrauterine devices (12.5%) were “always” available to adolescents. Conclusions The assessment highlighted opportunities for health center improvement. Strategies to build capacity of health center partners to implement evidence-based clinical practices may lead to accessibility and quality of reproductive health services for adolescents in the funded communities. PMID:26381918
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Neonatal physical therapy. Part II: Practice frameworks and evidence-based practice guidelines.
Sweeney, Jane K; Heriza, Carolyn B; Blanchard, Yvette; Dusing, Stacey C
2010-01-01
(1) To outline frameworks for neonatal physical therapy based on 3 theoretical models, (2) to describe emerging literature supporting neonatal physical therapy practice, and (3) to identify evidence-based practice recommendations. Three models are presented as a framework for neonatal practice: (1) dynamic systems theory including synactive theory and the theory of neuronal group selection, (2) the International Classification of Functioning, Disability and Health, and (3) family-centered care. Literature is summarized to support neonatal physical therapists in the areas of examination, developmental care, intervention, and parent education. Practice recommendations are offered with levels of evidence identified. Neonatal physical therapy practice has a theoretical and evidence-based structure, and evidence is emerging for selected clinical procedures. Continued research to expand the science of neonatal physical therapy is critical to elevate the evidence and support practice recommendations.
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Kirn, Thomas J.; Westblade, Lars F.; Humphries, Romney
2017-01-01
ABSTRACT As part of the American Society for Microbiology (ASM) Evidence-Based Laboratory Medicine Practice Guidelines Committee of the Professional Practice Committee, an ad hoc committee was formed in 2014 to assess guidelines published by the committee using an assessment tool, Appraisal of Guidelines for Research Evaluation II (AGREE II). The AGREE II assessment helps reviewers determine whether published guidelines are robust, transparent, and clear in presenting practice recommendations in a standardized manner. Identifying strengths and weaknesses of practice guidelines by ad hoc assessments helps with improving future guidelines through the participation of key stakeholders. This minireview describes the development of the ad hoc committee and results from their review of several ASM best practices guidelines and a non-ASM practice guideline from the Emergency Nurses Association. PMID:28835476
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Factor, Elisa Monette R; de Guzman, Allan B
2017-08-01
The role of clinical instructor in student nurses' preparation for the professional nursing practice cannot be underestimated. The extent to which such role is achieved depends highly on the instructors' ability to realize the desired qualities expected of them. While a number of empirical studies have qualitatively explored the attributes of an effective clinical instructor, no attempt has ventured yet on the power of experimental vignettes for conjoint analysis in explicating the preferences of a select group of Filipino student nurses relative to their clinical instructors' attributes. Junior and senior nursing students (n=227), recruited from one of the comprehensive universities in the Philippines, were asked to sort out orthogonal cards generated by Sawtooth Software. As shown, the full-profile conjoint analysis was considerably fit for this study: Pearson's R=0.988, (p<0.05) and Kendall's t=0.944, (p<0.05). Results indicated that the student nurses are one in terms of their most preferred clinical instructor attribute, which was clinical teaching capacity (38.14%) followed by interpersonal relationship and caring behavior (33.17%). In regard to the clinical teaching capability, a clinical instructor who parallels clinical teaching skills with the students' understanding and experience (0.089) was the highest part-worth. As for the interpersonal relationship and caring behavior, the highest part-worth was a clinical instructor who respects a student nurse as an individual and cares about him/her as a person (0.114). Findings of this study can be a basis for clinical instructors as to which qualities to cultivate best to facilitate a first-rate clinical nursing instruction. Likewise, the results of this study can inform current practices of clinical instructors by making them aware of how they can nurture a pedagogical approach consistent with the student nurses' preferences. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Cannell, P J
2012-09-01
A mandatory scheme for clinical audit in the general dental services (GDS) was launched in April 2001. No evaluation of this mandatory scheme exists in the literature. This study provides an evaluation of this scheme. More recently a new dental contract was introduced in the general dental services (GDS) in April 2006. Responsibility for clinical audit activities was devolved to primary care trusts (PCTs) as part of their clinical governance remit. All GDPs within Essex were contacted by letter and invited to participate in the research. A qualitative research method was selected for this evaluation, utilising audio-taped semi-structured research interviews with eight general dental practitioners (GDPs) who had taken part in the GDS clinical audit scheme and who fitted the sampling criteria and strategy. The evaluation focused on dentists' experiences of the scheme. The main findings from the analysis of the GDS scheme data suggest that there is clear evidence of change following audit activities occurring within practices and for the benefit of patients. However, often it is the dentist only that undertakes a clinical audit project rather than the dental team, there is a lack of dissemination of project findings beyond the individual participating practices, very little useful feedback provided to participants who have completed a project and very limited use of formal re-auditing of a particular topic. This study provides evaluation of the GDS clinical audit scheme. Organisations who propose to undertake clinical audit activities in conjunction with dentistry in the future may benefit from incorporating and/or developing some findings from this evaluation into their project design and avoiding others.
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Luo, Ling; Yuan, Cheng-Kai; Yin, Hai-Yan; Zeng, Fang; Tang, Yong; Yu, Shu-Guang
2012-02-01
Standardized Manipulation of Acupuncture and Moxibustion Part 8: Intradermal Needle was compiled with the following principles. The compiling standard, technical features and clinic manipulations of intradermal needle were taken as the basic principle for compiling. Literature research, expert survey and clinic practice verification were applied as the drafting methods. The key issues were focused on the relationship between standardization and individualization, normalization and effectiveness, qualification and quantification. And the postural selection, reinforcing and reducing manipulations, fixing materials and embedding duration involved in intradermal needling were emphasized particularly. At the same time, details and the future way of thinking of intradermal needle were expounded in this article as well.
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The role of pulse oximetry in chiropractic practice: a rationale for its use
Hall, Michael W.; Jensen, Anne M.
2012-01-01
Objective Pulse oximetry is used regularly to assess oxygen saturation levels. The objective of this commentary is to discuss a rationale for using pulse oximetry in chiropractic practice. Discussion Pulse oximetry may offer doctors of chiropractic a way to monitor patients' oxygen saturation levels. Quantification of saturation values with heart rate may give clinical aid to the management of chiropractic patients. Markedly reduced saturation levels may necessitate medical referral, whereas mildly reduced levels could lead to changes in chiropractic management. Conclusions Pulse oximetry has the potential to be an integral part of chiropractic practice. PMID:23204957
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Bose, Ruma
2016-07-01
Parental meaning systems (ethnotheories) constitute a very important part of the context in which children live and develop. Parental ethnotheories are in turn shaped by implicit cultural ideals that organize parental beliefs and actions and frame child-rearing practices. The article presents a qualitative research into Bangladeshi parental ethnotheories in the United Kingdom, which illustrates both the rich cultural meanings that orientate parental action and also demonstrates how parents generate new meanings following migration and culture change. Professional understandings about children's developmental needs, of child rearing and parenting, are not culture free and an examination of the cultural frames of professional theories is important as parenting is often taught as a universal technique that takes little account of the cultural context and of what parents think. An engagement with other cultural theories about child development can enhance critical reflexivity in clinical practice by provoking reflection on the cultural constructions of professional theories. Creating a context for the expression of parental ethnotheories is necessary for developing cross-cultural collaborations in clinical practice as it empowers families and redresses the power relationship between the therapist and the parent. © The Author(s) 2014.
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Physical therapists' perceptions of sexual boundaries in clinical practice in the United States.
Roush, Susan E; Cox, Kenneth; Garlick, John; Kane, Molly; Marchand, Lauren
2015-07-01
Physical therapists' perceptions of sexual boundaries in clinic settings in the United States have not been studied. Given the magnitude of potential consequences of sexual boundary violations, examination of this topic is imperative. The purpose of this study was to describe the perceptions of sexual boundaries among licensed physical therapists in the United States. Licensed physical therapists from Arkansas, Kansas, Maine, Ohio, and Oregon were contacted by email and asked to complete a sexual boundaries questionnaire via Survey Monkey™; 967 surveys (7.3%) were returned. While most physical therapists practice within the profession's Code of Ethics, there are practitioners who date current and former patients, and condone patients' sexual banter in the clinic. Almost half (42%) of the participants acknowledged feeling sexually attracted to a patient. While gender differences were seen throughout the analyses, generally, the demographic and professional variables did not account for meaningful variance. Results were similar to previous research on physiotherapists in other countries. Sexuality is part of the physical therapy practice environment and physical therapists' understanding of sexual boundaries is ambiguous. These data can inform professional conversation on sexual boundaries in physical therapy practice leading to greater understanding and decreased potential for violations.
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Haidari, Mehran; Yared, Marwan; Olano, Juan P; Alexander, C Bruce; Powell, Suzanne Z
2017-02-01
-Previous studies suggest that training in pathology residency programs does not adequately prepare pathology residents to become competent in clinical chemistry. -To define the beliefs of pathology residents in the United States regarding their preparation for practicing clinical chemistry in their career, their attitude toward the discipline, and the attractiveness of clinical chemistry as a career. -The residents of all pathology residency programs in the United States were given the opportunity to participate in an online survey. -Three hundred thirty-six pathology residents responded to the survey. Analysis of the survey results indicates that pathology residents are more likely to believe that their income may be lower if they select a career that has a clinical chemistry focus and that their faculty do not value clinical chemistry as much as the anatomic pathology part of the residency. Residents also report that clinical chemistry is not as enjoyable as anatomic pathology rotations during residency or preferable as a sole career path. A large proportion of residents also believe that they will be slightly prepared or not prepared to practice clinical chemistry by the end of their residency and that they do not have enough background and/or time to learn clinical chemistry during their residency programs to be able to practice this specialty effectively post graduation. -Our survey results suggest that many pathology residents do not have a positive attitude toward clinical chemistry and do not experience a supportive learning environment with an expectation that they will become competent in clinical chemistry with a residency alone.
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Handling Big Data in Modern Healthcare.
Aziz, Hassan A
2016-11-01
The constant growth of medical knowledge and the increases in specialization in clinical practice have created a significant need to share and access patient information with speed and efficiency. However, current technology is centered on processing data, rather than gathering information. To realize the potential of modern technology in improving patient health, merely collecting and storing data are insufficient: one must convert these data into information and knowledge. In this article, I present an overview of 2 recent advances in technology and their assimilation into the practice of medicine, in the attempt to make clinical data meaningful and then to learn from aggregated clinical data. We address the emergence of clinical data warehouses (CDWs) and health information exchanges (HIEs), as features of the Health Information Technology for Economic and Clinical Health (HITECH) Act. This act, enacted in the United States as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. © American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Jackknife variance of the partial area under the empirical receiver operating characteristic curve.
Bandos, Andriy I; Guo, Ben; Gur, David
2017-04-01
Receiver operating characteristic analysis provides an important methodology for assessing traditional (e.g., imaging technologies and clinical practices) and new (e.g., genomic studies, biomarker development) diagnostic problems. The area under the clinically/practically relevant part of the receiver operating characteristic curve (partial area or partial area under the receiver operating characteristic curve) is an important performance index summarizing diagnostic accuracy at multiple operating points (decision thresholds) that are relevant to actual clinical practice. A robust estimate of the partial area under the receiver operating characteristic curve is provided by the area under the corresponding part of the empirical receiver operating characteristic curve. We derive a closed-form expression for the jackknife variance of the partial area under the empirical receiver operating characteristic curve. Using the derived analytical expression, we investigate the differences between the jackknife variance and a conventional variance estimator. The relative properties in finite samples are demonstrated in a simulation study. The developed formula enables an easy way to estimate the variance of the empirical partial area under the receiver operating characteristic curve, thereby substantially reducing the computation burden, and provides important insight into the structure of the variability. We demonstrate that when compared with the conventional approach, the jackknife variance has substantially smaller bias, and leads to a more appropriate type I error rate of the Wald-type test. The use of the jackknife variance is illustrated in the analysis of a data set from a diagnostic imaging study.
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Ahmed, Farooq; Dugdale, Charlotte; Malik, Ovais; Waring, David
2018-03-01
Orthodontic therapists (OTs) are the most recent addition to the orthodontic clinical team. The General Dental Council (GDC) and the British Orthodontic Society have formulated guidance and guidelines relating to their scope of practice and level of supervision, however there has been no contemporary UK-based research investigating practice and supervision of OTs. The aim of this study was to investigate the scope of practice and level of supervision of OTs working in the UK. Ethical approval was received from the University of Manchester Research Ethics Committee. An anonymous postal questionnaire was dispatched using postal details acquired through the British Orthodontic Societies mailing list. Three mailings of the questionnaire were conducted. A 74% response rate was achieved. OTs routinely conducted 16 of the 20 procedures from their scope of practice. Uncommon procedures included fitting headgear (24%), lingual appliances (27%), inserting or removing temporary anchorage devices (20%), and taking facebow record (18%). A total of 62% of OTs took patient consent for treatment. 59% were supervised through a written prescription with no direct supervision. OTs were directly supervised for only a quarter of their clinical practice. Orthodontists viewing frequency for OTs varied significantly, and was found to be the following: every 2-4 visits (36%), every other visit (35%), and every visit (26%). OTs mostly carried out the scope of practice as permitted by the GDC. Procedures uncommon to routine orthodontic practice were also uncommon to Orthodontic therapist clinical practice. OTs work mostly through written prescription with no direct supervision.
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Marx, Wolfgang; Kiss, Nicole; McKavanagh, Daniel; Isenring, Elisabeth
2016-11-01
The aim of this study was to investigate the attitudes, beliefs and behaviors of Australian dietitians regarding dietary supplements. An online survey was disseminated through the mailing lists of multiple healthcare organizations. There were 231 Australian dietitians that replied to the online survey. The results indicate that Australian dietitians are interested in dietary supplements (65%); however, the results also indicate that Australian dietitians are tentative about integrating dietary supplements into their dietetic practice. Concerns regarding potential drug-nutrient/herbal interactions were reported as the primary barrier (67%) to utilizing dietary supplements as part of clinical practice. In addition, there was a strong interest in additional training in dietary supplements (79%). In summary, Australian dietitians are interested in the use of dietary supplements; however, due to current barriers, few dietitians utilize dietary supplements as part of dietetic practice. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Gjengedal, Eva; Moltu, Christian; Råheim, Målfrid
2014-01-01
Health experts advise and expect patients to eat healthily after bariatric surgery. For patients, difficulties with eating might have been a long-standing, problematic part of life—a part that is not necessarily healed by surgery. Empirical research on patients’ experiences of eating practices after bariatric surgery is lacking. Aiming to contribute to the development of clinical practice, we explored meanings attached to eating in the long term and sought descriptions of change and bodily sensations. We interviewed 14 patients at least 5 years after bariatric surgery. The surgical restriction forced changes in the way patients sensed their own body in eating, but the uncertainty related to maintaining weight loss in the long term remained. Meanings attached to eating transcended food as choices situated in a nourishment and health perspective, and were not necessarily changed. Eating was an existential and embodied practice, which remained an ambiguous and sensitive matter after surgery. PMID:25156217
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Medicines optimisation: priorities and challenges.
Kaufman, Gerri
2016-03-23
Medicines optimisation is promoted in a guideline published in 2015 by the National Institute for Health and Care Excellence. Four guiding principles underpin medicines optimisation: aim to understand the patient's experience; ensure evidence-based choice of medicines; ensure medicines use is as safe as possible; and make medicines optimisation part of routine practice. Understanding the patient experience is important to improve adherence to medication regimens. This involves communication, shared decision making and respect for patient preferences. Evidence-based choice of medicines is important for clinical and cost effectiveness. Systems and processes for the reporting of medicines-related safety incidents have to be improved if medicines use is to be as safe as possible. Ensuring safe practice in medicines use when patients are transferred between organisations, and managing the complexities of polypharmacy are imperative. A medicines use review can help to ensure that medicines optimisation forms part of routine practice.
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Guidelines, Algorithms, and Evidence-Based Psychopharmacology Training for Psychiatric Residents
ERIC Educational Resources Information Center
Osser, David N.; Patterson, Robert D.; Levitt, James J.
2005-01-01
Objective: The authors describe a course of instruction for psychiatry residents that attempts to provide the cognitive and informational tools necessary to make scientifically grounded decision making a routine part of clinical practice. Methods: In weekly meetings over two academic years, the course covers the psychopharmacology of various…
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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.…
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Pediatric Oncology Branch - Support Services | Center for Cancer Research
Support Services As part of the comprehensive care provided at the NCI Pediatric Oncology Branch, we provide a wide range of services to address the social, psychological, emotional, and practical facets of pediatric cancer and to support patients and families while they are enrolled in clinical research protocols.
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"I Can Do Better": Exploring Purposeful Improvement in Daily Clinical Work
ERIC Educational Resources Information Center
Mylopoulos, Maria; Farhat, Walid
2015-01-01
Clinicians' purposeful improvement of practice is vital to maintaining excellence in patient care. This activity is understood as a core competency of adaptive expertise. As part of a broader program of research exploring adaptive expertise in healthcare, this study explored purposeful improvement in paediatric minimally invasive surgery. A…
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Health Care Delivery Practices in Huntington's Disease Specialty Clinics: An International Survey.
Frich, Jan C; Rae, Daniela; Roxburgh, Richard; Miedzybrodzka, Zofia H; Edmondson, Mary; Pope, Erika Bjorklund; Goodman, LaVonne; Haddad, Monica S; Giuliano, Joe; Nelson, Eugene C; Guttman, Mark; Nance, Martha
2016-06-27
Little is known about the organization of clinical services for Huntington's disease (HD). To describe how health care services are organized and delivered in HD-clinics taking part in or eligible for the Enroll-HD study. In 2014, a 69-item survey was administered to sites taking part in or eligible for the Enroll-HD study. Of 231 sites surveyed, 121 (52.2%) sites in Europe, North America, Latin America, and Oceania responded. Most sites in the sample serve large populations, with 61.1% serving more than 1.5 million people, and a further 33% serving >500,000. Almost all (86.0%) centers see patients from outside their region. The majority of centers (59.7%) follow 50-199 patients, 21.9% care for more than 200. Most centers provide care in all stages of HD, and nearly all review pre-symptomatic cases. Multidisciplinary case reviews are offered in 54.5% of sites, with outreach clinics offered by 48.1%. Videoconferencing and telemedicine are used by 23.6%. Separate consultations for caregivers are offered in more than half of the centers. Most centers (70.4%) report following published guidelines or local care pathways for HD. Most centers serve a large population and use a multidisciplinary approach. The survey gives insight into factors underpinning HD service delivery globally. There is a need for more in-depth studies of clinical practice to understand how services are organized and how such features may be associated with quality of care.
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Interpretation of medical information acts by UK occupational physicians.
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.
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McKinney, Mark C; Riley, Jeffrey B
2007-12-01
The incidence of heparin resistance during adult cardiac surgery with cardiopulmonary bypass has been reported at 15%-20%. The consistent use of a clinical decision-making algorithm may increase the consistency of patient care and likely reduce the total required heparin dose and other problems associated with heparin dosing. After a directed survey of practicing perfusionists regarding treatment of heparin resistance and a literature search for high-level evidence regarding the diagnosis and treatment of heparin resistance, an evidence-based decision-making algorithm was constructed. The face validity of the algorithm decisive steps and logic was confirmed by a second survey of practicing perfusionists. The algorithm begins with review of the patient history to identify predictors for heparin resistance. The definition for heparin resistance contained in the algorithm is an activated clotting time < 450 seconds with > 450 IU/kg heparin loading dose. Based on the literature, the treatment for heparin resistance used in the algorithm is anti-thrombin III supplement. The algorithm seems to be valid and is supported by high-level evidence and clinician opinion. The next step is a human randomized clinical trial to test the clinical procedure guideline algorithm vs. current standard clinical practice.
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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.
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Dawber, Chris
2013-06-01
This paper outlines an evaluation of reflective practice groups (RPG) involving nurses and midwives from three clinical nursing specialties at Redcliffe and Caboolture Hospitals, Queensland, Australia. The groups were facilitated by the consultation liaison psychiatry nurse and author using a process-focused, whole-of-group approach to explore clinical narrative in a supportive group setting. This was a preliminary evaluation utilizing a recently-developed tool, the Clinical Supervision Evaluation Questionnaire, along with externally-facilitated focus groups. Nurses and midwives responded favourably to RPG, reporting a positive impact on clinical practice, self-awareness, and resilience. The majority of participants considered RPG had positive implications for team functioning. The focus groups identified the importance of facilitation style and the need to address aspects of workplace culture to enable group development and enhance the capacity for reflection. Evaluation of the data indicates this style of RPG can improve reflective thinking, promote team cohesion, and provide support for nurses and midwives working in clinical settings. Following on from this study, a second phase of research has commenced, providing more detailed, longitudinal evaluation across a larger, more diverse group of nurses. © 2012 The Author; International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.
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Cervellin, Gianfranco; Borghi, Loris; Lippi, Giuseppe
2014-08-01
Clinical judgment is a foundation of medical practice and lies at the heart of a physician's knowledge, expertise and skill. Although clinical judgment is an active part of all medical fields, thus including diagnosis and therapy, communication and decision making, it is still poorly defined. It can be considered a synthesis of intuition (mainly based on Gestalt principles) and an analytical approach. Gestalt perception finds its rationale in the evidence that perception of any given object or experience exhibits intrinsic qualities that cannot be completely reduced to visual, auditory, tactile, olfactory, or gustatory components. Thus, perceptions are not constructed in a "bottom-up" fashion from such elements, but are instead globally perceived, in a more "top-down" fashion. Gestalt perception, if cautiously and carefully combined with structured (techno)logical tools, would permit one to defoliate the often too-many-branches built diagnostic trees, and help physicians to better develop their competency. On the other hand, the practice of evidence-based medicine lies in the integration of individual clinical expertise and judgment with the best available external clinical evidence from systematic research. This article is aimed at providing some general concepts about Gestalt perception, and to discuss some aspects of clinical practice potentially influenced by this approach.
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Dell’Osso, Bernardo; Albert, Umberto; Atti, Anna Rita; Carmassi, Claudia; Carrà, Giuseppe; Cosci, Fiammetta; Del Vecchio, Valeria; Di Nicola, Marco; Ferrari, Silvia; Goracci, Arianna; Iasevoli, Felice; Luciano, Mario; Martinotti, Giovanni; Nanni, Maria Giulia; Nivoli, Alessandra; Pinna, Federica; Poloni, Nicola; Pompili, Maurizio; Sampogna, Gaia; Tarricone, Ilaria; Tosato, Sarah; Volpe, Umberto; Fiorillo, Andrea
2015-01-01
More than half a century after their discovery, benzodiazepines (BDZs) still represent one of the largest and most widely prescribed groups of psychotropic compounds, not only in clinical psychiatry but also in the entire medical field. Over the last two decades, however, there has been an increased focus on the development of antidepressants and antipsychotics on the part of the pharmaceutical industry, clinicians, and researchers, with a reduced interest in BDZs, in spite of their widespread clinical use. As a consequence, many psychiatric residents, medical students, nurses, and other mental health professionals might receive poor academic teaching and training regarding these agents, and have the false impression that BDZs represent an outdated chapter in clinical psychopharmacology. However, recent advances in the field, including findings concerning epidemiology, addiction risk, and drug interactions, as well as the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with related diagnostic changes, strongly encourage an updated appraisal of the use of BDZs in clinical practice. During a recent thematic event convened with the aim of approaching this topic in a critical manner, a group of young Italian psychiatrists attempted to highlight possible flaws in current teaching pathways, identify the main clinical pros and cons regarding current use of BDZs in clinical practice, and provide an updated overview of their use across specific clinical areas and patient populations. The main results are presented and discussed in this review. PMID:26257524
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[Education in our time: competency or aptitude? The case for medicine. Part II].
Viniegra-Velázquez, Leonardo
Part II is focused on participatory education (PE), a distinctive way to understand and practice education in contrast to passive education. The core of PE is to develop everyone's own cognitive potentialities frequently mutilated, neglected or ignored. Epistemological and experiential basis of PE are defined: the concept of incisive and creative criticism, the idea of knowledge as each person's own construct and life experience as the main focus of reflection and cognition. The PE aims towards individuals with unprecedented cognitive and creative faculties, capable of approaching a more inclusive and hospitable world. The last part criticizes the fact that medical education has remained among the passive education paradigm. The key role of cognitive aptitudes, both methodological and practical (clinical aptitude), in the progress of medical education and practice is emphasized. As a conclusion, the knowhow of education is discussed, aiming towards a better world away from human and planetary degradation. Copyright © 2017 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.
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Developing person-centred practice in hip fracture care for older people.
Christie, Jane; Macmillan, Maureen; Currie, Colin; Matthews-Smith, Gerardine
2016-12-14
To facilitate a multidisciplinary collaborative approach to developing person-centred practice in hip fracture care for older people. Collaborative inquiry, a form of action research, was used to collect data for this study. It involved exploration of dilemmas, questions and problems that are part of human experience. Clinical leaders from different disciplines (n=16), who work with older people with hip fractures at different stages of the care pathway, participated in a series of facilitated action meetings. The practice development techniques used in this study included: identifying the strengths and limitations of the current service, values clarification, creating a shared vision, sharing clinical stories, reviewing case records, and reflecting on the experiences of three older people and two caregivers. Hip fracture care was based on meeting service targets, national guidelines and audits. Care was fragmented across different service delivery units, with professional groups working independently. This resulted in suboptimal communication between members of the multidisciplinary group of clinical leaders and care that was process-driven rather than person-centred. Spending time away from clinical practice enabled the multidisciplinary group to collaborate to understand care from the patients' and caregivers' perspectives, and to reflect critically on the care experience as a whole. To develop a person-centred workplace culture, the multidisciplinary team requires facilitated time for reflection. Ongoing facilitative leadership would enable the multidisciplinary team to collaborate effectively to deliver safe, effective person-centred practice in hip fracture care for older people.
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Perspectives on specialist nursing in Saudi Arabia: a national model for success.
Hibbert, Denise; Al-Sanea, Nasser A; Balens, Julie A
2012-01-01
In many parts of the world, vulnerable patient populations may be cared for by a clinical nurse specialist (CNS). Nurses desiring to develop themselves professionally in the clinical arena, within the specialty of their choice, have the opportunity to obtain the knowledge, skills, experience and qualifications necessary to attain advanced practice positions such as CNS or nurse consultant (NC). Although studies have demonstrated the benefits of such roles and while the World Health Organization (WHO) recommends it, advanced nursing practice is not yet integrated into the health care culture in Saudi Arabia. The reasons for this are multiple, but the most important is the poor image of clinical nursing throughout the country. This article aims to share a perspective on CNS practice, while casting light on some of the obstacles encountered within Saudi Arabia. A model is proposed representing specialist nurse-physician collaborative practice for implementation nationally. The model has been implemented in the care of the colorectal and stoma patient populations while taking into consideration patient population needs and local health care culture. This model is based on the concepts of holistic "patient-centered care", specialist nurse-physician collaborative practice, and the four practice domains for NCs (expert practice, leadership, research and education) as indicated by the Department of Health in the United Kingdom. We suggest this model will enable the introduction of advanced specialist nursing and collaborative partnerships in Saudi Arabia with benefits for patients, physicians, health care organizations and the nursing profession as a whole.
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Stamatakis, Emmanuel; Weiler, Richard; Ioannidis, John P A
2013-05-01
Expenditure on industry products (mostly drugs and devices) has spiraled over the last 15 years and accounts for substantial part of healthcare expenditure. The enormous financial interests involved in the development and marketing of drugs and devices may have given excessive power to these industries to influence medical research, policy, and practice. Review of the literature and analysis of the multiple pathways through which the industry has directly or indirectly infiltrated the broader healthcare systems. We present the analysis of the industry influences at the following levels: (i) evidence base production, (ii) evidence synthesis, (iii) understanding of safety and harms issues, (iv) cost-effectiveness evaluation, (v) clinical practice guidelines formation, (vi) healthcare professional education, (vii) healthcare practice, (viii) healthcare consumer's decisions. We located abundance of consistent evidence demonstrating that the industry has created means to intervene in all steps of the processes that determine healthcare research, strategy, expenditure, practice and education. As a result of these interferences, the benefits of drugs and other products are often exaggerated and their potential harms are downplayed, and clinical guidelines, medical practice, and healthcare expenditure decisions are biased. To serve its interests, the industry masterfully influences evidence base production, evidence synthesis, understanding of harms issues, cost-effectiveness evaluations, clinical practice guidelines and healthcare professional education and also exerts direct influences on professional decisions and health consumers. There is an urgent need for regulation and other action towards redefining the mission of medicine towards a more objective and patient-, population- and society-benefit direction that is free from conflict of interests. © 2013 Stichting European Society for Clinical Investigation Journal Foundation. Published by Blackwell Publishing Ltd.
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www.mydrugdealer.com: Ethics and legal implications of Internet-based access to substances of abuse.
Klein, Carolina A; Kandel, Surendra
2011-01-01
The Internet has increasingly become an intrinsic part of everyday life, offering countless possibilities for education, services, recreation, and more. In fact, an entire virtual life within the digitalized World Wide Web is possible and common among many Internet users. Today's psychiatrists must therefore incorporate this dimension of human life into clinical practice, to achieve an adequate assessment of the tools and risks available to the patient. We focus on the Internet as a portal for the trade of and access to substances of abuse. We review the legal regulations that may inform care and standards of practice and analyze the difficulties that arise in assessment and monitoring of the current situation. We consider the potential impact of Internet-based narcotics trade on addiction morbidities and the practice of clinical psychiatry, as well as on the potential legal implications that the forensic expert may face.
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Hospital culture--why create one?
Sovie, M D
1993-01-01
Hospitals, to survive, must be transformed into responsive, participative organizations capable of new practices that produce improved results in both quality of care and service at reduced costs. Creating, managing, and changing the culture are critical leadership functions that will enable the hospital to succeed. Strategic planning and effective implementation of planned change will produce the desired culture. Work restructuring, a focus on quality management along with changes in clinical practices, as well as the care and support processes, are all a part of the necessary hospital cultural revolution.
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Introduction to Genetics and Childhood Obesity: Relevance to Nursing Practice
Seal, Nuananong
2013-01-01
Purpose The aims for this article are to provide an overview of the current state of research on genetic contributions to the development of childhood obesity and to suggest genetic-focused nursing practices to prevent childhood obesity. Organizing Constructs Genetic epidemiology of childhood obesity, modes to identifying obesity genes, types of human obesity genes, and nursing implications are discussed. Clinical Relevance The successful integration of genetics into nursing practice will provide opportunities for nurses to participate fully as major agents and collaborators in the health care revolution. Conclusions Practicing nurses across the profession will need to become knowledgeable about genetics and take part in obesity prevention through genetic assessment of susceptibility and appropriate environmental interventions. PMID:20798151
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Gupta, Anjali; Calfas, Karen J.; Marshall, Simon J.; Robinson, Thomas N.; Rock, Cheryl L.; Huang, Jeannie S.; Epstein-Corbin, Melanie; Servetas, Christina; Donohue, Michael C.; Norman, Gregory J.; Raab, Fredric; Merchant, Gina; Fowler, James H.; Griswold, William G.; Fogg, B.J.; Patrick, Kevin
2015-01-01
Advances in information technology and near ubiquity of the Internet have spawned novel modes of communication and unprecedented insights into human behavior via the digital footprint. Health behavior randomized controlled trials (RCTs), especially technology-based, can leverage these advances to improve the overall clinical trials management process and benefit from improvements at every stage, from recruitment and enrollment to engagement and retention. In this paper, we report the results for recruitment and retention of participants in the SMART study and introduce a new model for clinical trials management that is a result of interdisciplinary team science. The MARKIT model brings together best practices from information technology, marketing, and clinical research into a single framework to maximize efforts for recruitment, enrollment, engagement, and retention of participants into a RCT. These practices may have contributed to the study’s on-time recruitment that was within budget, 86% retention at 24 months, and a minimum of 57% engagement with the intervention over the 2-year RCT. Use of technology in combination with marketing practices may enable investigators to reach a larger and more diverse community of participants to take part in technology-based clinical trials, help maximize limited resources, and lead to more cost-effective and efficient clinical trial management of study participants as modes of communication evolve among the target population of participants. PMID:25866383
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Optimal Pain Assessment in Pediatric Rehabilitation: Implementation of a Nursing Guideline.
Kingsnorth, Shauna; Joachimides, Nick; Krog, Kim; Davies, Barbara; Higuchi, Kathryn Smith
2015-12-01
In Ontario, Canada, the Registered Nurses' Association promotes a Best Practice Spotlight Organization initiative to enhance evidence-based practice. Qualifying organizations are required to implement strategies, evaluate outcomes, and sustain practices aligned with nursing clinical practice guidelines. This study reports on the development and evaluation of a multifaceted implementation strategy to support adoption of a nursing clinical practice guideline on the assessment and management of acute pain in a pediatric rehabilitation and complex continuing care hospital. Multiple approaches were employed to influence behavior, attitudes, and awareness around optimal pain practice (e.g., instructional resources, electronic reminders, audits, and feedback). Four measures were introduced to assess pain in communicating and noncommunicating children as part of a campaign to treat pain as the fifth vital sign. A prospective repeated measures design examined survey and audit data to assess practice aligned with the guideline. The Knowledge and Attitudes Survey (KNAS) was adapted to ensure relevance to the local practice setting and was assessed before and after nurses' participation in three education modules. Audit data included client demographics and pain scores assessed annually over a 3-year window. A final sample of 69 nurses (78% response rate) provided pre-/post-survey data. A total of 108 pediatric surgical clients (younger than 19 years) contributed audit data across the three collection cycles. Significant improvements in nurses' knowledge, attitudes, and behaviors related to optimal pain care for children with disabilities were noted following adoption of the pain clinical practice guideline. Targeted guideline implementation strategies are central to supporting optimal pain practice. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
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Terror management theory applied clinically: implications for existential-integrative psychotherapy.
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.
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Pay attention! The critical importance of assessing attention in older adults with dementia.
Kolanowski, Ann M; Fick, Donna M; Yevchak, Andrea M; Hill, Nikki L; Mulhall, Paula M; McDowell, Jane A
2012-11-01
Attention is an important cognitive domain that is affected in Alzheimer's disease and other dementias. It influences performance in most other cognitive domains, as well as activities of daily living. Nurses are often unaware of the critical importance of assessing attention as part of the overall mental status examination. This article addresses an important gap in nurses' knowledge. The authors present a brief overview of attention as a critical cognitive domain in dementia; review instruments/methods for standardizing and enhancing the assessment of attention; and offer ways to help ensure that best practices in the assessment, recognition, and documentation of inattention are implemented in the clinical area. Clinical resources that practicing nurses may find helpful are included. Copyright 2012, SLACK Incorporated.
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Practice management for academic dermatology departments.
Eaglstein, W H
2000-09-01
Practice management in the academic medical center (AMC) is different than in other environments. Practice is only a part of the practitioner's mission within an AMC. Practice revenue will be subject to a tax or overhead by both the school and the department. Contract and practice guidelines cannot be tailored to the needs of the dermatology practice, because contracts and guidelines are negotiated globally for all of the practices within the AMC. Personnel, on which the practice depends, may report to hospitals and clinics rather than to the practice's management. Even control of the practice's manager may be diluted by a dual or "dotted line" reporting relationship between the department manager and the school practice manager. Although more constraints exist within the AMC, there are some strategic and operational choices that affect a practice's success. Among these are: (1) selection of services offered; (2) creation of satellites; (3) stimulation of faculty effort; (4) enhancement of faculty billing knowledge; and (5) creation of a "tie" between staff and the practice.
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Perraton, L; Machotka, Z; Gibbs, C; Mahar, C; Kennedy, K; Grimmer, K
2017-07-01
Assisting physiotherapists to implement research evidence into clinical practice is essential to ensure the quality of practice and encourage lifelong learning and professional progression. However, many physiotherapists report barriers to implementing research, and there is little evidence regarding the sustainability of intended evidence-based practice (EBP) behaviours following EBP education programmes. This paper reports on intended and actual long-term EBP behaviours of physiotherapy students who completed an intensive EBP training programme embedded within a post-graduate coursework programme. An intensive 3-week course in quantitative health research methods and EBP was delivered annually from 2007 to 2014 as part of the programme to national and international students. Following the course, students were asked about their intention of using evidence to inform their future clinical practice. An online survey was used to evaluate EBP behaviours of graduates. Of a possible total of 202 students, contact details for 193 students were sourced, and 65 students responded to the survey (34% response rate). At course completion, 174 students (86%) indicated that they intended to use research to guide their clinical decisions at least once a week. At follow-up, most graduates reported frequently using research to inform their clinical practice; indicated by a mean score of 6.5 (±1.9) from a possible range of 0 (not at all) to 10 (all the time). On average, students reported spending 2.2 (±2.2) hours accessing and reading research evidence per week. The most common barriers to implementing evidence were lack of time, limited access to evidence sources and a perceived lack of generalizability of research findings to specific patient groups. Graduates of an intensive EBP training programme embedded within an existing post-graduate physiotherapy programme regularly implemented EBP in clinical practice. Barriers to evidence implementation were time, access to research and perceived lack of generalizability of research findings. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
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Tjoflåt, I; Karlsen, B
2013-12-01
This paper, based on the experience of the first author as an expatriate nurse, aims to describe and discuss some aspects of collaboration that contributed to the building of clinical practice when implementing an operating theatre programme in the Palestine Red Crescent Society (PRCS) hospitals in Lebanon. The operation theatre programme lasted for 8 months: 6 months in 2008 and 2 months in 2009. The programme was part of the partnership project 'Quality of care in the five PRCS hospitals in Lebanon' between the International Committee of the Red Cross and the PRCS Lebanon (PRCS-L) branch. The essential aspects that may have contributed to the building of clinical practice in the operation theatre programme included the expatriate nurse and the Palestine Red Crescent operating theatre nurses working together over time as colleagues, the socio-cultural pedagogic perspective selected for the implementation and the collaboration with the management of the hospitals and counterparts in the PRCS-L branch. One should also note the human and structural issues that seemed to influence the implementation of the programme in a more negative way. This experience may provide insight for other nurses into the importance of working as colleagues, selecting an appropriate pedagogic perspective and establishing productive collaboration with all partners when building clinical practice during a humanitarian mission. © 2013 International Council of Nurses.
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Johnson, T
2010-12-01
Thoracic epidural catheter placement is an example of a demanding and high-risk clinical skill that junior anaesthetists need to learn by experience and under the supervision of consultants. This learning is known to present challenges that require further study. Ten consultant and 10 trainee anaesthetists in a teaching hospital were interviewed about teaching and learning this skill in the operating theatre, and a phenomenological analysis of their experience was performed. Trainee participation was limited by time pressure, lack of familiarity with consultants, and consultants' own need for clinical experience. There was a particular tension between safe and effective consultant practice and permitting trainees' independence. Three distinct stages of participation and assistance were identified from reports of ideal practice: early (part-task or basic procedure, consultant always present giving instruction and feedback), middle (independent practice with straightforward cases without further instruction), and late (skill extension and transfer). Learning assistance provided by consultants varied, but it was often not matched to the trainees' stages of learning. Negotiation of participation and assistance was recognized as being useful, but it did not happen routinely. There are many obstacles to trainees' participation in thoracic epidural catheter insertion, and learning assistance is not matched to need. A more explicit understanding of stages of learning is required to benefit the learning of this and other advanced clinical skills.
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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.
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Principles and practice of external digital photography in ophthalmology
Mukherjee, Bipasha; Nair, Akshay Gopinathan
2012-01-01
It is mandatory to incorporate clinical photography in an ophthalmic practice. Patient photographs are routinely used in teaching, presentations, documenting surgical outcomes and marketing. Standardized clinical photographs are part of an armamentarium for any ophthalmologist interested in enhancing his or her practice. Unfortunately, many clinicians still avoid taking patient photographs for want of basic knowledge or inclination. The ubiquitous presence of the digital camera and digital technology has made it extremely easy and affordable to take high-quality images. It is not compulsory to employ a professional photographer or invest in expensive equipment any longer for this purpose. Any ophthalmologist should be able to take clinical photographs in his/her office settings with minimal technical skill. The purpose of this article is to provide an ophthalmic surgeon with guidelines to achieve standardized photographic views for specific procedures, to achieve consistency, to help in pre-operative planning and to produce accurate pre-operative and post-operative comparisons, which will aid in self-improvement, patient education, medicolegal documentation and publications. This review also discusses editing, storage, patient consent, medicolegal issues and importance of maintenance of patient confidentiality. PMID:22446907
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Todd, Christopher A; Sanchez, Ana M; Garcia, Ambrosia; Denny, Thomas N; Sarzotti-Kelsoe, Marcella
2014-07-01
The EQAPOL contract was awarded to Duke University to develop and manage global proficiency testing programs for flow cytometry-, ELISpot-, and Luminex bead-based assays (cytokine analytes), as well as create a genetically diverse panel of HIV-1 viral cultures to be made available to National Institutes of Health (NIH) researchers. As a part of this contract, EQAPOL was required to operate under Good Clinical Laboratory Practices (GCLP) that are traditionally used for laboratories conducting endpoint assays for human clinical trials. EQAPOL adapted these guidelines to the management of proficiency testing programs while simultaneously incorporating aspects of ISO/IEC 17043 which are specifically designed for external proficiency management. Over the first two years of the contract, the EQAPOL Oversight Laboratories received training, developed standard operating procedures and quality management practices, implemented strict quality control procedures for equipment, reagents, and documentation, and received audits from the EQAPOL Central Quality Assurance Unit. GCLP programs, such as EQAPOL, strengthen a laboratory's ability to perform critical assays and provide quality assessments of future potential vaccines. © 2013.
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Ask about ice, then consider iron
Rabel, Antoinette; Leitman, Susan F.; Miller, Jeffery L.
2015-01-01
Background and purpose To review a condition defined by the desire to consume ice in order to satisfy an addictive-like compulsion, rather than for purposes of hydration or pain relief. This condition is called ice pica, or pagophagia. Explain the association between ice pica and iron deficiency. Suggest to clinicians how to perform clinical screening for patients at risk for ice pica. Recommend treatment and follow-up care, if needed. Methods Extensive published literature review of original research articles, reviews, clinical practice manuscripts and scientific publications on pica and pagophagia. Conclusions A compulsion or craving for the consumption of ice is often overlooked in clinical practice. It is therefore important for clinicians to include ice pica as part of the review of systems for certain patient populations. Ice pica is frequently associated with iron deficiency, and iron supplementation is an effective therapy in most cases. Implications for practice Knowledge gained from screening for ice pica can generate valuable patient information and lead to the diagnosis and treatment of iron deficiency. The populations at risk include young women and blood donors of either sex. PMID:25943566
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Principles and practice of external digital photography in ophthalmology.
Mukherjee, Bipasha; Nair, Akshay Gopinathan
2012-01-01
It is mandatory to incorporate clinical photography in an ophthalmic practice. Patient photographs are routinely used in teaching, presentations, documenting surgical outcomes and marketing. Standardized clinical photographs are part of an armamentarium for any ophthalmologist interested in enhancing his or her practice. Unfortunately, many clinicians still avoid taking patient photographs for want of basic knowledge or inclination. The ubiquitous presence of the digital camera and digital technology has made it extremely easy and affordable to take high-quality images. It is not compulsory to employ a professional photographer or invest in expensive equipment any longer for this purpose. Any ophthalmologist should be able to take clinical photographs in his/her office settings with minimal technical skill. The purpose of this article is to provide an ophthalmic surgeon with guidelines to achieve standardized photographic views for specific procedures, to achieve consistency, to help in pre-operative planning and to produce accurate pre-operative and post-operative comparisons, which will aid in self-improvement, patient education, medicolegal documentation and publications. This review also discusses editing, storage, patient consent, medicolegal issues and importance of maintenance of patient confidentiality.
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Establishing an endovascular carotid stent program.
Raabe, Rod; Chong, Brian
2004-12-01
FDA approval of carotid stent and distal protection devices has transformed carotid artery stenting (CAS) from an investigational procedure to a practical application. Recent approval by the Center for Medicare Services (CMS) has ensured that CAS will be a part of everyday practice throughout the country. To establish a competitive endovascular carotid stent program, one needs to develop an effective strategy. The key to success is substance and service. A high-quality clinical program with excellent communication between the patient and referring physician is essential. You must first get access to the patient by establishing a clinical practice. As a radiologist, you have the advantage of gaining access by identifying appropriate patients through noninvasive vascular labs, CTA, and MRA. An algorithm-driven evaluation and treatment protocol with good pre- and postoperative care, along with a quality assurance program, will ensure that your carotid stent program has substance and delivers optimal service. With good planning, you will have a firm clinical foundation for treatment of carotid artery stenosis in your community. Putting all of the ingredients together will ensure a successful carotid endovascular program.
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Interdisciplinary rural immersion week.
Deutchman, Mark E; Nearing, Kathryn; Baumgarten, Brenda; Westfall, John M
2012-01-01
Health professions students interested in future rural practice locations spend a week learning about and investigating all aspects of small town personal, professional and community life. This augments the mainly clinical experience provided by clinical rotations they complete as part of their professional academic training program. Students from professional programs in medicine, physician assistant, pharmacy, nursing, public health and psychology travel to a small community, receive an orientation and in small interprofessional groups investigate health care, education, government, law enforcement, public health, economy and natural resources. Participants report that the experience raises their interest in future rural practice, answers questions they have about rural life and enhances their understanding of the issues they must learn more about before making a career location choice. The interdisciplinary rural immersion program provides students with the time, structure and permission to move out of their clinical 'comfort zone' and think about the cultural, economic and environmental aspects of rural life and work.
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Berry, Andrew B.L.; Lim, Catherine; Hartzler, Andrea L.; Hirsch, Tad; Ludman, Evette; Wagner, Edward H.; Ralston, James D.
2017-01-01
Eliciting, understanding, and honoring patients’ values— the things most important to them in daily life—is a cornerstone of patient-centered care. However, this rarely occurs explicitly as a routine part of clinical practice. This is particularly problematic for individuals with multiple chronic conditions (MCC) because they face difficult choices about how to balance competing demands for self-care in accordance with their values. In this study, we sought to inform the design of interventions to support conversations about patient values between patients with MCC and their health care providers. We conducted a field study that included observations of 21 clinic visits for patients who have MCC, and interviews with 16 care team members involved in those visits. This paper contributes a practice-based account of ways in which providers engage with patient values, and discusses how future work in interactive systems design might extend and enrich these engagements. PMID:28890950
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Evaluation of ConPrim: A three-part model for continuing education in primary health care.
Berggren, Erika; Strang, Peter; Orrevall, Ylva; Ödlund Olin, Ann; Sandelowsky, Hanna; Törnkvist, Lena
2016-11-01
To overcome the gap between existing knowledge and the application of this knowledge in practice, a three-part continuing educational model for primary health care professionals (ConPrim) was developed. It includes a web-based program, a practical exercise and a case seminar. To evaluate professionals' perceptions of the design, pedagogy and adaptation to primary health care of the ConPrim continuing educational model as applied in a subject-specific intervention. A total of 67 professionals (nurses and physicians) completed a computer-based questionnaire evaluating the model's design, pedagogy and adaptation to primary health care one week after the intervention. Descriptive statistics were used. Over 90% found the design of the web-based program and case seminar attractive; 86% found the design of the practical exercise attractive. The professionals agreed that the time spent on two of the three parts was acceptable. The exception was the practical exercise: 32% did not fully agree. Approximately 90% agreed that the contents of all parts were relevant to their work and promoted interactive and interprofessional learning. In response to the statements about the intervention as whole, approximately 90% agreed that the intervention was suitable to primary health care, that it had increased their competence in the subject area, and that they would be able to use what they had learned in their work. ConPrim is a promising model for continuing educational interventions in primary health care. However, the time spent on the practical exercise should be adjusted and the instructions for the exercise clarified. ConPrim should be tested in other subject-specific interventions and its influence on clinical practice should be evaluated. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Nachamkin, Irving; Kirn, Thomas J; Westblade, Lars F; Humphries, Romney
2017-11-01
As part of the American Society for Microbiology (ASM) Evidence-Based Laboratory Medicine Practice Guidelines Committee of the Professional Practice Committee, an ad hoc committee was formed in 2014 to assess guidelines published by the committee using an assessment tool, Appraisal of Guidelines for Research Evaluation II (AGREE II). The AGREE II assessment helps reviewers determine whether published guidelines are robust, transparent, and clear in presenting practice recommendations in a standardized manner. Identifying strengths and weaknesses of practice guidelines by ad hoc assessments helps with improving future guidelines through the participation of key stakeholders. This minireview describes the development of the ad hoc committee and results from their review of several ASM best practices guidelines and a non-ASM practice guideline from the Emergency Nurses Association. Copyright © 2017 American Society for Microbiology.
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Huang, Jeannie S; Chun, Stanford; Sandhu, Amanpreet; Terrones, Laura
2013-11-01
To assess the Health and Obesity: Prevention and Education (HOPE) Curriculum Project, a web-based clinician education program that promotes appropriate screening, prevention, and management of weight among youth by pediatric practitioners, based on the 2007 Expert Committee recommendations. The project currently provides Maintenance of Certification (MOC) Part 4 credit through the American Board of Pediatrics. Participants identified themselves to the HOPE MOC Part 4 program. Enrollees were required to complete all continuing medical education modules (10.5 hours). Knowledge acquisition and self-reported confidence levels related to screening, prevention, and management practices of pediatric obesity were measured using preknowledge and postknowledge questionnaires. Participants were also required to perform a quality improvement project and submit practice performance data from repeated medical chart reviews over time. Knowledge acquisition, self-efficacy, and practice performance data were analyzed using repeated-measures analyses. The 51 participants demonstrated significant improvements in knowledge acquisition and self-efficacy scores after viewing individual modules. In addition, participants demonstrated significant improvements in measured clinical compliance with recommended practices over time. Participation in the HOPE MOC Part 4 program appeared to improve knowledge acquisition, self-efficacy, and physician compliance with recommended practice recommendations for the screening, prevention, and management of pediatric obesity. Further data are required to determine whether such practice-based improvements translate into actual reduction in patient weight and/or reduction in health-related costs related to overweight and obesity in youth. Copyright © 2013 Mosby, Inc. All rights reserved.
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2011-11-28
This final rule with comment period addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It also addresses, implements or discusses certain statutory provisions including provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. In addition, this final rule with comment period discusses payments for Part B drugs; Clinical Laboratory Fee Schedule: Signature on Requisition; Physician Quality Reporting System; the Electronic Prescribing (eRx) Incentive Program; the Physician Resource-Use Feedback Program and the value modifier; productivity adjustment for ambulatory surgical center payment system and the ambulance, clinical laboratory, and durable medical equipment prosthetics orthotics and supplies (DMEPOS) fee schedules; and other Part B related issues.
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Kelly, Martina; Bennett, Deirdre; O'Flynn, Siun
2012-01-01
The clinical learning environment is changing. General practice placements are now a fundamental part of undergraduate medical education. There is growing recognition that changes in hospital work practices are altering the breadth of exposure available to students. Surprisingly little work has been done comparing the quality of clinical placements between the hospital and community using validated tools. Such comparisons inform curriculum planning and resource allocation. The aim of this study was to compare the quality of the educational environment experienced by junior medical students during hospital and general practice placements using a widely used tool. Following the introduction of a new integrated curriculum, all Year 3 students (n=108) completed a standardised evaluation instrument, the Dundee Ready Education Environment Measure (DREEM) at the end of each of their clinical attachments (two different hospital sites and one in general practice), giving a total of 324 questionnaires. All forms were analysed and input into Graphpad INSTAT version 3. Total DREEM scores as well as subscale scores were calculated for each site. These were compared across sites using a Mann-Whitney U non-parametric test. By comparison with international standards, clinical attachments in our new integrated curriculum were rated highly. In particular, attachments in general practice scored highly with a mean score of 156.6 and perform significantly better (P < 0.01) when compared with the mean score for hospital rotations of 149.0. Significant differences between general practice and hospital rotations exist in the domains of students' perceptions of atmosphere and students' social self-perceptions. Finally, significant differences also emerged in students' perceptions of teachers in general practice when compared to those in the hospital setting. These findings provide evidence of the high-quality educational environment afforded students in primary care. They challenge the traditional emphasis on hospital-based teaching and preempt the question - Is the community a better place for junior students to learn?
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Inquimbert, Camille; Tramini, Paul; Alsina, Ivan; Valcarcel, Jean; Giraudeau, Nicolas
2017-01-01
Objectives: The purpose of this study was to identify the major sources of perceived stress and their relation to a student satisfaction questionnaire about the curriculum and the pedagogy among French dental students. Materials and Methods: All dental students (n = 178) from years 4 to 6 at the University of Montpellier (France) participated in this exploratory survey. In spring 2016, a 3-part questionnaire was distributed during clinical sessions: the first part asked about sociodemographic and living conditions, the second part aimed to assess the students' perceived stress (Dental Environmental Stress questionnaire), and the third part was a satisfaction questionnaire exploring the clinical organization and the teaching methodologies (Student Course Experience Questionnaire). A Spearman's correlation test and a principal component analysis were used to assess the relation between the variables of the questionnaire. Results: The response rate was 99.4%. The most stressful items were “the number of tasks to be performed during clinical practice,” “the waiting time before opinion from teachers,” and “the administrative part and computer problems.” Fifty-four percent of the students claimed to be satisfied with their studies, showing a score of seven or higher. There was a negative correlation between the level of student satisfaction and the level of perceived stress. Conclusion: Although most of the students were globally satisfied with their curriculum, this study highlighted dysfunctions in the clinical education with a level of stress correlated with the student's dissatisfaction. Most of all, students found that examinations were too stressful and that the clinical requested task quotas were overestimated. PMID:29184835
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Specialist outreach clinics in primary care and rural hospital settings.
Gruen, R L; Weeramanthri, T S; Knight, S E; Bailie, R S
2004-01-01
Specialist medical practitioners have conducted clinics in primary care and rural hospital settings for a variety of reasons in many different countries. Such clinics have been regarded as an important policy option for increasing the accessibility and effectiveness of specialist services and their integration with primary care services. To undertake a descriptive overview of studies of specialist outreach clinics and to assess the effectiveness of specialist outreach clinics on access, quality, health outcomes, patient satisfaction, use of services, and costs. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) specialised register (March 2002), the Cochrane Controlled Trials Register (CCTR) (Cochrane Library Issue 1, 2002), MEDLINE (including HealthStar) (1966 to May 2002), EMBASE (1988 to March 2002), CINAHL (1982 to March 2002), the Primary-Secondary Care Database previously maintained by the Centre for Primary Care Research in the Department of General Practice at the University of Manchester, a collection of studies from the UK collated in "Specialist Outreach Clinics in General Practice" (Roland 1998), and the reference lists of all retrieved articles. Randomised trials, controlled before and after studies and interrupted time series analyses of visiting specialist outreach clinics in primary care or rural hospital settings, either providing simple consultations or as part of complex multifaceted interventions. The participants were patients, specialists, and primary care providers. The outcomes included objective measures of access, quality, health outcomes, satisfaction, service use, and cost. Four reviewers working in pairs independently extracted data and assessed study quality. 73 outreach interventions were identified covering many specialties, countries and settings. Nine studies met the inclusion criteria. Most comparative studies came from urban non-disadvantaged populations in developed countries. Simple 'shifted outpatients' styles of specialist outreach were shown to improve access, but there was no evidence of impact on health outcomes. Specialist outreach as part of more complex multifaceted interventions involving collaboration with primary care, education or other services was associated with improved health outcomes, more efficient and guideline-consistent care, and less use of inpatient services. The additional costs of outreach may be balanced by improved health outcomes. This review supports the hypothesis that specialist outreach can improve access, outcomes and service use, especially when delivered as part of a multifaceted intervention. The benefits of simple outreach models in urban non-disadvantaged settings seem small. There is a need for good comparative studies of outreach in rural and disadvantaged settings where outreach may confer most benefit to access and health outcomes.
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Are psychoanalytic billing practices ethical?
Blackmon, W D
1993-01-01
The changing climate of "health care reform" and increased third-party intrusion into psychotherapy are raising challenges over the ethics of traditional psychoanalytic practices such as billing for missed sessions. The practice of billing for missed sessions is an integral part of some analytic psychotherapies and forms the basis of the field of operation of many therapies. When used in this way, the billing practices are unique in medicine in that only these therapies use billing as a part of treatment. This practice is used for a variety of practical reasons but especially to emphasize to patients that the therapy occurs in their internal lives and addresses the symbols they use in organizing their world view. The symbolic use of a time commitment and the obligation to pay for that commitment are necessary so as not to present the patient with a contaminated field of operation. In this way the practice is similar to many other areas of medicine, such as surgeries that are viewed as global procedures whose billing allows for time that is not actually spent in contact with patients. This paper discusses the clinical rationale for the ability to bill for missed sessions and its ethics in terms of the newer language of utilization review. By laying down the principle of billing as a practice parameter for an open-ended bundled service that is billed globally the author translates the practice into more modern utilization-review terminology.
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2014-01-01
Background There is a need for theoretically grounded and evidence-based interventions that enhance the use of research evidence in physical therapist practice. This paper and its companion paper introduce the Physical therapist-driven Education for Actionable Knowledge translation (PEAK) program, an educational program designed to promote physical therapists’ integration of research evidence into clinical decision-making. The pedagogical foundations for the PEAK educational program include Albert Bandura’s social cognitive theory and Malcolm Knowles’s adult learning theory. Additionally, two complementary frameworks of knowledge translation, the Promoting Action on Research Implementation in Health Services (PARiHS) and Knowledge to Action (KTA) Cycle, were used to inform the organizational elements of the program. Finally, the program design was influenced by evidence from previous attempts to facilitate the use of research in practice at the individual and organizational levels. Discussion The 6-month PEAK program consisted of four consecutive and interdependent components. First, leadership support was secured and electronic resources were acquired and distributed to participants. Next, a two-day training workshop consisting of didactic and small group activities was conducted that addressed the five steps of evidence based practice. For five months following the workshop, participants worked in small groups to review and synthesize literature around a group-selected area of common clinical interest. Each group contributed to the generation of a “Best Practices List” - a list of locally generated, evidence-based, actionable behaviors relevant to the groups’ clinical practice. Ultimately, participants agreed to implement the Best Practices List in their clinical practice. Summary This, first of two companion papers, describes the underlying pedagogical theories, knowledge translation frameworks, and research evidence used to derive the PEAK program – an educational program designed to promote the use of research evidence to inform physical therapist practice. The four components of the program are described in detail. The companion paper reports the results of a mixed methods feasibility analysis of this complex educational intervention. PMID:24965501
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Holland, Agi; Smith, Fiona; McCrossan, Gill; Adamson, Elizabeth; Watt, Susan; Penny, Kay
2013-06-01
Improvements in the safety of the prescribing, dispensing and administration of medicines are identified as a priority across international healthcare systems. It is therefore essential that higher education institutions play their part in helping to meet this patient safety objective. New developments in clinical skills education which are aligned to emerging educational theory are available, but evaluations and supportive evidence are limited. To evaluate the use of an online best practice exemplar as an adjunct to the clinical skills teaching of oral medication administration to undergraduate student nurses. Mixed-methods prospective cohort design. Two intakes of undergraduate nursing students (n=168, n=154) undertaking a first year clinical skills based module at a British university. The Control group received standard teaching using lectures and skills classes facilitated by experienced clinical skills lecturers. The Intervention group received the standard teaching and unlimited access to an online video clip of medication administration. Performance and satisfaction were measured using module assessment results and a satisfaction questionnaire. Qualitative data were gathered using focus groups (n=16, n=20). The Intervention group was significantly (p=0.021) more likely to pass the assessment and rate their satisfaction with the teaching significantly higher (p<0.05) on more than half of the items from the Student Satisfaction Survey. Two Categories were identified from focus group data; Classroom Learning and Transfer to Practice. Classroom Learning included four themes of Peers, Self, Teaching and Time and when Classroom Learning was positive, the Transfer to Practice of the clinical skill was enhanced. An online video of a best practice exemplar as an adjunct to taught clinical skills sessions improves student assessment results and satisfaction ratings. The video was also reported to positively influence all themes identified in Classroom Learning and was perceived to promote the Transfer to Practice of teaching input. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Gordon, J; Hazlett, C; Ten Cate, O; Mann, K; Kilminster, S; Prince, K; O'Driscoll, E; Snell, L; Newble, D
2000-10-01
The 1999 Cambridge Conference was held in Northern Queensland, Australia, on the theme of clinical teaching and learning. It provided an opportunity for groups of academic medical educators to consider some of the challenges posed by recent changes to health care delivery and medical education across a number of countries. This paper describes the issues raised by the practical challenges posed by the current environment and how they might be addressed in ways that could promote more effective learning in clinical settings. A SWOT analysis is a tool that can help in forward planning by identifying the strengths, weaknesses, opportunities and threats presented by any situation. Our SWOT analysis was used to generate a list of items, from which we chose those most feasible and most likely to promote positive change. Twenty different issues were identified, with four of them chosen by consensus for further elaboration. The discussion gave rise to four main recommended strategies: ensuring that clinical teachers thoroughly understand the purpose and process of learning in clinical settings; equipping learners with 'survival skills'; making the best use of learning resources within different clinical environments and making judicious use of information technology to enhance learning efficiency. The four strategies were selected not only because of their inherent importance, but also because of their feasibility. Modest changes can motivate students to feel part of a clinical team and a 'community of practice' and enhance their capacity for self-regulated practice.
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Practitioner involvement in clinical evaluation.
Penka, C E; Kirk, S A
1991-11-01
Contrary to popular belief, social workers are evaluating their practice, but what they do falls short of the use of quantitative procedures that researchers have promoted. Data obtained from a survey of social workers drawn from the National Association of Social Workers national membership list suggest that the gap between practitioners and clinical researchers may stem in part from different mindsets as well as from actual differences in the commitment to the importance of clinical evaluation. Moreover, in the minds of practitioners there appears to be a sharp distinction between formal single-subject design studies and the general evaluative tasks in which they routinely engage.
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An overview of CAM: components and clinical uses.
Kiefer, David; Pitluk, Jessica; Klunk, Kathryn
2009-01-01
Complementary and alternative medicine (CAM), more recently known as integrative health or integrative medicine, is a diverse field comprising numerous treatments and practitioners of various levels of training. This review defines several of the main CAM modalities and reviews some of the research relevant to their clinical application. The goal is to provide healthcare providers with a basic understanding of CAM to start the incorporation of proven treatments into their clinical practice as well as guide them to working with CAM providers; ultimately, such knowledge is a fundamental part of a collaborative approach to optimal patient health and wellness.
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NASA Astrophysics Data System (ADS)
Rivera Rodriguez, Ivelisse
Clinical experiences are an essential part of the training of future nursing professionals. The period of clinical experience aims to develop in the student the necessary skills to practice as a nursing professional, when the academic program ends. This case study aimed to understand the opinion and explore the perception of faculty, clinical instructors, and nursing students on the meaning, contributions and challenges presented during clinical experiences. Among the themes explored in the focus groups were the meaning and importance to learning about the profession of clinical experiences, teaching strategies used during the practice scenarios, didactic relationships developed among students, clinical instructors, and teachers. The goal was to learn from all participants about what they do, their expectations, and the challenges presented during the clinical experiences. A qualitative, descriptive and contextual research design was followed, which required conducting six focus groups to collect the information from the perspective of all the participants. Faculty, clinical instructors, and nursing students participated each in two focus groups. Collected data were transcribed, coded and analyzed in order to organize it under themes related to the research framework. The qualitative analysis of the focus groups revealed that nursing faculty and clinical instructors perceived clinical experiences as a very important element in the training of nursing students, but that coordination between the academy and practice scenarios is disconnected and needs improvement. They also expressed that they use various learning strategies during the clinical experiences, however, they recognize it needs more structure and suggested mentoring as a strategy to consider. They affirmed that mentoring could contribute positively to enhance the teaching-learning process. Clinical instructors understand they perform mentoring roles, but they would like to have a more defined role and structured process. Nursing students, also, recognized the importance of clinical experiences in their professional training. They expressed the need to improve the communication between the academy and the practice scenarios in order to reduce the levels of anxiety they experience when entering the clinical experiences. Nursing students also expressed the need to consider the use of different teaching strategies, such as mentoring, to improve clinical experiences.
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Current Status of Postdoctoral and Graduate Programs in Dentistry.
Assael, Leon
2017-08-01
Advanced dental education has evolved in the context of societal needs and economic trends to its current status. Graduate programs have positioned their role in the context of health systems and health science education trends in hospitals, interprofessional clinical care teams, and dental schools and oral health care systems. Graduate dental education has been a critical factor in developing teams in trauma care, craniofacial disorders, pediatric and adult medicine, and oncology. The misalignment of the mission of graduate dental programs and the demands of private practice has posed a challenge in the evolution of programs as educational programs have been directed towards tertiary and indigent care while the practice community focuses on largely healthy affluent patients for complex clinical interventions. Those seeking graduate dental education today are smaller in number and include more international dental graduates than in the past. Graduate dental education in general dentistry and in the nine recognized dental specialties now includes Commission on Dental Accreditation (CODA) recognition of training standards as part of its accreditation process and a CODA accreditation process for areas of clinical education not recognized as specialties by the American Dental Association. Current types of programs include fellowship training for students in recognized specialties. This article was written as part of the project "Advancing Dental Education in the 21 st Century."
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Drevs, Florian; Gebele, Christoph; Tscheulin, Dieter K
2014-10-01
This study introduces a comprehensive model to explain patients' prosocial behavioral intentions to participate in clinical training. Using the helping decision model, the authors analyze the combined impact of factors that affect participation intentions. The model includes intrapersonal and interpersonal appraisals triggered by an awareness of the societal need for clinical training as a practical part of medical education. The results of our empirical study (N=317) show that personal costs and anxiety as negative appraisals and a warm glow as a positive appraisal affect participation intentions and fully mediate the effect of the patient's awareness of the societal need. The study results indicate that communication strategies should address patient beliefs about negative personal consequences of participation rather than highlighting the societal need for practical medical education related to clinical training. Based on the results, medical associations could develop guidelines and provide training for physicians on how to motivate patients to participate in clinical training, resulting in more patient-centered standardized consent discussions. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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Solomon, Andrew J; Klein, Eran P; Corboy, John R; Bernat, James L
2015-10-01
Pharmaceutical industry financial support of physicians, physician practices, and academic departments involved in multicenter industry-sponsored clinical trials of novel therapeutic agents is a relatively new and infrequently acknowledged source of potential physician conflict of interest. Detailed disclosure of these relationships to study participants is not uniformly a part of informed consent and documentation practices. To understand attitudes of patients with multiple sclerosis concerning disclosure of potential physician-industry conflicts of interest created by clinical trials and how such disclosures may influence study participation An anonymous online instrument was developed. 597 people with multiple sclerosis participated in the study. The study found that detailed disclosure of conflicts of interest is important to potential participants in industry-sponsored clinical trials for multiple sclerosis therapies and that the presence of these conflicts of interest may influence patients' decisions to participate in these studies. Findings from this study support a call for uniform guidelines regarding disclosure of physician-industry relationships to prospective research participants for industry-sponsored clinical trials. © The Author(s), 2015.
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How do general practice registrars learn from their clinical experience? A critical incident study.
Holmwood, C
1997-01-01
This preliminary study of RACGP registrars in the period of subsequent general practice experience examines the types of clinical experiences from which registrars learn, what they learn from the experiences and the process of learning from such experiences. A critical incident method was used on a semi structured interview process. Registrars were asked to recall clinical incidents where they had learnt something of importance. Data were sorted and categorised manually. Nine registrars were interviewed before new categories of data ceased to develop. Registrars learnt from the opportunity to follow up patients. An emotional response to the interaction was an important part of the learning process. Learning from such experiences is haphazard and unstructured. Registrars accessed human resources in response to their clinical difficulties rather than text or electronic based information sources. Registrars should be aware of their emotional responses to interactions with patients; these emotional responses often indicate important learning opportunities. Clinical interactions and resultant learning could be made less haphazard by structuring consultations with patients with specific problems. These learning opportunities should be augmented by the promotion of follow up of patients.
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Canine blastomycosis in Wisconsin: a survey of small-animal veterinary practices.
Anderson, Jennifer L; Dieckman, Jordan L; Reed, Kurt D; Meece, Jennifer K
2014-10-01
The disease burden and impact of canine blastomycosis in Wisconsin is uncertain. We surveyed small-animal veterinary practices to obtain estimates of disease incidence, determine patient outcomes, and investigate variation in diagnostic and treatment strategies used by veterinarians. Veterinarians representing small-animal practices in Wisconsin were contacted by mail with the option to complete a paper or online questionnaire. Questionnaires were returned from 68 of 443 veterinary practices (15%) that estimated diagnosing 239 cases of canine blastomycosis annually, with an overall mortality of 36%. Annual incidence rates of canine blastomycosis were calculated for 43 individual veterinary clinics and differed significantly between clinics in endemic and nonendemic counties (P = 0.01), with the mean in endemic counties being 204/100,000/yr and nonendemic counties being 72/100,000/yr. Veterinarians reported an increase in canine blastomycosis cases from April through August. A wide variety of methods were used for diagnosis, ranging from clinical signs alone to antigen testing and "in-house" cytology. Of note, fungal culture was used rarely for diagnosis. In addition, veterinarians at these 68 clinics estimated diagnosing 36 cases of feline blastomycosis annually. The incidence of canine blastomycosis is high but quite variable among veterinary practices in Wisconsin. Diagnosis is based frequently on clinical signs exclusively due, in part, to the perceived high cost of laboratory tests. Similarly, the mortality associated with blastomycosis is likely negatively impacted because some dog owners defer therapy due to the cost of antifungal drugs. © The Author 2014. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Hardy, Sally; Mushore, Manyara; Goddard, Linda
2016-11-01
The integration of technology in nurse education has become an essential element of academic practice. Yet innovation uptake between academic institutions across the four countries of the UK and their clinical practice partners has proved problematic, leading to a slow introduction of digitally enhanced teaching and learning innovations, particularly in the area of clinical decision making and leadership. The Virtual in Practice Support (VIPS) project involved two academic institutions working with the same mental health care service partner aiming to maximise student clinical placement learning. Student nurses in their final year of training were invited to take part in testing the viability of distance e-tutoring (via computer access to academic nurse lecturers) for facilitated critical reflection. An evaluation of the use of video linked conference sessions, set up for students to undertake a group based online (i.e. virtual) group tutorial is presented. All participants completed an evaluation data sheet using a five point Likert scale and free text evaluation feedback form completed at the end of each online tutorial session. Students were also invited to a focus group and all tutors were interviewed at the completion of the project. The VIPS project findings highlight; i) the importance of a clear project vision for innovation uptake ii) consequences of working with innovation champions and iii) how technology can be used to maximise student learning across geographical distance through online facilitated group critical discussion. VIPS' participants were able to articulate positive outcomes as a result of engaging in a multi-institutional project that capitalised on the richness of nursing clinical practice learning experience for both the students and the academics involved as innovation champions. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Bioethics for clinicians: 25. Teaching bioethics in the clinical setting
McKneally, Martin F.; Singer, Peter A.
2001-01-01
BIOETHICS IS NOW TAUGHT IN EVERY CANADIAN MEDICAL SCHOOL. Canada needs a cadre of teachers who can help clinicians learn bioethics. Our purpose is to encourage clinician teachers to accept this important responsibility and to provide practical advice about teaching bioethics to clinicians as an integral part of good clinical medicine. We use 5 questions to focus the discussion: Why should I teach? What should I teach? How should I teach? How should I evaluate? How should I learn? PMID:11338804
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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.
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Benefits of social media for nurses and service users.
Betton, Victoria is deputy; Tomlinson, Victoria
People with mental health problems are increasingly using social media channels as part of their recovery and to improve their lives. This article discusses social media and how it can be used to complement healthcare, offers useful tips on using social media, and explores case studies for nurses to use in clinical practice.
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-06-28
... laboratory studies with good laboratory practices, (4) name and address of each clinical investigator, (5... assumptions used; (3) ways to enhance the quality, utility, and clarity of the information to be collected... technology. New Animal Drugs for Investigational Uses--21 CFR Part 511 (OMB Control Number 0910-0117...
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Can We Separate Verbs from Their Argument Structure? A Group Study in Aphasia
ERIC Educational Resources Information Center
Caley, Sarah; Whitworth, Anne; Claessen, Mary
2017-01-01
Background: Given the integral role that verbs play in sentence production, understanding verb deficits is critical to clinical practice. Difficulties in sentence production are often directly related to an inability to retrieve argument structure information which, according to most theoretical accounts, is specified at a lexical level as part of…
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Understanding the properties of diagnostic tests - Part 2: Likelihood ratios.
Ranganathan, Priya; Aggarwal, Rakesh
2018-01-01
Diagnostic tests are used to identify subjects with and without disease. In a previous article in this series, we examined some attributes of diagnostic tests - sensitivity, specificity, and predictive values. In this second article, we look at likelihood ratios, which are useful for the interpretation of diagnostic test results in everyday clinical practice.
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Actinic cheilitis in dental practice.
Savage, N W; McKay, C; Faulkner, C
2010-06-01
Actinic cheilitis is a potentially premalignant condition involving predominantly the vermilion of the lower lip. The aim of the current paper was to review the clinical presentation of actinic cheilitis and demonstrate the development of management plans using a series of cases. These are designed to provide immediate treatment where required but also to address the medium and long-term requirements of the patient. The authors suggest that the clinical examination of lips and the assessment of actinic cheilitis and other lip pathology become a regular part of the routine soft tissue examination undertaken as a part of the periodic examination of dental patients. Early recognition of actinic cheilitis can allow the development of strategies for individual patients that prevent progression. These are based on past sun exposure, future lifestyle changes and the daily use of emollient sunscreens, broad-brimmed hats and avoidance of sun exposure during the middle of the day. This is a service that is not undertaken as a matter of routine in general medical practice as patients are not seen with the regularity of dental patients and generally not under the ideal examination conditions available in the dental surgery.
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Medical ethics in its American context. An historical survey.
Toulmin, S
1988-01-01
Until the 1950's, moral aspects of clinical practice were handled in the USA within the medical profession. Over the last 30 years, these issues have become subjects for public debate, and have changed the public perception of medicine, in four steps. In the 1950's, moral theologians questioned the implications of medical technology at the edges of life. In the late '60s and '70s, these theologians were joined by political activists, whose zeal provoked a counter-reaction from physicians. In the late '70s and early '80s, the debate became largely theoretical; but in the late '80s it is once again "clinical", though respecting the rights of patients, their families, and other nonphysicians to participate in the relevant moral decisions. In part, these four steps reflect the special feature of American social history in the last 30 years; but in part they also had counterparts in Britain and elsewhere. Either way, the monopoly control over the ethics of medical practice exercised by doctors before the 1950s is unlikely to return.
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Performance of new alternative providers of primary care services in England: an observational study
Greaves, Felix; Laverty, Anthony A; Pape, Utz; Ratneswaren, Anenta; Majeed, Azeem
2015-01-01
Summary Objectives Health system reforms in England are opening broad areas of clinical practice to new providers of care. As part of these reforms, new entrants – including private companies – have been allowed into the primary care market under ‘alternative provider of medical services’ contracting mechanisms since 2004. The characteristics and performance of general practices working under new alternative provider contracts are not well described. We sought to compare the quality of care provided by new entrant providers to that provided by the traditional model of general practice. Design Open cohort study of English general practices. We used linear regression in cross-sectional and time series analyses, adjusting for practice and population characteristics, to compare quality in practices using alternative provider contracts to traditional practices. We created regression models using practice fixed effects to estimate the impact of practices changing to the new contract type. Setting The English National Health Service. Participants All general practices open from 2008/2009 to 2012/2013. Main outcome measures Seventeen established quality indicators – covering clinical effectiveness, efficiency, access and patient experience. Results In total, 4.1% (347 of 8300) of general practices in England were run by alternative contract providers. These practices tended to be smaller, and serve younger, more diverse and more deprived populations than traditional providers. Practices run by alternative providers performed worse than traditional providers on 15 of 17 indicators after adjusting for practice and population characteristics (p < 0.01 for all). Switching to a new alternative provider contract did not result in improved performance. Conclusions The introduction of new alternative providers to deliver primary care services in England has not led to improvements in quality and may have resulted in worse care. Regulators should ensure that new entrants to clinical provider markets are performing to adequate standards and at least as well as traditional providers. PMID:25908312
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Greaves, Felix; Laverty, Anthony A; Pape, Utz; Ratneswaren, Anenta; Majeed, Azeem; Millett, Christopher
2015-05-01
Health system reforms in England are opening broad areas of clinical practice to new providers of care. As part of these reforms, new entrants--including private companies--have been allowed into the primary care market under 'alternative provider of medical services' contracting mechanisms since 2004. The characteristics and performance of general practices working under new alternative provider contracts are not well described. We sought to compare the quality of care provided by new entrant providers to that provided by the traditional model of general practice. Open cohort study of English general practices. We used linear regression in cross-sectional and time series analyses, adjusting for practice and population characteristics, to compare quality in practices using alternative provider contracts to traditional practices. We created regression models using practice fixed effects to estimate the impact of practices changing to the new contract type. The English National Health Service. All general practices open from 2008/2009 to 2012/2013. Seventeen established quality indicators--covering clinical effectiveness, efficiency, access and patient experience. In total, 4.1% (347 of 8300) of general practices in England were run by alternative contract providers. These practices tended to be smaller, and serve younger, more diverse and more deprived populations than traditional providers. Practices run by alternative providers performed worse than traditional providers on 15 of 17 indicators after adjusting for practice and population characteristics (p < 0.01 for all). Switching to a new alternative provider contract did not result in improved performance. The introduction of new alternative providers to deliver primary care services in England has not led to improvements in quality and may have resulted in worse care. Regulators should ensure that new entrants to clinical provider markets are performing to adequate standards and at least as well as traditional providers. © The Royal Society of Medicine.
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Howlin, Frances; Halligan, Phil; O'Toole, Sinead
2014-09-01
Engagement and successful completion of nursing and midwifery programmes may be predicated on the identification and implementation of reasonable accommodations to facilitate clinical learning for students with a disability. This qualitative study aims to evaluate a clinical needs assessment for students with a disability and explore their experiences of support in clinical practice. A purposive sample of year one undergraduate students was used. Four students consented to participate and undertook an individual interview. Their disabilities were categorised as specific learning disability (dyslexia) (n = 3) and mental health (n = 1). Data analysis revealed two main themes 'students' experiences of disclosure' and 'receiving support'. Findings revealed that all students disclosed on placement, however, the extent of disclosure was influenced by personal and environmental factors. Students used the clinical needs assessment to highlight accommodations to clinical staff on placement. Issues of concern that arose, included communication between all key stakeholders, negative staff attitudes and the need to improve the provision of accommodations. This preliminary evaluation indicates that the Clinical Needs Assessment bridges the gap in provision of student support between higher education and healthcare institutions. Findings suggest that competence based needs assessments can identify individualised reasonable accommodations for students undertaking clinical placements. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Beastall, Graham H
2008-07-01
Education and training to become a senior professional in UK clinical biochemistry is coordinated at national level and is largely dependent upon completion of the MRCPath examination. The number of training commissions is regulated to accord with workforce planning requirements. Both medical and science graduates are eligible to undertake this training and the core curriculum is similar for both groups. Medical trainees have the option of including additional clinical training in metabolic medicine. Increasingly, with the introduction of new methods of assessment, the MRCPath examination is becoming a measure of competence rather than knowledge. Structured CPD is mandatory for career grade doctors and scientists as part of the requirements for them to maintain their individual licence to practice and in order that the laboratory in which they work may be accredited. The education, training and assessment of trainees in clinical biochemistry enable the production of a flexible workforce that is competent and designed to be fit for purpose. The requirement for structured CPD is one part of maintaining competence.
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Avula, Haritha; Pandey, Ruchi; Bolla, Vijayalakshmi; Rao, Harika; Avula, Jaya Kumar
2013-09-01
Research in the field of periodontology has witnessed a tremendous upsurge in the last two decades unveiling newer innovations in techniques, methodologies, and material science. The recent focus in periodontal research is an evidence-based approach which offers a bridge from science to clinical practice. This three part review series intends to take a reader through a maze of periodontal research, unraveling and simplifying various issues in the design, conduct and interpretation of various study designs routinely used in the field of periodontal research. This understanding would facilitate a researcher with a focused and an enhanced vision toward formulating studies which can more efficiently translate sound scientific phenomena into clinically meaningful results.
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Avula, Haritha; Pandey, Ruchi; Bolla, Vijayalakshmi; Rao, Harika; Avula, Jaya Kumar
2013-01-01
Research in the field of periodontology has witnessed a tremendous upsurge in the last two decades unveiling newer innovations in techniques, methodologies, and material science. The recent focus in periodontal research is an evidence-based approach which offers a bridge from science to clinical practice. This three part review series intends to take a reader through a maze of periodontal research, unraveling and simplifying various issues in the design, conduct and interpretation of various study designs routinely used in the field of periodontal research. This understanding would facilitate a researcher with a focused and an enhanced vision toward formulating studies which can more efficiently translate sound scientific phenomena into clinically meaningful results. PMID:24174746
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Should patients be allowed to veto their participation in clinical research?
Evans, H
2004-01-01
Patients participating in the shared benefits of publicly funded health care enjoy the benefits of treatments tested on previous patients. Future patients similarly depend on treatments tested on present patients. Since properly designed research assumes that the treatments being studied are—so far as is known at the outset—equivalent in therapeutic value, no one is clinically disadvantaged merely by taking part in research, provided the research involves administering active treatments to all participants. This paper argues that, because no other practical or moral considerations count decisively against so doing, we could and should oblige patients to agree to receive indicated treatment within the terms of any concurrent research protocols. This ensures their treatment will benefit not only themselves but also future patients through contributing to new knowledge. By analogy with the paying of income tax, patients should not be allowed to "veto" their social responsibility to take part in clinical research. PMID:15082818
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Marshall, Nina L; Spooner, Muirne; Galvin, P Leo; Ti, Joanna P; McElvaney, N Gerald; Lee, Michael J
2011-01-01
A preliminary audit of orders for computed tomography was performed to evaluate the typical performance of interns ordering radiologic examinations. According to the audit, the interns showed only minimal improvement after 8 months of work experience. The online radiology ordering module (ROM) program included baseline assessment of student performance (part I), online learning with the ROM (part II), and follow-up assessment of performance with simulated ordering with the ROM (part III). A curriculum blueprint determined the content of the ROM program, with an emphasis on practical issues, including provision of logistic information, clinical details, and safety-related information. Appropriate standards were developed by a committee of experts, and detailed scoring systems were devised for assessment. The ROM program was successful in addressing practical issues in a simulated setting. In the part I assessment, the mean score for noting contraindications for contrast media was 24%; this score increased to 59% in the part III assessment (P = .004). Similarly, notification of methicillin-resistant Staphylococcus aureus status and pregnancy status and provision of referring physician contact information improved significantly. The quality of the clinical notes was stable, with good initial scores. Part III testing showed overall improvement, with the mean score increasing from 61% to 76% (P < .0001). In general, medical students lack the core knowledge that is needed for good-quality ordering of radiology services, and the experience typically afforded to interns does not address this lack of knowledge. The ROM program was a successful intervention that resulted in statistically significant improvements in the quality of radiologic examination orders, particularly with regard to logistic and radiation safety issues.
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Clinical neuropsychology practice and training in Canada.
Janzen, Laura A; Guger, Sharon
2016-11-01
This invited paper provides information about professional neuropsychology issues in Canada and is part of a special issue addressing international perspectives on education, training, and practice in clinical neuropsychology. Information was gathered from literature searches and personal communication with other neuropsychologists in Canada. Canada has a rich neuropsychological history. Neuropsychologists typically have doctoral-level education including relevant coursework and supervised practical experience. Licensure requirements vary across the 10 provinces and there are regional differences in salary. While training at the graduate and internship level mirrors that of our American colleagues, completion of a two-year postdoctoral fellowship in neuropsychology is not required to obtain employment in many settings and there are few postdoctoral training programs in this country. The majority of neuropsychologists are employed in institutional settings (e.g. hospitals, universities, rehabilitation facilities), with a growing number entering private practice or other settings. There are challenges in providing neuropsychological services to the diverse Canadian population and a need for assessment measures and normative data in multiple languages. Canadian neuropsychologists face important challenges in defining ourselves as distinct from other professions and other psychologists, in maintaining funding for high-quality training and research, in establishing neuropsychology-specific training and practice standards at the provincial or national level, and ensuring the clinical care that we provide is efficient and effective in meeting the needs of our patient populations and consumers, both within and outside of the publically funded health care system.
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Grant, Suzanne; Ring, Adele; Gabbay, Mark; Guthrie, Bruce; McLean, Gary; Mair, Frances S; Watt, Graham; Heaney, David; O'Donnell, Catherine
2015-01-01
In the UK National Health Service, primary care organisation (PCO) managers have traditionally relied on the soft leadership of general practitioners based on professional self-regulation rather than direct managerial control. The 2004 general medical services contract (nGMS) represented a significant break from this arrangement by introducing new performance management mechanisms for PCO managers to measure and improve general practice work. This article examines the impact of nGMS on the governance of UK general practice by PCO managers through a qualitative analysis of data from an empirical study in four UK PCOs and eight general practices, drawing on Hood's four-part governance framework. Two hybrids emerged: (i) PCO managers emphasised a hybrid of oversight, competition (comptrol) and peer-based mutuality by granting increased support, guidance and autonomy to compliant practices; and (ii) practices emphasised a broad acceptance of increased PCO oversight of clinical work that incorporated a restratified elite of general practice clinical peers at both PCO and practice levels. Given the increased international focus on the quality, safety and efficiency in primary care, a key issue for PCOs and practices will be to achieve an effective, contextually appropriate balance between the counterposing governance mechanisms of peer-led mutuality and externally led comptrol. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.
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Reed, Richard L; Barton, Christopher A; Isherwood, Linda M; Baxter, Jodie M Oliver; Roeger, Leigh
2013-08-28
A robust research base is required in General Practice. The research output for General Practice is much less than those of other clinical disciplines. A major impediment to more research in this sector is difficulty with recruitment. Much of the research in this area focuses on barriers to effective recruitment and many projects have great difficulty with this process. This paper seeks to describe a systematic approach to recruitment for a randomized controlled trial that allowed the study team to recruit a substantial number of subjects from General Practice over a brief time period. A systematic approach to recruitment in this setting based on prior literature and the experience of the investigator team was incorporated into the design and implementation of the study. Five strategies were used to facilitate this process. These included designing the study to minimize the impact of the research on the day-to-day operations of the clinics, engagement of general practitioners in the research, making the research attractive to subjects, minimizing attrition and ensuring recruitment was a major focus of the management of the study. Outcomes of the recruitment process were measured as the proportion of practices that agreed to participate, the proportion of potentially eligible subjects who consented to take part in the trial and the attrition rate of subjects. Qualitative interviews with a subset of successfully recruited participants were done to determine why they chose to participate in the study; data were analyzed using thematic analysis. Five out of the six general practices contacted agreed to take part in the study. Thirty-eight per cent of the 1663 subjects who received a letter of invitation contacted the university study personnel regarding their interest in the project. Recruitment of the required number of eligible participants (n = 256) was accomplished in seven months. Thematic analysis of interviews with 30 participants regarding key factors in their study participation identified a personalised letter of endorsement from their general practitioner, expectation of personal benefit and altruism as important factors in their decision to participate. Recruitment can be successfully achieved in General Practice through design of the research project to facilitate recruitment, minimize the impact on general practice operations and ensure special care in enrolling and maintaining subjects in the project.
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Practice parameters and financial factors impacting developmental-behavioral pediatrics.
Adair, Robin; Perrin, Ellen; Hubbard, Carol; Savageau, Judith A
2010-01-01
Little has been published about the professional activities of developmental-behavioral (DB) pediatricians. To better understand the settings in which DB pediatricians work, allocation of their professional time, and how financial considerations impact their practice, the Society for Developmental and Behavioral Pediatrics surveyed its membership. An extensive on-line three-part survey was conducted in 2006-2007 assessing sociodemographic characteristics, practice descriptors, coding and billing practices, productivity goals and perceived pressures among Society for Developmental and Behavioral Pediatric's 438 physician members. Of the pediatricians responding, representing all regions of the United States, 93% were DB pediatrics subspecialty board certified or eligible. The majority was practicing DB pediatrics full-time (73%); and 67% were exclusively in academic settings. All reported seeing patients, 84% reported teaching, 76% reported having administrative responsibilities, and 46% reported conducting research. Despite having non-clinical responsibilities, full-time equivalent positions included an average of 25 hours per week in direct patient care and 14.5 hours per week (37% of clinical time) in indirect patient care. Only 42% reported working with multidisciplinary teams. Salaries varied widely within and across regions. Deficits in billing/coding practices, awareness of personal clinical productivity, and familiarity with national productivity benchmarks were identified. DB pediatricians work in diverse settings nationwide. They provide considerable time in indirect patient care, which is poorly reimbursed in general and relative to direct patient care. The results of this survey offer opportunities for provider, institutional and payer education.
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Introducing guidelines into clinical practice.
Fowkes, F G; Roberts, C J
1984-04-01
The impetus for guidelines of practice has been accelerated by a worldwide trend towards insurance based systems of health care. In the past it has been the tradition for the clinician to order all the diagnostic procedures that conceivably might help to clarify what is wrong with a patient, or what course of treatment should be followed. This traditional view ignores the stubborn economic reality that resources are finite and that it is no longer possible to be both endlessly generous and continually fair. Making judgements about the need for, and value of, services now forms an important part of coping with this problem. Clinical practice has to strive to be as safe as possible and to produce a given benefit at a socially acceptable cost. Guidelines are recommendations, preferably developed by clinicians themselves, which describe how and when individual clinical activities should be offered in order to achieve these objectives. Utilisation review of current practice is a valuable source of information for the development of guidelines. In the United Kingdom the Royal College of Radiologists attempted to do this in connection with the use of pre-operative chest X-rays. In 1979 they published the findings of a multicentre review of 10,619 consecutive cases of elective non-cardiopulmonary surgery undertaken in 8 centres throughout the United Kingdom. Substantial variations were found in national practice. Use of pre-operative chest X-rays varied from 11.5% of patients in one centre to 54.2% of patients in another centre. The study also found that the chest X-ray report did not seem to have much influence on the decision to operate nor on the decision to use inhalation anaesthesia. The College study failed to find "any evidence at all for the effectiveness of pre-operative chest X-ray when used routinely" and it was estimated that even if the procedure was 10% effective the costs of avoiding one death would be approximately 1 million pounds. These findings provided the impetus for the College to develop guidelines for the use of pre-operative chest X-rays in hospitals in the United Kingdom. Creating a change in clinical practice through the introduction of guidelines is a three stage process: Stage I: introducing the idea of a change in practice. Stage II: introduction of guidelines into clinical practice. Stage III: sustained implementation of guidelines in clinical practice.(ABSTRACT TRUNCATED AT 400 WORDS)
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Mearin, F; Ciriza, C; Mínguez, M; Rey, E; Mascort, J J; Peña, E; Cañones, P; Júdez, J
2017-03-01
In this Clinical practice guide we examine the diagnostic and therapeutic management of adult patients with constipation and abdominal discomfort, at the confluence of the spectrum of irritable bowel syndrome and functional constipation. Both fall within the framework of functional intestinal disorders and have major personal, health and social impact, altering the quality of life of the patients affected. The former is a subtype of irritable bowel syndrome in which constipation and altered bowel habit predominate, often along with recurring abdominal pain, bloating and abdominal distension. Constipation is characterised by infrequent or hard-to-pass bowel movements, often accompanied by straining during defecation or the sensation of incomplete evacuation. There is no underlying organic cause in the majority of cases; it being considered a functional bowel disorder. There are many clinical and pathophysiological similarities between the two conditions, the constipation responds in a similar way to commonly used drugs, the fundamental difference being the presence or absence of pain, but not in an "all or nothing" way. The severity of these disorders depends not only on the intensity of the intestinal symptoms but also on other biopsychosocial factors: association of gastrointestinal and extraintestinal symptoms, degree of involvement, forms of perception and behaviour. Functional bowel disorders are diagnosed using the Rome criteria. This Clinical practice guide adapts to the Rome IV criteria published at the end of May 2016. The first part (96, 97, 98) examined the conceptual and pathophysiological aspects, alarm criteria, diagnostic test and referral criteria between Primary Care and Gastroenterology. This second part reviews all the available treatment alternatives (exercise, fluid ingestion, diet with soluble fibre-rich foods, fibre supplements, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antdepressants, psychological treatment, acupuncture, enemas, sacral root neurostimulation and surgery), and practical recommendations are made for each. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
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Taslakian, Bedros; Sridhar, Divya
2017-09-01
Interventional radiology (IR) has evolved into a full-fledged clinical specialty with attendant comprehensive patient care responsibilities. Providing excellent and thorough clinical care is as essential to the practice of IR as achieving technical success in procedures. Basic clinical skills that every interventional radiologist should learn include routine management of percutaneously inserted drainage and vascular catheters and rapid effective management of common systemic post-procedural complications. A structured approach to post-procedural care, including routine follow-up and early identification and management of complications, facilitates efficient and thorough management with an emphasis on quality and patient safety. The aim of this second part, in conjunction with part 1, is to complete the comprehensive review of post-procedural care in patients undergoing interventional radiology procedures. We discuss common problems encountered after insertion of drainage and vascular catheters and describe effective methods of troubleshooting these problems. Commonly encountered systemic complications in IR are described, and ways for immediate identification and management of these complications are provided.
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Boyle, Eileen; Saunders, Rosemary; Drury, Vicki
2016-07-01
To explore patient experiences of type 2 diabetes mellitus care delivered by general practice nurses in collaboration with the general practitioner. Australian general practice nurses are expanding their role in multidisciplinary type 2 diabetes care with limited research on patient perceptions of care provision within this collaborative model. Qualitative interpretive. Purposeful sampling was used to invite the patients (n = 10). Data were collected from semi-structured face-to-face interviews. Braun and Clarke's () inductive coding thematic analysis process was used to interpret the data. All participants experienced their General Practice Nurse consultation as a clinical assessment for their General Practitioner. While they appreciated the extra time with the General Practice Nurse, they were unsure of the purpose of the consultation beyond clinical assessment. They described the ongoing challenge of living with T2DM and identified a need for additional information and advice. The results suggest that the model of general practice nurse type 2 diabetes care has an important role to play in the delivery of effective ongoing care of patients. However, this role requires further development to ensure that it is understood by the patients as a role that not only conducts clinical assessments but also provides relevant education and self-management support as part of a collaborative approach to care delivery with General Practitioners. The findings are relevant to primary health care clinicians providing diabetes care to inform more relevant supportive care by general practice nurses. © 2016 John Wiley & Sons Ltd.
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Nursing students' experiences of ethical issues in clinical practice: A New Zealand study.
Sinclair, J; Papps, E; Marshall, B
2016-03-01
Nursing students experience ethical problems in clinical practice in a different way from registered nurses. In order to develop ethical reasoning and competence in nursing students, nurse educators must recognise the unique issues students face. This research described the occurrence of ethical issues in clinical practice for 373 undergraduate nursing students who responded to a national questionnaire investigating the frequency of pre-determined ethical issues and the corresponding level of distress. Over two thirds of respondents experienced breaches of a patient's right to confidentiality, privacy, dignity or respect and 87% experienced unsafe working conditions. The most distressing issues were those that compromised patient safety, including unsafe healthcare practices, working conditions and suspected abuse or neglect. Themes that emerged from an open-ended question included lack of support and supervision, bullying and end of life issues. This research found the frequency at which ethical issues are experienced was highest in year three participants. However, the overall distress levels were lower for the majority of issues for those participants in the later part of their degree. Recommendations from this research include developing ethics education around the main concerns that students face in order to enhance students' understanding, resilience and ability to respond appropriately. Copyright © 2016 Elsevier Ltd. All rights reserved.
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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.
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Bhat, Sarita; Baker, Paul; Eyres, Renata
2008-01-01
Postgraduate medical training is undergoing major change, shortening and disrupting traditional practices. Scholarship remains highly valued, but increasingly difficult to fit in. Workplace-based Masters study offers a solution. We want consultants who are driven by enquiry, good teachers and team workers. Academic qualifications demonstrate trainees' commitment and expertise in competitive employment markets. Most Deaneries allow two sessions weekly for research/personal development, so this resource demands effective use. The good will, talent and commitment of colleagues are vital. A credible structured curriculum combines real-life consultant-level generic practice, with technical medical skills. Academic writing and practical assignments are assessed. Linking with a far-sighted academic institution brings vast expertise in education administration and delivery of accredited learning. The course is more cost-effective than traditional study leave activities. Running part-time over 4 years fits with Higher Specialist Training. Structured programmes, over 9 month 'terms', fit with clinical rotations. Module leaders run yearly clinical modules alongside continuous generic modules. Clinical units are signed up to releasing trainees to attend. Evaluation is external to faculty, with highly favourable feedback. We believe training in academic disciplines underpins practice. With strong partnership working, planning and especially hard work, such a course is deliverable.
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Nurses' Experiences of End-of-life Photography in NICU Bereavement Support.
Martel, Sara; Ives-Baine, Lori
2018-06-07
To qualitatively explore neonatal intensive care nurses' experiences with end-of-life photography as part of their bereavement support work with families. An Interpretive Phenomenological Analysis with data collected through a focus group (n = 6) and one semi-structured interview (n = 1) with neonatal nurses from a Level 3/4 NICU in a Canadian pediatric hospital. Participants' comfort with EOL photography developed over time through exposure to bereavement scenarios and positive experiences with families. Participants' experienced a feeling of pressure to balance the photography with clinical responsibilities and find the right time to introduce photography while being sensitive to family experiences. Participants experienced EOL photography as something tangible to give families and were satisfied knowing the images might play an important role in the family's healing after the NICU. All participants had come to value EOL photography as a positive and meaningful part of their work with bereaved families. Identified challenges related to balancing the practice with the unpredictable flow and demands of critical care and to developing an appreciation for and comfort with the photography as part of their healing and the families' healing. Findings contribute insight into care-provider experience that can inform best practices, training, and staff support for palliative and bereavement work in neonatal and pediatric settings. The findings suggest a need to support nurses emotionally and clinically in carrying out this photography as part of their care for families. Copyright © 2018 Elsevier Inc. All rights reserved.
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Health Care Delivery Practices in Huntington’s Disease Specialty Clinics: An International Survey
Frich, Jan C.; Rae, Daniela; Roxburgh, Richard; Miedzybrodzka, Zofia H.; Edmondson, Mary; Pope, Erika Bjorklund; Goodman, LaVonne; Haddad, Monica S.; Giuliano, Joe; Nelson, Eugene C.; Guttman, Mark; Nance, Martha
2016-01-01
Background: Little is known about the organization of clinical services for Huntington’s disease (HD). Objective: To describe how health care services are organized and delivered in HD-clinics taking part in or eligible for the Enroll-HD study. Methods: In 2014, a 69-item survey was administered to sites taking part in or eligible for the Enroll-HD study. Results: Of 231 sites surveyed, 121 (52.2%) sites in Europe, North America, Latin America, and Oceania responded. Most sites in the sample serve large populations, with 61.1% serving more than 1.5 million people, and a further 33% serving >500,000. Almost all (86.0%) centers see patients from outside their region. The majority of centers (59.7%) follow 50–199 patients, 21.9% care for more than 200. Most centers provide care in all stages of HD, and nearly all review pre-symptomatic cases. Multidisciplinary case reviews are offered in 54.5% of sites, with outreach clinics offered by 48.1%. Videoconferencing and telemedicine are used by 23.6%. Separate consultations for caregivers are offered in more than half of the centers. Most centers (70.4%) report following published guidelines or local care pathways for HD. Conclusions: Most centers serve a large population and use a multidisciplinary approach. The survey gives insight into factors underpinning HD service delivery globally. There is a need for more in-depth studies of clinical practice to understand how services are organized and how such features may be associated with quality of care. PMID:27372053
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Green, Carolyn J; Fortin, Patricia; Maclure, Malcolm; Macgregor, Art; Robinson, Sylvia
2006-12-01
Improvement of chronic disease management in primary care entails monitoring indicators of quality over time and across patients and practices. Informatics tools are needed, yet implementing them remains challenging. To identify critical success factors enabling the translation of clinical and operational knowledge about effective and efficient chronic care management into primary care practice. A prospective case study of positive deviants using key informant interviews, process observation, and document review. A chronic disease management (CDM) collaborative of primary care physicians with documented improvement in adherence to clinical practice guidelines using a web-based patient registry system with CDM guideline-based flow sheet. Thirty community-based physician participants using predominantly paper records, plus a project management team including the physician lead, project manager, evaluator and support team. A critical success factor (CSF) analysis of necessary and sufficient pathways to the translation of knowledge into clinical practice. A web-based CDM 'toolkit' was found to be a direct CSF that allowed this group of physicians to improve their practice by tracking patient care processes using evidence-based clinical practice guideline-based flow sheets. Moreover, the information and communication technology 'factor' was sufficient for success only as part of a set of seven direct CSF components including: health delivery system enhancements, organizational partnerships, funding mechanisms, project management, practice models, and formal knowledge translation practices. Indirect factors that orchestrated success through the direct factor components were also identified. A central insight of this analysis is that a comprehensive quality improvement model was the CSF that drew this set of factors into a functional framework for successful knowledge translation. In complex primary care settings environment where physicians have low adoption rates of electronic tools to support the care of patients with chronic conditions, successful implementation may require a set of interrelated system and technology factors.
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Clinical Simulation in Psychiatric-Mental Health Nursing: Post-Graduation Follow Up.
Lilly, Mary LuAnne; Hermanns, Melinda; Crawley, Bill
2016-10-01
In psychiatric-mental health, creating an innovative strategy to help students learn content that may not be frequently seen in a clinical setting is challenging. Thus, simulation helps narrow this gap. Using Kirkpatrick and Kirkpatrick's model of evaluation to guide the current study, faculty contacted baccalaureate nursing program graduates who completed a psychiatric-mental health clinical simulation scenario featuring a hanging suicide and wrist cutting suicide attempt scenario in the "Behind the Door" series as part of the clinical component of their undergraduate psychiatric-mental health course. Eleven nurses responded to a survey regarding their post-graduate encounters with these types of clinical situations, and their perception of recall and application of knowledge and skills acquired during the simulation experience to the clinical situation. Nursing graduates' responses are expressed through three major themes: emotional, contextual/behavioral, and assessment outcomes. Data from the survey indicate that nursing graduates perceived the "Behind the Door" simulations as beneficial to nursing practice. This perception is important in evaluating knowledge transfer from a simulation experience as a student into application in nursing practice. [Journal of Psychosocial Nursing and Mental Health Services, 54(10), 40-45.]. Copyright 2016, SLACK Incorporated.
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Big Data in Designing Clinical Trials: Opportunities and Challenges
Mayo, Charles S.; Matuszak, Martha M.; Schipper, Matthew J.; Jolly, Shruti; Hayman, James A.; Ten Haken, Randall K.
2017-01-01
Emergence of big data analytics resource systems (BDARSs) as a part of routine practice in Radiation Oncology is on the horizon. Gradually, individual researchers, vendors, and professional societies are leading initiatives to create and demonstrate use of automated systems. What are the implications for design of clinical trials, as these systems emerge? Gold standard, randomized controlled trials (RCTs) have high internal validity for the patients and settings fitting constraints of the trial, but also have limitations including: reproducibility, generalizability to routine practice, infrequent external validation, selection bias, characterization of confounding factors, ethics, and use for rare events. BDARS present opportunities to augment and extend RCTs. Preliminary modeling using single- and muti-institutional BDARS may lead to better design and less cost. Standardizations in data elements, clinical processes, and nomenclatures used to decrease variability and increase veracity needed for automation and multi-institutional data pooling in BDARS also support ability to add clinical validation phases to clinical trial design and increase participation. However, volume and variety in BDARS present other technical, policy, and conceptual challenges including applicable statistical concepts, cloud-based technologies. In this summary, we will examine both the opportunities and the challenges for use of big data in design of clinical trials. PMID:28913177
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Big Data in Designing Clinical Trials: Opportunities and Challenges.
Mayo, Charles S; Matuszak, Martha M; Schipper, Matthew J; Jolly, Shruti; Hayman, James A; Ten Haken, Randall K
2017-01-01
Emergence of big data analytics resource systems (BDARSs) as a part of routine practice in Radiation Oncology is on the horizon. Gradually, individual researchers, vendors, and professional societies are leading initiatives to create and demonstrate use of automated systems. What are the implications for design of clinical trials, as these systems emerge? Gold standard, randomized controlled trials (RCTs) have high internal validity for the patients and settings fitting constraints of the trial, but also have limitations including: reproducibility, generalizability to routine practice, infrequent external validation, selection bias, characterization of confounding factors, ethics, and use for rare events. BDARS present opportunities to augment and extend RCTs. Preliminary modeling using single- and muti-institutional BDARS may lead to better design and less cost. Standardizations in data elements, clinical processes, and nomenclatures used to decrease variability and increase veracity needed for automation and multi-institutional data pooling in BDARS also support ability to add clinical validation phases to clinical trial design and increase participation. However, volume and variety in BDARS present other technical, policy, and conceptual challenges including applicable statistical concepts, cloud-based technologies. In this summary, we will examine both the opportunities and the challenges for use of big data in design of clinical trials.
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Tachi, Tomoya; Noguchi, Yoshihiro; Teramachi, Hitomi
2017-01-01
The clinical professors at Gifu Pharmaceutical University (GPU) provide pharmaceutical services at GPU Pharmacy, Gifu University Hospital, and Gifu Municipal Hospital to keep their clinical skills up-to-date; they also perform clinical research in collaboration with many clinical institutes. The Laboratory of Clinical Pharmacy is part of the Department of Pharmacy Practice and Science, to which the clinical professors belong, and is composed of three clinical professors (a professor, an associate professor, and an assistant professor). The professor administers the GPU Pharmacy as its director, while the associate professor and assistant professor provide pharmaceutical services to patients at Gifu Municipal Hospital, and also provide practical training for students in the GPU Pharmacy. Collectively, they have performed research on such topics as medication education for students, clinical communication education, and analysis of clinical big data. They have also conducted research in collaboration with clinical institutes, hospitals, and pharmacies. Here, we introduce the collaborative research between the Laboratory of Clinical Pharmacy and Gifu Municipal Hospital. These studies include "Risk factors contributing to urinary protein expression resulting from bevacizumab combination chemotherapy", "Hyponatremia and hypokalemia as risk factors for falls", "Economic evaluation of adjustments of levofloxacin dosage by dispensing pharmacists for patients with renal dysfunction", and "Effect of patient education upon discharge for use of a medication notebook on purchasing over-the-counter drugs and health foods". In this symposium, we would like to demonstrate one model of the association and collaborative research between these clinical professors and clinical institutes.
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Normann, Britt; Sørgaard, Knut W; Salvesen, Rolf; Moe, Siri
2014-03-01
Clinical guidance to community physiotherapists (cPTs) is an integral part of physiotherapy service offered in hospital outpatient (OP) clinics for people with multiple sclerosis (PwMS). There is currently a lack of knowledge on the significance of such guidance. The aims of this study were 1) to identify the features that cPTs perceive to be significant in clinical guidance and 2) how this guidance may affect the cPTs' subsequent treatment of PwMS. A phenomenological-hermeneutical framework was selected, and qualitative research interviews were performed and complemented with non-participating observations of a strategic sample of nine cPTs who received clinical guidance for their patients. The interviews were recorded and transcribed, and content analysis was conducted by using systematic text condensation, using theories of practice knowledge as analytic perspectives. The results indicate that cPTs identify participation in authentic movement analysis of a familiar patient as significant for professional development. Vital features are evaluation of the interplay between body parts, exploration of improvement of movement embedded in the OP clinic physiotherapist's explanations, followed by discussion. These elements provide access to dynamic elements in practice knowledge that are available only through first-hand experience and promote clinical reasoning through enhanced reflection during action as well as following action. Such guidance suggests direction for subsequent treatment and may enhance the continuity of care, particularly if the cPTs are experienced. Mutual information flow implementing the cPTs' perspective is requested, as are the use of plain language and supervision of the cPTs handling skills. Professional guidance for cPTs in OP clinics for PwMS should be considered when programmes aiming to develop competency in neurological physiotherapy are designed and when continuity of care for PwMS is discussed. More research regarding potential long-term impact of professional guidance in these clinics is requested. Copyright © 2013 John Wiley & Sons, Ltd.
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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.
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Hadji, P; Coleman, R E; Wilson, C; Powles, T J; Clézardin, P; Aapro, M; Costa, L; Body, J-J; Markopoulos, C; Santini, D; Diel, I; Di Leo, A; Cameron, D; Dodwell, D; Smith, I; Gnant, M; Gray, R; Harbeck, N; Thurlimann, B; Untch, M; Cortes, J; Martin, M; Albert, U-S; Conte, P-F; Ejlertsen, B; Bergh, J; Kaufmann, M; Holen, I
2016-03-01
Bisphosphonates have been studied in randomised trials in early breast cancer to investigate their ability to prevent cancer treatment-induced bone loss (CTIBL) and reduce the risk of disease recurrence and metastasis. Treatment benefits have been reported but bisphosphonates do not currently have regulatory approval for either of these potential indications. This consensus paper provides a review of the evidence and offers guidance to breast cancer clinicians on the use of bisphosphonates in early breast cancer. Using the nominal group methodology for consensus, a systematic review of the literature was augmented by a workshop held in October 2014 for breast cancer and bone specialists to present and debate the available pre-clinical and clinical evidence for the use of adjuvant bisphosphonates. This was followed by a questionnaire to all members of the writing committee to identify areas of consensus. The panel recommended that bisphosphonates should be considered as part of routine clinical practice for the prevention of CTIBL in all patients with a T score of <-2.0 or ≥2 clinical risk factors for fracture. Compelling evidence from a meta-analysis of trial data of >18,000 patients supports clinically significant benefits of bisphosphonates on the development of bone metastases and breast cancer mortality in post-menopausal women or those receiving ovarian suppression therapy. Therefore, the panel recommends that bisphosphonates (either intravenous zoledronic acid or oral clodronate) are considered as part of the adjuvant breast cancer treatment in this population and the potential benefits and risks discussed with relevant patients. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.
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Rello, J; Solé-Lleonart, C; Rouby, J-J; Chastre, J; Blot, S; Poulakou, G; Luyt, C-E; Riera, J; Palmer, L B; Pereira, J M; Felton, T; Dhanani, J; Bassetti, M; Welte, T; Roberts, J A
2017-09-01
With an established role in cystic fibrosis and bronchiectasis, nebulized antibiotics are increasingly being used to treat respiratory infections in critically ill invasively mechanically ventilated adult patients. Although there is limited evidence describing their efficacy and safety, in an era when there is a need for new strategies to enhance antibiotic effectiveness because of a shortage of new agents and increases in antibiotic resistance, the potential of nebulization of antibiotics to optimize therapy is considered of high interest, particularly in patients infected with multidrug-resistant pathogens. This Position Paper of the European Society of Clinical Microbiology and Infectious Diseases provides recommendations based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology regarding the use of nebulized antibiotics in invasively mechanically ventilated adults, based on a systematic review and meta-analysis of the existing literature (last search July 2016). Overall, the panel recommends avoiding the use of nebulized antibiotics in clinical practice, due to a weak level of evidence of their efficacy and the high potential for underestimated risks of adverse events (particularly, respiratory complications). Higher-quality evidence is urgently needed to inform clinical practice. Priorities of future research are detailed in the second part of the Position Paper as guidance for researchers in this field. In particular, the panel identified an urgent need for randomized clinical trials of nebulized antibiotic therapy as part of a substitution approach to treatment of pneumonia due to multidrug-resistant pathogens. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
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Carney, Patricia A; Eiff, M Patrice; Saultz, John W; Douglass, Alan B; Tillotson, Carrie J; Crane, Steven D; Jones, Samuel M; Green, Larry A
2009-10-01
The Patient-centered Medical Home (PCMH) is a central concept in the evolving debate about American health care reform. We studied family medicine residency training programs' continuity clinics to assess baseline status of implementing PCMH components and to compare implementation status between community-based and university training programs. We conducted a survey 24 continuity clinics in 14 residency programs that are part of the Preparing the Personal Physicians for Practice (P(4)) program. We asked questions about aspects of P(4) that had been already implemented at the beginning of the P(4) program. We defined high implementation as aspects that were present in >50% of clinics and low implementation as those present in <50% of clinics. We compared features at university-based and community-based clinics. High areas of implementation were having an electronic health record (EHR), fully secured remote access, electronic patient notes/scheduling/billing, chronic disease management registries, and open-access scheduling. Low areas of implementation included hospital EHR with computerized physician order entry, asynchronous communication with patients, ongoing population-based QA using EHR, use of preventive registries, and practice-based research using EHR. Few differences were noted between university- and community-based residency programs. Many features of the PCMH were already established at baseline in programs participating in P(4).
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Johnson, Steven W; Ammirati, Shelby R; Hartis, Charles E; Weber, Stephen F; Morgan, Michael R; Darnell, Timothy A; Silwal, Adwait; Schmidlin, Holly N; Priest, David H
2017-06-01
The effectiveness of ledipasvir/sofosbuvir (LDV/SOF) in routine use in clinical practice for the management of chronic hepatitis C virus (HCV) has not been well described. Data with prior agents suggest that management of HCV using an interprofessional approach in clinical practice is associated with better outcomes. This single-centre, prospective, observational cohort study evaluated patients treated with LDV/SOF for 8, 12 or 24 weeks as part of the standardized interprofessional treatment protocol at Novant Health Infectious Diseases Specialists. Eighty-four patients treated with LDV/SOF were evaluated; of these, 97.5% and 91.7% of patients achieved a sustained virological response (SVR) in the per-protocol analysis and the intention-to-treat analysis, respectively. Two patients were not cured after relapse of HCV. No patients required LDV/SOF discontinuation and all patients completed the appropriate treatment duration. The majority (56%) of patients reported no adverse effects and all adverse effects that were reported were mild. The most commonly reported adverse effects were headache and fatigue. SVR and tolerability rates were similar to those seen in the clinical trials. LDV/SOF was associated with a successful translation from the clinical trial setting to clinical practice. A collaborative treatment approach should be considered in the management of HCV. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.
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Mobile learning: a workforce development strategy for nurse supervisors.
Mather, Carey; Cummings, Elizabeth
2014-01-01
Digital technology provides opportunities for using mobile learning strategies in healthcare environments. To realise the vision of the National Workforce Development Strategy there needs to be innovation of health professionals to further develop knowledge and skills of clinical supervisors to access and gain an understanding of the value of mobile learning at the workplace. The use of digital technology by clinical supervisors was explored in 2012 as part of a teaching development grant to evaluate the use of Web 2.0 technology to develop a community of practice about clinical supervision. Prior to developing the virtual network of clinical supervisors, feedback about the use of Web 2.0 technology by clinicians was sought via an online survey. Over 90% of respondents used social media, 85% understood what a blog and wiki were and approximately half of the respondents used smart phones. More than one-third indicated they would participate in a virtual community of practice and would like to receive information about clinical facilitation at least once per week. Findings indicate both inhibitors and opportunities for workforce development within healthcare environments that need to be addressed. Support of graduate-ready nurses can be achieved through an integrated outlook that enables health professionals within organisations to undertake mobile learning in situ. A flexible and collaborative approach to continuing professional development within organisations could enhance practice development and could positively impact on workforce development.
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Roth, Christopher J; Lannum, Louis M; Dennison, Donald K; Towbin, Alexander J
2016-10-01
Clinical specialties have widely varied needs for diagnostic image interpretation, and clinical image and video image consumption. Enterprise viewers are being deployed as part of electronic health record implementations to present the broad spectrum of clinical imaging and multimedia content created in routine medical practice today. This white paper will describe the enterprise viewer use cases, drivers of recent growth, technical considerations, functionality differences between enterprise and specialty viewers, and likely future states. This white paper is aimed at CMIOs and CIOs interested in optimizing the image-enablement of their electronic health record or those who may be struggling with the many clinical image viewers their enterprises may employ today.
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Crabtree, Elizabeth A; Brennan, Emily; Davis, Amanda; Squires, Jerry E
2017-01-01
Evidence-based practice (EBP) skills are crucial for delivering high-quality patient care. It is essential that medical students learn EBP concepts through a practical, in-depth research project. To date, literature on preparing students in this manner is limited. In academic year 2014-2015, the Medical University of South Carolina's (MUSC's) Center for Evidence-Based Practice (now known as the Value Institute) partnered with College of Medicine faculty to revitalize the undergraduate medical student EBP curriculum. Without adding to the number of the lecture hours, the curriculum was restructured to be more process driven, project based, and clinically relevant. The resulting yearlong EBP course partnered small teams of medical students with interprofessional clinical teams to engage the students in developing evidence-based clinical decision support tools. The content developed during the EBP projects is currently being used to develop evidence-based clinical practice guidelines and accompanying order sets. It is likely that this model will serve as a new framework for guideline development and will greatly expand the breadth of evidence-based content currently produced and available for clinicians at the MUSC. It would be feasible to offer a similar course within the MUSC to other disciplines and colleges, or at other institutions, if there were support from administration, interest on the part of clinicians and medical faculty, and individuals with the required expertise available to develop the curriculum and facilitate the course. It is worth considering how to improve the course and evaluating opportunities to implement it within other settings.
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Current status of electroconvulsive therapy for mood disorders: a clinical review.
Kolar, Dusan
2017-02-01
Electroconvulsive therapy (ECT) is an effective treatment for mood disorders and a viable treatment option especially when urgency of clinical situation requires a prompt treatment response. After acute series of ECT, the ECT long-term treatment may be considered, although this practice may vary significantly between countries or even within the same country, because there is no universal consensus about its indications, duration and frequency of administration. Continuation or maintenance ECT is common in routine clinical practice and clinicians should be aware of the risks of using ECT long term. Neuropsychological assessment should be an essential part of a good clinical practice in ECT services. Cognitive side effects of ECT are sometimes underestimated and may last much longer after completed treatment than it is usually expected. These cognitive impairments associated with ECT may cause significant functional difficulties and prevent patients to return to work. Cognitive assessment during ECT treatment is usually not comprehensive enough and is limited to bedside assessment. A more proactive approach to careful neuropsychological assessment and consideration of combined maintenance medication treatment after ECT are essential. 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/.
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[Gaps of Evidence in ENT-Surgery - a Qualitative Survey].
Löhler, J; Akcicek, B; Müller, F; Dreier, G; Meerpohl, J J; Vach, W; Werner, J
2016-04-01
As in other disciplines, the burgeoning knowledge in ENT medicine long ago surpassed our ability to adequately absorb it and maintain a proper overview. This can give rise to actual or assumed knowledge gaps that can impede the progress of the discipline and evidence-based treatment of patients. Clinics and medical practices also hold to traditional doctrines that shape day-to-day medicine, without these schools being challenged based on evidence. Between February and June 2015, 160 ENT clinics, including 34 university hospitals, and 2,670 ENT practices took part in a two-arm online survey on existing or perceived evidentiary gaps in ENT medicine using a previously development questionnaire. The survey used for half the participants was open in form; the other half were given a closed survey with systematics of the field for orientation. The survey was augmented with additional data such as the number of publications and focus areas in the clinics and the age and type of practice of the established physicians. The return rate from the clinics was 39.7%; the return rate of the closed surveys was 29.3%. Of the physicians in medical practice, 14.6% responded to the closed and 18.6% to the open survey. There were no major differences between the two forms of survey. Otological and oncological issues comprised approximately 30% of the list of answers from clinics. Corresponding questions were formulated regarding the current diagnostic and therapeutic problems, such as with stage-related tumor treatment or implantable hearing aids. Diagnostic procedures, e.g., special new procedures in audiology and vestibulogy, dominated the surveys from the practices. However clinics and practices alike cited marginal areas of the discipline that are of daily relevance. The cited knowledge gaps then needed to be verified or refuted and clarified based on research of the literature as to whether the existing evidence actually reached healthcare providers in the form of guidelines, publications, conferences or continuing training for application in daily practice. Other steps would include prioritizing future research, evidence mapping, deciding on further systematic reviews, and targeted studies in conjunction with procuring third-party funding and in cooperation with patient associations. The knowledge thus gained should ultimately be transferred in improved form for application in daily clinical practice. Ten questions of key importance each needed to be formulated for the hospitals and practices. © Georg Thieme Verlag KG Stuttgart · New York.
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Using a spreadsheet/table template for economic value added analysis.
Cassey, Margaret
2008-01-01
Translating clinical research into practical applications that are cost effective has received significant attention as staff nurses attempt to expand new knowledge into an already complex daily workflow. spreadsheet/table template created in a word processing format can assist with setting up and carrying out the analysis of costs for comparing different approaches to routine activities. By encouraging nurses to take the initiative to examine parts of everyday nursing practice with an eye to cost analysis, significant contributions can be made to maximizing the bottom line.
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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.
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Sibling violence silenced: rivalry, competition, wrestling, playing, roughhousing, benign.
Phillips, Debby A; Phillips, Kate H; Grupp, Kitty; Trigg, Lisa J
2009-01-01
In this article, sibling violence and the silence surrounding it is explicated through professional literature and research findings, exemplars from clinical practice, and statistics. Theoretical positions and discourse analysis have been used to help explain how regular broken bones, bruises, lacerations, and verbal humiliation can be minimized as normal sibling rivalry or roughhousing, which does not cause serious consequences. Nursing should be on the front lines of ending practices of violence. Recognizing sibling violence as such is part of this work and is a social justice issue.
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Emergency mental health nursing for self-harming refugees and asylum seekers.
Procter, Nicholas G
2005-09-01
This article describes the structure and function of emergency mental health nursing practice for self-harming refugees and asylum seekers on Temporary Protection Visas. Emergency nurses working in accident and emergency departments or as part of crisis intervention teams will see self-harming refugees and asylum seekers at the very point of their distress. This clinical paper is intended to support nurses in their practice should they encounter an adult asylum seeker needing emergency mental health care. Practical strategies are highlighted to help mental health nurses assess, care, and comfort refugees and asylum seekers in this predicament. Mental health nurses should, where possible, work closely with asylum seekers, their support workers, and accredited interpreters and translators to ensure the appropriate use of language when dealing with mental and emotional health issues without further isolating the asylum seeker from appropriate services. To help strengthen continuity and integration of mental health supports for refugees and asylum seekers, well-resourced care must be experienced as coherent and connected. A coherent, interdisciplinary and team-orientated approach will synthesize different viewpoints to shape clinical practice and create workable solutions in local situations.
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Practical Clinical Training in Skills Labs: Theory and Practice
Bugaj, T. J.; Nikendei, C.
2016-01-01
Today, skills laboratories or “skills labs”, i.e. specific practical skill training facilities, are a firmly established part of medical education offering the possibility of training clinical procedures in a safe and fault-forging environment prior to real life application at bedside or in the operating room. Skills lab training follows a structured teaching concept, takes place under supervision and in consideration of methodological-didactic concepts, ideally creating an atmosphere that allows the repeated, anxiety- and risk-free practice of targeted skills. In this selective literature review, the first section is devoted to (I) the development and dissemination of the skills lab concept. There follows (II) an outline of the underlying idea and (III) an analysis of key efficacy factors. Thereafter, (IV) the training method’s effectiveness and transference are illuminated, before (V) the use of student tutors, in the sense of peer-assisted-learning, in skills labs is discussed separately. Finally, (VI) the efficiency of the skills lab concept is analyzed, followed by an outlook on future developments and trends in the field of skills lab training. PMID:27579363
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Shared decision making in mental health: the importance for current clinical practice.
Alguera-Lara, Victoria; Dowsey, Michelle M; Ride, Jemimah; Kinder, Skye; Castle, David
2017-12-01
We reviewed the literature on shared decision making (regarding treatments in psychiatry), with a view to informing our understanding of the decision making process and the barriers that exist in clinical practice. Narrative review of published English-language articles. After culling, 18 relevant articles were included. Themes identified included models of psychiatric care, benefits for patients, and barriers. There is a paucity of published studies specifically related to antipsychotic medications. Shared decision making is a central part of the recovery paradigm and is of increasing importance in mental health service delivery. The field needs to better understand the basis on which decisions are reached regarding psychiatric treatments. Discrete choice experiments might be useful to inform the development of tools to assist shared decision making in psychiatry.
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Paul, Sara; Page, Robert L
2016-01-01
Pharmacologic treatment for systolic heart failure, otherwise known as heart failure with reduced ejection fraction, has been established through clinical trials and is formulated into guidelines to standardize the diagnosis and treatment. The premise of pharmacologic therapy in heart failure with reduced ejection fraction is aimed primarily at interrupting the neurohormonal cascade that is responsible for altering left ventricular shape and function. This is the first in a series of articles to describe the pharmacologic agents in the guidelines that impact the morbidity and mortality associated with heart failure. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and vasodilators will be presented in the context of the mechanism of action in heart failure, investigational trials that showed beneficial effects, and the practical application for clinical use.
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An Undergraduate Research Fellowship Program to Prepare Nursing Students for Future Workforce Roles
Slattery, Mary Jo; Logan, Bridget; Mudge, Bridget; Secore, Karen; Von Reyn, LInda J.; Maue, Robert A.
2016-01-01
It is important for nurses today and for those joining the workforce in the future to have familiarity and training with respect to interprofessional research, evidence-based practice, and quality improvement. In an effort to address this need, we describe a 10-week summer research program that immerses undergraduate nursing students in a broad spectrum of clinical and translational research projects as part of their exposure to advanced nursing roles. In doing so, the program increases the ability of the students to participate in research, effectively interact with academic medical center researchers, and incorporate elements of evidence-based practice into future nursing interventions. Their mentors are nurses practicing in roles as nurse researcher, advanced practice nurses involved in evidence-based practice or quality improvement, and clinical trials research nurses. Each student is matched with 3 of these mentors and involved in 3 different projects. Through this exposure, the students benefit from observing multiple nursing roles, taking an active role in research-related activities participating in interdisciplinary learning experiences. Overall, the program provides benefits to the students, who demonstrate measured improvement with respect to the program objectives, and to their mentors and each of the participating organizations. PMID:27964811
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Gupta, Anjali; Calfas, Karen J; Marshall, Simon J; Robinson, Thomas N; Rock, Cheryl L; Huang, Jeannie S; Epstein-Corbin, Melanie; Servetas, Christina; Donohue, Michael C; Norman, Gregory J; Raab, Fredric; Merchant, Gina; Fowler, James H; Griswold, William G; Fogg, B J; Patrick, Kevin
2015-05-01
Advances in information technology and near ubiquity of the Internet have spawned novel modes of communication and unprecedented insights into human behavior via the digital footprint. Health behavior randomized controlled trials (RCTs), especially technology-based, can leverage these advances to improve the overall clinical trials management process and benefit from improvements at every stage, from recruitment and enrollment to engagement and retention. In this paper, we report the results for recruitment and retention of participants in the SMART study and introduce a new model for clinical trials management that is a result of interdisciplinary team science. The MARKIT model brings together best practices from information technology, marketing, and clinical research into a single framework to maximize efforts for recruitment, enrollment, engagement, and retention of participants into a RCT. These practices may have contributed to the study's on-time recruitment that was within budget, 86% retention at 24 months, and a minimum of 57% engagement with the intervention over the 2-year RCT. Use of technology in combination with marketing practices may enable investigators to reach a larger and more diverse community of participants to take part in technology-based clinical trials, help maximize limited resources, and lead to more cost-effective and efficient clinical trial management of study participants as modes of communication evolve among the target population of participants. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.
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Transforming community services through the use of a multidimensional model of clinical leadership.
Leigh, Jacqueline Anne; Wild, Jill; Hynes, Celia; Wells, Stuart; Kurien, Anish; Rutherford, June; Rosen, Lyn; Ashcroft, Tim; Hartley, Victoria
2015-03-01
To evaluate the application of a Multidimensional Model of Clinical Leadership on the community healthcare leader and on transforming community services. Healthcare policy advocates clinical leadership as the vehicle to transform community and healthcare services. Few studies have identified the key components of an effective clinical leadership development model. The first two stages of Kirkpatrick's (Personnel Administrator 28, 1983, 62) Four/Five Levels of Evaluation were used to evaluate the application of the multidimensional model of clinical leadership. Eighty community healthcare leaders were exposed to this multidimensional clinical leadership development model through attendance of a community clinical leadership development programme. Twenty five leaders participated in focus group interviews. Data from the interviews were analysed utilising thematic content analysis. Three key themes emerged that influenced the development of best practice principles for clinical leadership development: 1. Personal leadership development 2. Organisational leadership 3. The importance of multiprofessional action learning/reflective groups Emergent best practice principles for clinical leadership development include adopting a multidimensional development approach. This approach encompasses: preparing the individual leader in the role and seeking organisational leadership development that promotes the vision and corporate values of the organisation and delivers on service improvement and innovation. Moreover, application of the Multidimensional Model of Clinical Leadership could offer the best platform for embedding the Six C's of Nursing (Compassion in Practice - Our Culture of Compassionate Care, Department of Health, Crown Copyright, 2012) within the culture of the healthcare organisation: care, compassion, courage, commitment, communication, and competency. This is achieved in part through the application of emotional intelligence to understand self and to develop the personal integrity of the healthcare leader and through supporting a culture of lifelong leadership learning. Embedding the best practice principles of clinical leadership development within a multidimensional model of clinical leadership provides a promising approach to: equipping the healthcare leader with those transferable leadership skills required to help them embark on a journey of lifelong leadership learning; and producing the healthcare leader who is caring, compassionate and can confidently and effectively transform community services. © 2014 John Wiley & Sons Ltd.
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Infrasonic analysis of carotid vibration as a diagnostic method in carotid insufficiency syndrome.
Anastassiades, A J; Petounis, A D
1976-01-01
The infrasonic part of the spectrum of the carotid artery wall vibration in the neck was obtained. Differences between the spectral content and vibrational amplitude in normal and occluded carotids were found. The application of this technique in clinical practice could be useful in the detection of the carotid insufficiency syndrome.
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Addressing the Social Determinants of Health: A Call to Action for School Nurses
ERIC Educational Resources Information Center
Schroeder, Krista; Malone, Susan Kohl; McCabe, Ellen; Lipman, Terri
2018-01-01
Social determinants of health (SDOH), the conditions in which children are born, grow, live, work or attend school, and age, impact child health and contribute to health disparities. School nurses must consider these factors as part of their clinical practice because they significantly and directly influence child well-being. We provide clinical…
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The Sensuous Hippie Part II: Gay/Straight Differences in Regard to Drugs and Sexuality
ERIC Educational Resources Information Center
Newmeyer, John A.
1977-01-01
This paper derives from a study of sexual practices and drug use of clients of the Haight-Ashbury Free Medical Clinics in San Francisco, California. A separate paper described how "junkie" and "nonjunkie" portions of this sample differed. The present paper attempts a similar analysis of "straight" and "gay"…
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ERIC Educational Resources Information Center
Hussmann, Katja; Grande, Marion; Meffert, Elisabeth; Christoph, Swetlana; Piefke, Martina; Willmes, Klaus; Huber, Walter
2012-01-01
Although generally accepted as an important part of aphasia assessment, detailed analysis of spontaneous speech is rarely carried out in clinical practice mostly due to time limitations. The Aachener Sprachanalyse (ASPA; Aachen Speech Analysis) is a computer-assisted method for the quantitative analysis of German spontaneous speech that allows for…
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Using Response Ratios for Meta-Analyzing Single-Case Designs with Behavioral Outcomes
ERIC Educational Resources Information Center
Pustejovsky, James E.
2018-01-01
Methods for meta-analyzing single-case designs (SCDs) are needed to inform evidence-based practice in clinical and school settings and to draw broader and more defensible generalizations in areas where SCDs comprise a large part of the research base. The most widely used outcomes in single-case research are measures of behavior collected using…
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Klymenko, Iryna; Kampf, Günter
2015-01-01
Aim: Every year, millions of people around the world suffer from different infectious diseases, considerable part of which are hospital-acquired infections. WHO considers hand hygiene as a priority measure aimed to reduce the level of infection. We evaluated various aspects related to the situational behavior and prioritization regarding hand hygiene measures among the healthcare workers of Ukraine. Method: Identification of system mistakes in hand hygiene was carried out first of all by direct and indirect observation of the activities of medical and pharmaceutical personnel in their everyday practice as well as during their participation in trainings on routine hand hygiene. Questionnaires also were used to estimate the level of hand hygiene compliance of participants of the study. During this period 112 training courses, 315 master-classes and presentations on proper hand hygiene were realized. The target audience included health care workers of medical centers, clinics, maternity hospitals, health care organizations and staff of pharmacies and pharmaceutical manufacturing enterprises in all regions of Ukraine. 638 respondents took part in anonymous survey on hand hygiene practice. Results: The most common mistakes were to regard hand washing and hand disinfection equally, to wash hands before doing a hand disinfection, to neglect the five moments for hand hygiene and to ignore hand hygiene before and after wearing protective gloves. Practitioners, medical attendants, pharmacy and pharmaceutical industry workers highlighted the need for practical and understandable instructions of various hand hygiene procedures, including the clarification of the possible technical mistakes. This became a ground for us to create individual master classes on hand hygiene for each cluster of healthcare workers. Conclusions: Changing hand hygiene behavior and attitude is possible by beginning to observe clinical practice and by involving healthcare workers in teaching and training. PMID:25699224
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Ritual and ceremony in intraoperative magnetic resonance imaging-assisted brain surgery.
Gellert, Vance
2012-01-01
Previous photographic research into traditional and shamanic healing practices in Peru and Bolivia and a review of the literature suggested that all medical practices have cultural determined nonmedical activities as integral parts of the healing encounter. These include costume, ritual, ceremony, environment factors that were looked for in a western clinical encounter for this paper. A patient was followed through pre-op preparation and iMRI assisted brain surgery. All activities were photographed extensively and evaluated in a broader healing context. A number of activities were visually and metaphorically comparable with those seen in other practices. These are discussed as rituals of intention on the part of the caregivers to focus their skills on healing and also to mindfully engage the patient in the healing process. Artistic observation and analysis may be an effective way to identify these non quantifiable elements of the healing encounter and suggest directions for further research into the emotional components of the healing process. Copyright © 2012 Elsevier Inc. All rights reserved.
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WE-A-210-00: Educational: Diagnostic Ultrasound QA
DOE Office of Scientific and Technical Information (OSTI.GOV)
NONE
This presentation will focus on the present role of ultrasound medical physics in clinical practices. The first part of the presentation will provide an overview of ultrasound QC methodologies and testing procedures. A brief review of ultrasound phantoms utilized in these testing procedures will be presented. The second part of the presentation will summarize ultrasound imaging technical standards and professional guidelines by American College of Radiology (ACR), American Institute of Ultrasound in Medicine (AIUM), American Association of Physicists in Medicine (AAPM) and International Electrotechnical Commission (IEC). The current accreditation requirements by ACR and AIUM for ultrasound practices will be describedmore » and the practical aspects of implementing QC programs to be compliant with these requirements will be discussed. Learning Objectives: Achieve familiarity with common ultrasound QC test methods and ultrasound phantoms. Understand the coverage of the existing testing standards and professional guidelines on diagnostic ultrasound imaging. Learn what a medical physicist needs to know about ultrasound program accreditation and be able to implement ultrasound QC programs accordingly.« less
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Scoping the role and education needs of practice nurses in London.
Procter, Susan; Griffiths, Lauren; Fanning, Agnes; Wallman, Lizzie; Loveday, Heather P
2017-07-01
Aims To identify education priorities for practice nursing across eight London Clinical Commissioning Groups (CCGs); to identify the education, training, development and support needs of practice nurses in undertaking current and future roles. The education needs of practice nurses have long been recognised but their employment status means that accessing education requires the support of their GP employer. This study scopes the educational requirements of the practice nurse workforce and working with educational providers and commissioners describes a coherent educational pathway for practice nurses. A survey of practice nurses to scope their educational attainment needs was undertaken. Focus groups were carried out which identified the education, training, development and support needs of practice nurses to fulfil current and future roles. Findings A total of 272 respondents completed the survey. Practice nurses took part in three focus groups (n=34) and one workshop (n=39). Findings from this research indicate a practice nurse workforce which lacked career progression, role autonomy or a coherent educational framework. Practice nurses recognised the strength of their role in building relationship-centred care with patients over an extended period of time. They valued this aspect of their role and would welcome opportunities to develop this to benefit patients. This paper demonstrates an appetite for more advanced education among practice nurses, a leadership role by the CCGs in working across the whole system to address the education needs of practice nurses, and a willingness on the part of National Health Service education commissioners to commission education which meets the education needs of the practice nurse workforce. Evidence is still required, however, to inform the scope of the practice nurse role within an integrated system of care and to identify the impact of practice nursing on improving health outcomes and care of local populations.
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Vavken, Patrick; Ganal-Antonio, Anne Kathleen B.; Quidde, Julia; Shen, Francis H.; Chapman, Jens R.; Samartzis, Dino
2015-01-01
Study Design A broad narrative review. Objectives Outcome assessment in spinal disorders is imperative to help monitor the safety and efficacy of the treatment in an effort to change the clinical practice and improve patient outcomes. The following article, part two of a two-part series, discusses the various outcome tools and instruments utilized to address spinal disorders and their management. Methods A thorough review of the peer-reviewed literature was performed, irrespective of language, addressing outcome research, instruments and tools, and applications. Results Numerous articles addressing the development and implementation of health-related quality-of-life, neck and low back pain, overall pain, spinal deformity, and other condition-specific outcome instruments have been reported. Their applications in the context of the clinical trial studies, the economic analyses, and overall evidence-based orthopedics have been noted. Additional issues regarding the problems and potential sources of bias utilizing outcomes scales and the concept of minimally clinically important difference were discussed. Conclusion Continuing research needs to assess the outcome instruments and tools used in the clinical outcome assessment for spinal disorders. Understanding the fundamental principles in spinal outcome assessment may also advance the field of “personalized spine care.” PMID:26225283
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Methods to Succeed in Effective Knowledge Translation in Clinical Practice.
Kitson, Alison L; Harvey, Gillian
2016-05-01
To explore the evidence around facilitation as an intervention for the successful implementation of new knowledge into clinical practice. The revised version of the Promoting Action on Research Implementation in Health Services (PARIHS) framework, called the integrated or i-PARIHS framework, is used as the explanatory framework. This framework posits that evidence is a multidimensional construct embedded within innovation and operationalized by clinicians (individuals and within teams), working across multiple layers of context. Facilitation is the active ingredient that promotes successful implementation. An emerging body of evidence supports facilitation as a mechanism to getting new knowledge into clinical practice. Facilitation roles are divided into beginner, experienced, and expert facilitators. Facilitators can be internal or external to the organization they work in, and their skills and attributes complement other knowledge translation (KT) roles. Complex KT projects require facilitators who are experienced in implementation methods. Facilitation is positioned as the active ingredient to effectively introduce new knowledge into a clinical setting. Levels of facilitation experience are assessed in relation to the complexity of the KT task. Three core facilitation roles are identified, and structured interventions are established taking into account the nature and novelty of the evidence, the receptiveness of the clinicians, and the context or setting where the new evidence is to be introduced. Roles such as novice, experienced, and expert facilitators have important and complementary parts to play in enabling the successful translation of evidence into everyday practice in order to provide effective care for patients. © 2016 Sigma Theta Tau International.
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Egerton-Warburton, Diana; Cullen, Louise; Keijzers, Gerben; Fatovich, Daniel M
2018-06-01
Appropriate deliberate clinical inertia refers to the art of doing nothing as a positive clinical response. It includes shared decision-making to improve patient care with the use of clinical judgement. We discuss common clinical scenarios where the use of deliberate clinical inertia can occur. The insertion of peripheral intravenous cannulae, investigating patients with suspected renal colic and the investigation of low risk chest pain are all opportunities for the thoughtful clinician to 'stand there' and use effective patient communication to avoid low value tests and procedures. Awareness is key to identifying these opportunities to practice deliberate clinical inertia, as many of the situations may be so much a part of our environment that they are hidden in plain view. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
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Recommendations for the management of biofilm: a consensus document.
Bianchi, T; Wolcott, R D; Peghetti, A; Leaper, D; Cutting, K; Polignano, R; Rosa Rita, Z; Moscatelli, A; Greco, A; Romanelli, M; Pancani, S; Bellingeri, A; Ruggeri, V; Postacchini, L; Tedesco, S; Manfredi, L; Camerlingo, Maria; Rowan, S; Gabrielli, A; Pomponio, G
2016-06-01
The potential impact of biofilm on healing in acute and chronic wounds is one of the most controversial current issues in wound care. A significant amount of laboratory-based research has been carried out on this topic, however, in 2013 the European Wound Management Association (EWMA) pointed out the lack of guidance for managing biofilms in clinical practice and solicited the need for guidelines and further clinical research. In response to this challenge, the Italian Nursing Wound Healing Society (AISLeC) initiated a project which aimed to achieve consensus among a multidisciplinary and multiprofessional international panel of experts to identify what could be considered part of 'good clinical practice' with respect to the recognition and management of biofilms in acute and chronic wounds. The group followed a systematic approach, developed by the GRADE working group, to define relevant questions and clinical recommendations raised in clinical practice. An independent librarian retrieved and screened approximately 2000 pertinent published papers to produce tables of levels of evidence. After a smaller focus group had a multistep structured discussion, and a formal voting process had been completed, ten therapeutic interventions were identified as being strongly recommendable for clinical practice, while another four recommendations were graded as being 'weak'. The panel subsequently formulated a preliminary statement (although with a weak grade of agreement): 'provided that other causes that prevent optimal wound healing have been ruled out, chronic wounds are chronically infected'. All members of the panel agreed that there is a paucity of reliable, well-conducted clinical trials which have produced clear evidence related to the effects of biofilm presence. In the meantime it was agreed that expert-based guidelines were needed to be developed for the recognition and management of biofilms in wounds and for the best design of future clinical trials. This is a fundamental and urgent task for both laboratory-based scientists and clinicians.
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Adjusting for case mix and social class in examining variation in home visits between practices.
Sullivan, Caoimhe O; Omar, Rumana Z; Forrest, Christopher B; Majeed, Azeem
2004-08-01
The purpose of this study was to investigate whether adjusting for clinical case mix and social class explains more of the variation in home visits between general practices than adjusting for age and sex alone. The setting was 60 general practices in England and Wales taking part in the 1 year Fourth National Morbidity Survey. The participants comprised 349 505 patients who were registered with one of the participating general practices for at least 180 days, and who had at least one consultation during the period. The outcome measure is whether or not a patient received a home visit in that year. A clinical case mix category (morbidity class) based on 1 year's diagnostic information was assigned to each patient using the Johns Hopkins Adjusted Clinical Groups (ACG) Case Mix System. The social class measure was derived from occupation and employment status and is similar to that of the 1991 UK census. Variations in home visits between practices were examined using multilevel logistic regression models. The variability between practices before and after adjusting for clinical case mix and social class was estimated using the intracluster correlation coefficient (ICC). The overall percentage of patients receiving a home visit over the 1 year study period was 17%, and this varied from 7 to 31% across the 60 practices. The percentage of the total variation in home visits attributable to differences between practices was 2.5% [95% confidence interval (CI) 1.4-3.2%] after adjusting for age and sex. This reduced to 1.6% (95% CI 1.1-2.4%) after taking into account morbidity class. The results were similar when social class was included instead of morbidity class. Morbidity and social class together reduced variation in home visits between practices to 1.5% (95% CI 1.1-2.2%). Age, sex, social class and clinical case mix are strong determinants of home visits in the UK. Adjusting for morbidity and social class results in a small improvement in explaining the variability in home visits between practices compared with adjusting for age and sex alone. There is far more variation between patients within practices; however, it is not straightforward to examine the factors influencing this variation. In addition to morbidity and social class, there could also be other unmeasured factors such as varying patient demand for home visits, disability or differences in GP home visiting practice style that could influence the large within-practice variability observed in this study.
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Dean, Elizabeth
2009-07-01
Part II of this two-part introduction to this Special Issue on physical therapy practice in the 21st century outlines a health-focused strategy for physical therapists to lead in the assault on lifestyle conditions, global health care priorities, described in Part I. Consistent with contemporary definitions of physical therapy, its practice, professional education, and research, physical therapy needs to reflect 21st-century health priorities and be aligned with global and regional public health strategies. A proposed focus on health emphasizes clinical competencies, including assessments of health, lifestyle health behaviors, and lifestyle risk factors; and the prescription of interventions to promote health and well-being in every client or patient. Such an approach is aimed to increase the threshold for chronic conditions over the life cycle and reduce their rate of progression, thereby preventing, delaying, or minimizing the severity of illness and disability. The 21st-century physical therapist needs to be able to practice such competencies within the context of a culturally diverse society to effect positive health behavior change. The physical therapist is uniquely positioned to lead in health promotion and prevention of the lifestyle conditions, address many of their causes, as well as manage these conditions. Physical therapists need to impact health globally through public and social health policy as well as one-on-one care. This role is consistent with contemporary definitions of physical therapy as the quintessential noninvasive health care practitioner, and the established efficacy and often superiority of lifestyle and lifestyle change on health outcomes compared with invasive interventions, namely, drugs and surgery. A concerted commitment by physical therapists to health and well-being and reduced health risk is consistent with minimizing the substantial social and economic burdens of lifestyle conditions globally.
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Shin, Su Jin; Kim, Yeong Kyeong; Suh, Soon-Rim; Jung, Duk Yoo; Kim, Yunju; Yim, Mi Kyoung
2017-01-01
The purpose of this study was to analyze opinions about the action plan for implementation of clinical performance exam as part of the national nursing licensing examination and presents the expected effects of the performance exam and aspects to consider regarding its implementation. This study used a mixed-methods design. Quantitative data were collected by a questionnaire survey, while qualitative data were collected by focus group interviews with experts. The survey targeted 200 nursing professors and clinical nurses with more than 5 years of work experience, and the focus group interviews were conducted with 28 of professors, clinical instructors, and nurses at hospitals. First, nursing professors and clinical specialists agreed that the current written tests have limitations in evaluating examinees' ability, and that the introduction of a clinical performance exam will yield positive results. Clinical performance exam is necessary to evaluate and improve nurses' work ability, which means that the implementation of a performance exam is advisable if its credibility and validity can be verified. Second, most respondents chose direct performance exams using simulators or standardized patients as the most suitable format of the test. In conclusion, the current national nursing licensing exam is somewhat limited in its ability to identify competent nurses. Thus, the time has come for us to seriously consider the introduction of a performance exam. The prerequisites for successfully implementing clinical performance exam as part of the national nursing licensing exam are a professional training process and forming a consortium to standardize practical training.
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2017-01-01
Purpose The purpose of this study was to analyze opinions about the action plan for implementation of clinical performance exam as part of the national nursing licensing examination and presents the expected effects of the performance exam and aspects to consider regarding its implementation. Methods This study used a mixed-methods design. Quantitative data were collected by a questionnaire survey, while qualitative data were collected by focus group interviews with experts. The survey targeted 200 nursing professors and clinical nurses with more than 5 years of work experience, and the focus group interviews were conducted with 28 of professors, clinical instructors, and nurses at hospitals. Results First, nursing professors and clinical specialists agreed that the current written tests have limitations in evaluating examinees’ ability, and that the introduction of a clinical performance exam will yield positive results. Clinical performance exam is necessary to evaluate and improve nurses’ work ability, which means that the implementation of a performance exam is advisable if its credibility and validity can be verified. Second, most respondents chose direct performance exams using simulators or standardized patients as the most suitable format of the test. Conclusion In conclusion, the current national nursing licensing exam is somewhat limited in its ability to identify competent nurses. Thus, the time has come for us to seriously consider the introduction of a performance exam. The prerequisites for successfully implementing clinical performance exam as part of the national nursing licensing exam are a professional training process and forming a consortium to standardize practical training. PMID:29129904
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Basics of Compounding: Clinical Pharmaceutics, Part 1.
Allen, Loyd V
2016-01-01
Pharmaceutics is relevant far beyond the pharmaceutical industry, compounding, and the laboratory. Pharmaceutics can be used to solve many clinical problems in medication therapy. A pharmacists' knowledge of the physicochemical aspects of drugs and drug products should help the patient, physician, and healthcare professionals resolve issues in the increasingly complex world of modern medicine. Pharmacy is unique as it contains a knowledge base significantly different from that of physicians, nurses, and other health-related practitioners. The separation of the science and the practice of pharmacy have prevented the complete utilization of pharmaceutical sciences in the clinical environment far too long. Copyright© by International Journal of Pharmaceutical Compounding, Inc.
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Calle Rubio, Myriam; López-Campos, José Luis; Soler-Cataluña, Juan J; Alcázar Navarrete, Bernardino; Soriano, Joan B; Rodríguez González-Moro, José Miguel; Fuentes Ferrer, Manuel E; Rodríguez Hermosa, Juan Luis
2017-12-02
Clinical audits have reported considerable variability in COPD medical care and frequent inconsistencies with recommendations. The objectives of this study were to identify factors associated with a better adherence to clinical practice guidelines and to explore determinants of this variability at the the hospital level. EPOCONSUL is a Spanish nationwide clinical audit that evaluates the outpatient management of COPD. Multilevel logistic regression with two levels was performed to assess the relationships between individual and disease-related factors, as well as hospital characteristics. A total of 4508 clinical records of COPD patients from 59 Spanish hospitals were evaluated. High variability was observed among hospitals in terms of medical care. Some of the patient's characteristics (airflow obstruction, degree of dyspnea, exacerbation risk, presence of comorbidities), the hospital factors (size and respiratory nurses available) and treatment at a specialized COPD outpatient clinic were identified as factors associated with a better adherence to recommendations, although this only explains a small proportion of the total variance. To be treated at a specialized COPD outpatient clinic and some intrinsic patient characteristics were factors associated with a better adherence to guideline recommendations, although these variables were only explaining part of the high variability observed among hospitals in terms of COPD medical care.
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Boardman, Gayelene; Lawrence, Karen; Polacsek, Meg
2018-06-13
Providing nursing students with appropriate clinical practice during their undergraduate programme is critical to ensuring that graduates meet the competency requirements to gain registration as a nurse. In response to the predicted nursing workforce shortage, universities have been significantly increasing the enrolment of undergraduate nurses into Bachelor of Nursing courses. This has placed a demand on the availability of clinical placements and often universities struggle to find appropriate places. In this study, a Bachelor of Nursing course incorporated an Integrated Clinical Learning Model (ICLM) for the first time during a mental health placement. The model offered students the flexibility of attending their clinical placement over a 16-week period instead of a traditional block of 4 weeks. The aim of this study was to evaluate the student perspective of this model and whether it prepared them for the nursing workforce. Focus groups were conducted with undergraduate nursing students following their mental health clinical placement at an acute and extended care inpatient unit. Data were analysed using thematic analysis. Main themes included preparedness for practice, maintaining a work-life balance, and perceiving they were part of a team. The ICLM deepened students' knowledge and had a positive impact on their overall clinical learning. © 2018 Australian College of Mental Health Nurses Inc.
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Improving the Effectiveness of Electronic Health Record-Based Referral Processes
2012-01-01
Electronic health records are increasingly being used to facilitate referral communication in the outpatient setting. However, despite support by technology, referral communication between primary care providers and specialists is often unsatisfactory and is unable to eliminate care delays. This may be in part due to lack of attention to how information and communication technology fits within the social environment of health care. Making electronic referral communication effective requires a multifaceted “socio-technical” approach. Using an 8-dimensional socio-technical model for health information technology as a framework, we describe ten recommendations that represent good clinical practices to design, develop, implement, improve, and monitor electronic referral communication in the outpatient setting. These recommendations were developed on the basis of our previous work, current literature, sound clinical practice, and a systems-based approach to understanding and implementing health information technology solutions. Recommendations are relevant to system designers, practicing clinicians, and other stakeholders considering use of electronic health records to support referral communication. PMID:22973874
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Exploring the role of children's dreams in psychoanalytic practice today: a pilot study.
Lempen, Olivia; Midgley, Nick
2006-01-01
The aim of this research study was to investigate the role of children's dreams in the practice of child psychoanalysis today, and to explore contemporary psychoanalytic understanding of children's dreams. This pilot study consisted of two stages. The first involved a document analysis of published articles in The Psychoanalytic Study of the Child, making a comparison between those of the early 1950s and the 1990s, in order to see in what way the discourse around children's dreams within the psychoanalytic literature has changed over time. The second stage, based on questionnaires and in-depth interviews, attempted to understand in more detail the way contemporary child analysts, working in the Anna Freudian tradition, think about dreams and use them in their clinical practice. Results suggest that there has been a decreased focus on dreams in a clinical context over time, and that this may partly be a consequence of changing theoretical models and changes in training. When work with dreams does take place, it appears that child analysts have
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Bender, Miriam; Williams, Marjory; Su, Wei
2016-01-01
The Clinical Nurse Leader™ (CNL) initiative is in its 2nd decade. Despite a growing theoretical and empirical body of CNL knowledge, little is known about CNLs themselves or where and how their competencies are being integrated into care delivery across the country. The aim of this study was to describe certified CNL characteristics and roles as part of a larger study validating a model for CNL practice. This study used a descriptive analysis of survey data from a national sample of certified CNLs. Survey response rate was 19%. Sixty percent have greater than 10 years of RN experience, and 75% have additional specialty certifications. Fifty-eight percent are practicing in a formal CNL role and report a high degree of accountability for all 9 CNL essential competencies. Findings help understand the extent of CNL adoption and spread across the country and the level to which the initial vision of CNL practice is being achieved.
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Beyond Googling: The Ethics of Using Patients' Electronic Footprints in Psychiatric Practice.
Fisher, Carl E; Appelbaum, Paul S
Electronic communications are an increasingly important part of people's lives, and much information is accessible through such means. Anecdotal clinical reports indicate that mental health professionals are beginning to use information from their patients' electronic activities in treatment and that their data-gathering practices have gone far beyond simply searching for patients online. Both academic and private sector researchers are developing mental health applications to collect patient information for clinical purposes. Professional societies and commentators have provided minimal guidance, however, about best practices for obtaining or using information from electronic communications or other online activities. This article reviews the clinical and ethical issues regarding use of patients' electronic activities, primarily focusing on situations in which patients share information with clinicians voluntarily. We discuss the potential uses of mental health patients' electronic footprints for therapeutic purposes, and consider both the potential benefits and the drawbacks and risks. Whether clinicians decide to use such information in treating any particular patient-and if so, the nature and scope of its use-requires case-by-case analysis. But it is reasonable to assume that clinicians, depending on their circumstances and goals, will encounter circumstances in which patients' electronic activities will be relevant to, and useful in, treatment.
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Kubota, Rie; Shibuya, Kiyoshi; Tanaka, Yoichi; Aoki, Manahito; Shiomi, Megumi; Ando, Wataru; Otori, Katsuya; Komiyama, Takako
2018-06-01
The Japanese pharmaceutical curriculum was extended from four to six years in 2006. Students now receive practical communication-skills training in their fourth year, before progressing to train in hospital and community pharmacies in their fifth year. Kitasato University School of Pharmacy, Tokyo, had established a program to meet these aims before the 2006 guidance. In the present study, we discuss and evaluate the features of this communication-skills training program. This study enrolled 242 fourth-year pharmacy students at Kitasato University. Students filled out a questionnaire survey after completing the laboratory element of their undergraduate education. As part of training, students were asked to obtain patient data from a model medical chart, before performing simulated patient interviews covering hospital admission and patient counseling. These simulations were repeated in a small group, and feedback was provided to students by both the simulated patient and the faculty after each presentation. It was found that students were able to develop their communication skills through this approach. Thus, an effective system of gradual and continuous training has been developed, which allows students to acquire clinical and practical communication skills.
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Special care dentistry for general dental practice.
Greig, Vicki; Sweeney, Petrina
2013-01-01
Although special care dentistry (SCD) is a fairly recent specialty, the principles and practice of SCD have been developed since the 1980s. Shared care of these patients with general dental practitioners remains vital to ensure that comprehensive care is provided. This article aims to discuss some of the patient groups commonly seen in SCD clinics and give an insight into the varied complex medical and social aspects of care which are managed as part of providing appropriate, safe and holistic care. Many patients who currently fall under the remit of special care dentistry could be treated safely in general dental practice. This article acts as an introduction to special care dentistry for general dental practitioners.
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Entrepreneurs: leading the way to pharmacy's future.
Martin, Caren McHenry
2011-12-01
Entrepreneurship has always been central to the practice of pharmacy. Whether opening a new retail store, setting up a unique clinic practice, or researching a novel therapy, pharmacists are continually looking forward and following their visions of how pharmacy can be part of a new direction in health care. In 2011, the American Society of Consultant Pharmacists (ASCP) Foundation--itself the product of entrepreneurship--awarded grants to three entrepreneurs who are seeking to establish a fee-for-service component of their senior care pharmacy practices in the community. The grant recipients, while differing in their approaches, share the common goal of providing safe, effective, and cost-justified medication therapy and education to ambulatory older adults.
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Measuring the Cost of the Patient-Centered Medical Home: A Cost-Accounting Approach.
Lieberthal, Robert D; Payton, Colleen; Sarfaty, Mona; Valko, George
To explore the cost for individual practices to become more patient-centered, we inventoried and calculated the cost of costly activities involved in implementing the Patient-Centered Medical Home (PCMH) as defined by the National Committee for Quality Assurance. There were 3 key findings. The cost of each PCMH-related clinical activity can be classified in 1 of 3 major categories. Cost offsets can be used to defray part of the cost recognition. The cost of PCMH transformation varied by practice with no clear level or pattern of costs. Our study suggests that small- and medium-sized practices may experience difficulty with the financial burden of PCMH recognition.
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Engaging clinical nurses in quality and performance improvement activities.
Albanese, Madeline P; Evans, Dietra A; Schantz, Cathy A; Bowen, Margaret; Disbot, Maureen; Moffa, Joseph S; Piesieski, Patricia; Polomano, Rosemary C
2010-01-01
Nursing performance measures are an integral part of quality initiatives in acute care; however, organizations face numerous challenges in developing infrastructures to support quality improvement processes and timely dissemination of outcomes data. At the Hospital of the University of Pennsylvania, a Magnet-designated organization, extensive work has been conducted to incorporate nursing-related outcomes in the organization's quality plan and to integrate roles for clinical nurses into the Department of Nursing and organization's core performance-based programs. Content and strategies that promote active involvement of nurses and prepare them to be competent and confident stakeholders in quality initiatives are presented. Engaging clinical nurses in the work of quality and performance improvement is essential to achieving excellence in clinical care. It is important to have structures and processes in place to bring meaningful data to the bedside; however, it is equally important to incorporate outcomes into practice. When nurses are educated about performance and quality measures, are engaged in identifying outcomes and collecting meaningful data, are active participants in disseminating quality reports, and are able to recognize the value of these activities, data become one with practice.
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Federal Register 2010, 2011, 2012, 2013, 2014
2013-12-10
...This major final rule with comment period addresses changes to the physician fee schedule, clinical laboratory fee schedule, and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule with comment period also includes a discussion in the Supplementary Information regarding various programs. (See the Table of Contents for a listing of the specific issues addressed in the final rule with comment period.)
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2011-01-01
Background The goal of this study was to assess potential differences between administrators/policymakers and those involved in direct practice regarding factors believed to be barriers or facilitating factors to evidence-based practice (EBP) implementation in a large public mental health service system in the United States. Methods Participants included mental health system county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. As part of concept mapping procedures, brainstorming groups were conducted with each target group to identify specific factors believed to be barriers or facilitating factors to EBP implementation in a large public mental health system. Statements were sorted by similarity and rated by each participant in regard to their perceived importance and changeability. Multidimensional scaling, cluster analysis, descriptive statistics and t-tests were used to analyze the data. Results A total of 105 statements were distilled into 14 clusters using concept-mapping procedures. Perceptions of importance of factors affecting EBP implementation varied between the two groups, with those involved in direct practice assigning significantly higher ratings to the importance of Clinical Perceptions and the impact of EBP implementation on clinical practice. Consistent with previous studies, financial concerns (costs, funding) were rated among the most important and least likely to change by both groups. Conclusions EBP implementation is a complex process, and different stakeholders may hold different opinions regarding the relative importance of the impact of EBP implementation. Implementation efforts must include input from stakeholders at multiple levels to bring divergent and convergent perspectives to light. PMID:21899754
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Green, Amy E; Aarons, Gregory A
2011-09-07
The goal of this study was to assess potential differences between administrators/policymakers and those involved in direct practice regarding factors believed to be barriers or facilitating factors to evidence-based practice (EBP) implementation in a large public mental health service system in the United States. Participants included mental health system county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. As part of concept mapping procedures, brainstorming groups were conducted with each target group to identify specific factors believed to be barriers or facilitating factors to EBP implementation in a large public mental health system. Statements were sorted by similarity and rated by each participant in regard to their perceived importance and changeability. Multidimensional scaling, cluster analysis, descriptive statistics and t-tests were used to analyze the data. A total of 105 statements were distilled into 14 clusters using concept-mapping procedures. Perceptions of importance of factors affecting EBP implementation varied between the two groups, with those involved in direct practice assigning significantly higher ratings to the importance of Clinical Perceptions and the impact of EBP implementation on clinical practice. Consistent with previous studies, financial concerns (costs, funding) were rated among the most important and least likely to change by both groups. EBP implementation is a complex process, and different stakeholders may hold different opinions regarding the relative importance of the impact of EBP implementation. Implementation efforts must include input from stakeholders at multiple levels to bring divergent and convergent perspectives to light.
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Tan, Sin Yee; Hatah, Ernieda
2017-04-01
Background Research utilization is part of evidence-based practice referring to the process of reviewing and critiquing scientific research and applying the findings to one's own clinical practice. Many studies on research utilization have been conducted with doctors and nurses, but to our knowledge, none have been investigated amongst pharmacists. Objective To assess research utilization and its barriers among pharmacists and identify potential influencing factors. Setting Malaysia. Methods This cross-sectional survey was administered online and by mail to a convenient sample of pharmacists working in hospitals, health clinics, and retail pharmacies in rural and urban areas. Main outcome measure Pharmacists' research utilization knowledge, attitudes, and practices. Results Six hundred surveys were mailed to potential respondents, and 466 were returned (77.7% response rate). Twenty-eight respondents completed the survey online. The respondents' research utilization knowledge, attitudes, and practices were found to be moderate. Research utilization was associated with respondents' knowledge and attitude scores (P < 0.001). When factors related to research utilization were modelled, higher educational level was associated with higher level of research utilization (P < 0.001) while less involvement in journal clubs, more years of service (3-7 years and more than 7 years) were associated with low and moderate research utilization, respectively. The main reported barrier to research utilization was lack of sufficient authority to change patient care procedures. Conclusion Pharmacists' research utilization knowledge, attitudes, and practices can be improved by encouraging pharmacists to pursue higher degrees, promoting active participation in institutions' journal clubs, and introducing senior clinical pharmacist specialization.
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Using knowledge as the basis for evidence-based practice in primary care nurses.
Bennasar-Veny, M; Gonzalez-Torrente, S; De Pedro-Gomez, J; Morales-Asencio, J M; Pericas-Beltran, J
2016-06-01
The aim of this study was to explore the perception of primary care nurses regarding the need and use of knowledge from research, as a basis for evidence-based practice in their workplace. Additionally, the study aimed to determine which factors might hinder or enable implementation into daily practice. Evidence-based practice involves integrating best results in research with clinical experience, which enables us to provide a higher quality of care, as well as to optimize the care given. International studies show that nurses feel that there are still many barriers that hinder their doing research and incorporating new findings into clinical practice; although in the field of primary care, few studies have been carried out. This descriptive qualitative study design used focus groups to collect data. This study was carried out in Spanish primary care centres. Forty-six registered nurses took part in this study and were divided into five focus groups. Three significant themes emerged: awareness of the need to use research, nurses as knowledge-generation agents and motivation to use research despite barriers. A limited number of participants and a convenience sample were used. Nurses recognize that professional health care must be based on evidence obtained from daily work - both originated by their colleagues and by themselves - and they are willing to work on it although they perceive a lack of competence for this purpose and demand support from their institutions. Primary care institutions should empower nursing coordinators as leaders of evidence-based practice and implicate clinical nurses from the beginning on the implementation of guidelines. © 2016 International Council of Nurses.
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Hickel, Reinhard; Roulet, Jean-François; Bayne, Stephen; Heintze, Siegward D; Mjör, Ivar A; Peters, Mathilde; Rousson, Valentin; Randall, Ros; Schmalz, Gottfried; Tyas, Martin; Vanherle, Guido
2007-01-01
About 35 years ago, Ryge provided a practical approach to the evaluation of the clinical performance of restorative materials. This systematic approach was soon universally accepted. While that methodology has served us well, a large number of scientific methodologies and more detailed questions have arisen that require more rigor. Current restorative materials have vastly improved clinical performance, and any changes over time are not easily detected by the limited sensitivity of the Ryge criteria in short-term clinical investigations. However, the clinical evaluation of restorations not only involves the restorative material per se but also different operative techniques. For instance, a composite resin may show good longevity data when applied in conventional cavities but not in modified operative approaches. Insensitivity, combined with the continually evolving and nonstandard investigator modifications of the categories, scales, and reporting methods, has created a body of literature that is extremely difficult to interpret meaningfully. In many cases, the insensitivity of the original Ryge methods leads to misinterpretation as good clinical performance. While there are many good features of the original system, it is now time to move on to a more contemporary one. The current review approaches this challenge in two ways: (1) a proposal for a modern clinical testing protocol for controlled clinical trials, and (2) an in-depth discussion of relevant clinical evaluation parameters, providing 84 references that are primarily related to issues or problems for clinical research trials. Together, these two parts offer a standard for the clinical testing of restorative materials/procedures and provide significant guidance for research teams in the design and conduct of contemporary clinical trials. Part 1 of the review considers the recruitment of subjects, restorations per subject, clinical events, validity versus bias, legal and regulatory aspects, rationales for clinical trial designs, guidelines for design, randomization, number of subjects, characteristics of participants, clinical assessment, standards and calibration, categories for assessment, criteria for evaluation, and supplemental documentation. Part 2 of the review considers categories of assessment for esthetic evaluation, functional assessment, biological responses to restorative materials, and statistical analysis of results. The overall review represents a considerable effort to include a range of clinical research interests over the past years. As part of the recognition of the importance of these suggestions, the review is being published simultaneously in identical form in both the Journal of Adhesive Dentistry and Clinical Oral Investigations. Additionally, an extended abstract will be published in the International Dental Journal, giving a link to the web full version. This should help to introduce these considerations more quickly to the scientific community.
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Revenue cycle management, Part II.
Crew, Matt
2007-01-01
The proper management of your revenue cycle requires the application of "best practices" and the continual monitoring and measuring of the entire cycle. The correct technology will enable you to gain the insight and efficiencies needed in the ever-changing healthcare economy. The revenue cycle is a process that begins when you negotiate payor contracts, set fees, and schedule appointments and continues until claims are paid in full. Every single step in the cycle carries equal importance. Monitoring all phases and a commitment to continually communicating the results will allow you to achieve unparalleled success. In part I of this article, we explored the importance of contracting, scheduling, and case management as well as coding and clinical documentation. We will now take a closer look at the benefits charge capture, claim submission, payment posting, accounts receivable follow-up, and reporting can mean to your practice.
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Sweet, Jerry J; Benson, Laura M; Nelson, Nathaniel W; Moberg, Paul J
2015-01-01
The current survey updated professional practice and income information pertaining to clinical neuropsychology. Doctoral-level members of the American Academy of Clinical Neuropsychology, Division 40 (Clinical Neuropsychology) of the American Psychological Association, and the National Academy of Neuropsychology and other neuropsychologists, as well as postdoctoral trainees in the Association of Postdoctoral Programs in Clinical Neuropsychology and at other training sites were invited to participate in a web-based survey in early 2015. The sample of 1777 respondents, of whom 1579 were doctoral-level practitioners and 198 were postdoctoral trainees, was larger than the prior 2010 income and practice survey. The substantial proportional change in gender has continued, with women now a clear majority in the postdoctoral trainee sample as well as in the practitioner sample. Dissimilar from the median age trajectory of American Psychological Association members, the median age of clinical neuropsychologists remains essentially unchanged since 1989, indicating a substantial annual influx of young neuropsychologists. The question of whether the Houston Conference training model has become an important influence in the specialty can now be considered settled in the affirmative among postdoctoral trainees and practitioners. Testing assistant usage remains commonplace, and continues to be more common in institutions. The vast majority of clinical neuropsychologists work full-time and very few are unemployed and seeking employment. The numbers of neuropsychologists planning to retire in the coming 5-10 years do not suggest a "baby boomer" effect or an unexpected bolus of planned retirements in the next 10 years that would be large enough to be worrisome. Average length of time reported for evaluations appears to be increasing across time. The most common factors affecting evaluation length were identified, with the top three being: (1) goal of evaluation, (2) stamina/health of examinee, and (3) age of examinee. Pediatric specialists remain more likely than others to work part-time, more likely to work in institutions, report lower incomes than respondents with a lifespan professional identity, and are far more likely to be women. Incomes continue to vary considerably by years of clinical practice, work setting, amount of forensic practice, state, and region of country. Neurologists are the number one referral source in institutions and in private practice, as well as for pediatric, adult, and lifespan practitioners. Learning disability is no longer among the top five conditions seen by pediatric neuropsychologists; traumatic brain injury and seizure disorder are common reasons for clinical evaluations at all age ranges. There is a continued increase in forensic practice and a clear consensus on the use of validity testing. There is a substantial interest in subspecialization board certification, with the greatest interest evident among postdoctoral trainees. Income satisfaction, job satisfaction, and work-life balance satisfaction are higher for men. Job satisfaction varies across general work setting and across age range of practice. Work-life balance satisfaction is moderately correlated with income satisfaction and job satisfaction. Again in this five-year interval survey, a substantial majority of respondents reported increased incomes, despite experiencing substantial negative practice effects related to changes in the US health care system. Numerous breakdowns related to income and professional activities are provided. Professional practice survey information continues to provide valuable perspectives regarding consistency and change in the activities, beliefs, and incomes of US clinical neuropsychologists.
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Mehta, V; Kushniruk, A; Gauthier, S; Richard, Y; Deland, E; Veilleux, M; Grant, A
1998-01-01
The Autocontrol Project is concerned with the accessing, processing and communication of high quality information so that a clinical team can make and implement decisions for practice change, and then evaluate if improvement has been achieved. High quality information is used as evidence for change. In this study, we have evaluated how evidence is used by a clinical team to explain an identified problem of inappropriate use of blood gas tests. In an experimental study of the Surgical Intensive Care Unit, video recordings of team meetings of nurses and doctors were undertaken, structured according to a problem-based format. Evidence of current practice patterns derived from the hospital information system, as well as the results of a questionnaire to the unit's staff about knowledge and use of blood gas measurements, were supplied to the participants beforehand. At the second meeting, the output of the first meetings and a summarised analysis of pertinent literature were made available. This second meeting was required to finalise the list of causes of inappropriate blood gas use and propose pragmatic strategies for practice change. The video data of the meetings were coded to analyse the use of evidence, the categories of causes, issues and solutions proposed, and the quality of team interaction. The results indicate that in order to achieve consensus, the team used different types of evidence, including objective evidence of practice patterns, personal experience about direct and indirect organisational influences, and literature-based research evidence of best practice. Furthermore, group dynamics were favoured by the problem-based meeting structure, and a high level of cognitive critiquing between team members was observed. This research suggests that a combination of approaches involving identification of both operational factors (e.g. appropriate access to different types of evidence and meeting structure) and cognitive and behavioural approaches (e.g. ensuring expression of different viewpoints) is needed to support strategic decision-making for practice change in a clinical unit. This combined approach should favourably influence the provision of an effective and efficient evidence support environment for the clinical team.
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Diversity, Conflict, and Recognition in Hospital Medical Practice.
Fortin, Sylvie; Maynard, Serge
2018-03-01
The hospital is a place of encounter between health care providers, patients and family members, the healthy and the suffering, migrants and non-migrants, as well as social and cultural minorities, and majorities of various backgrounds. It is also a space where multiple conceptions of care, life, quality of life, and death are enacted, sometimes inhibiting mutual understanding between caregivers and the cared for, a scenario that in turn may provoke conflict. Through the lens of conflict, we explore in this article the theme of Otherness within the clinic, basing analysis on an ethnographic study conducted in recent years in three cosmopolitan Canadian cities. Daily practices and-on a larger scale-the social space of the clinic become material here for reflecting on recognition (and non-recognition) of the Other as actors in the clinical encounter. The examination of structural and situational conditions that contribute to the emergence of conflict offers an understanding of the diversity of values that pervade the clinic. By way of conclusion, we argue that recognition of diversity, at least on the part of practitioners, is a key condition for the emergence of a pluralist normativity in the social space of the clinic.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Pullum, Laura L; Hobson, Tanner C
We examine the use of electronic healthcare reimbursement claims (EHRC) for analyzing healthcare delivery and practice patterns across the United States (US). By analyzing over 1 billion EHRCs, we track patterns of clinical procedures administered to patients with heart disease (HD) using sequential pattern mining algorithms. Our analyses reveal that the clinical procedures performed on HD patients are highly varied leading up to and after the primary diagnosis. The discovered clinical procedure sequences reveal significant differences in the overall costs incurred across different parts of the US, indicating significant heterogeneity in treating HD patients. We show that a data-driven approachmore » to understand patient specific clinical trajectories constructed from EHRC can provide quantitative insights into how to better manage and treat patients.« less
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Sellers, Edward M
2018-02-01
This article brings to the attention of drug developers the Food and Drug Administration's (FDA's) recent final Guidance to Industry on Assessment of Abuse Potential and provides practical suggestions about compliance with the Guidance. The Guidance areas are reviewed, analyzed, and placed in the context of current scientific knowledge and best practices to mitigate regulatory risk. The Guidance provides substantial new detail on what needs to be done at all stages of drug development for central nervous system-active drugs. However, because many psychopharmacologic agents have unique preclinical and clinical features, the plan for each agent needs to be not only carefully prepared but also reviewed and approved by the FDA. Examples are provided where assumptions about interpretation of the Guidance can delay development. If the expertise and experience needed for assessing abuse potential during drug development do not exist within a company, external preclinical and clinical expert should be involved. Consultation with the FDA is encouraged and important because the specific requirements for each drug will vary.
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Stokes, Caroline S; Lammert, Frank; Volmer, Dietrich A
2018-02-01
A plethora of contradictory research surrounds vitamin D and its influence on health and disease. This may, in part, result from analytical difficulties with regard to measuring vitamin D metabolites in serum. Indeed, variation exists between analytical techniques and assays used for the determination of serum 25-hydroxyvitamin D. Research studies into the effects of vitamin D on clinical endpoints rely heavily on the accurate assessment of vitamin D status. This has important implications, as findings from vitamin D-related studies to date may potentially have been hampered by the quantification techniques used. Likewise, healthcare professionals are increasingly incorporating vitamin D testing and supplementation regimens into their practice, and measurement errors may be also confounding the clinical decisions. Importantly, the Vitamin D Standardisation Programme is an initiative that aims to standardise the measurement of vitamin D metabolites. Such a programme is anticipated to eliminate the inaccuracies surrounding vitamin D quantification. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
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I PREPARE: development and clinical utility of an environmental exposure history mnemonic.
Paranzino, Grace K; Butterfield, Patricia; Nastoff, Teresa; Ranger, Cherryll
2005-01-01
The I PREPARE environmental exposure history mnemonic is a quick reference tool created for primary care providers. Health care providers (N = 159) were asked to evaluate a prototype mnemonic, to suggest new health history questions, and to propose the deletion of less relevant questions. The goal of this evaluation was to create a practical and clinically relevant mnemonic, rather than to obtain quantitative estimates of validity. The final I PREPARE mnemonic cues the provider to "Investigate potential exposures;" ask questions related to "Present work," "Residence," "Environmental concerns," "Past work," and "Activities;" provide "Referrals and resources;" and "Educate" the patient by reviewing a checklist of strategies to prevent or minimize exposures. The sequence of I PREPARE makes intuitive sense by cueing the provider to ask specific questions and provide educational materials to the patient. National improvements in the quality of environmental exposure history data are predicated in part on the creation of simple and convenient tools for use in clinical practice.
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International definition of a point-of-care test in family practice: a modified e-Delphi procedure.
Schols, Angel M R; Dinant, Geert-Jan; Hopstaken, Rogier; Price, Christopher P; Kusters, Ron; Cals, Jochen W L
2018-01-29
The use of point-of-care tests (POCTs) in family practice is increasing, and the term POCT is often used in medical literature and clinical practice. Yet, no widely supported definition by several professional fields exists. To reach consensus on an international definition of a POCT in family practice. We performed a modified international e-Delphi procedure of four rounds among expert panel members from different professional backgrounds-family practitioners, laboratory specialists, policymakers, researchers and manufacturers. Of 27 panel members from seven different countries, 26 participated in all rounds. Most panel members were active in POCT research or policymaking and 70% worked in family medicine. After choosing important components, structuring of answers and feedback, the following definition was chosen as the best or second best definition by 81% of panel members: a point-of-care test in family practice is a test to support clinical decision making, which is performed by a qualified member of the practice staff nearby the patient and on any part of the patient's body or its derivatives, during or very close to the time of consultation, to help the patient and physician to decide upon the best suited approach, and of which the results should be known at the time of the clinical decision making. The definition emerging from this study can inform family practitioners, laboratory specialists, policymakers and manufacturers on the most widely supported and recognized definition and could act as a clear starting point for the organization and execution of professional point-of-care testing in family practice worldwide. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Exploring resilience in rural GP registrars--implications for training.
Walters, Lucie; Laurence, Caroline O; Dollard, Joanne; Elliott, Taryn; Eley, Diann S
2015-07-02
Resilience can be defined as the ability to rebound from adversity and overcome difficult circumstances. General Practice (GP) registrars face many challenges in transitioning into general practice, and additional stressors and pressures apply for those choosing a career in rural practice. At this time of international rural generalist medical workforce shortages, it is important to focus on the needs of rural GP registrars and how to support them to become resilient health care providers. This study sought to explore GP registrars' perceptions of their resilience and strategies they used to maintain resilience in rural general practice. In this qualitative interpretive research, semi-structured interviews were recorded, transcribed and analysed using an inductive approach. Initial coding resulted in a coding framework which was refined using constant comparison and negative case analysis. Authors developed consensus around the final conceptual model. Eighteen GP registrars from: Australian College of Rural and Remote Medicine Independent Pathway, and three GP regional training programs with rural training posts. Six main themes emerged from the data. Firstly, rural GP registrars described four dichotomous tensions they faced: clinical caution versus clinical courage; flexibility versus persistence; reflective practice versus task-focused practice; and personal connections versus professional commitment. Further themes included: personal skills for balance which facilitated resilience including optimistic attitude, self-reflection and metacognition; and finally GP registrars recognised the role of their supervisors in supporting and stretching them to enhance their clinical resilience. Resilience is maintained as on a wobble board by balancing professional tensions within acceptable limits. These limits are unique to each individual, and may be expanded through personal growth and professional development as part of rural general practice training.
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Manspeaker, Sarah; Van Lunen, Bonnie
2011-01-01
Context: The need to include evidence-based practice (EBP) concepts in entry-level athletic training education is evident as the profession transitions toward using evidence to inform clinical decision making. Objective: To evaluate athletic training educators' experience with implementation of EBP concepts in Commission on Accreditation of Athletic Training Education (CAATE)-accredited entry-level athletic training education programs in reference to educational barriers and strategies for overcoming these barriers. Design: Qualitative interviews of emergent design with grounded theory. Setting: Undergraduate CAATE-accredited athletic training education programs. Patients or Other Participants: Eleven educators (3 men, 8 women). The average number of years teaching was 14.73 ± 7.06. Data Collection and Analysis: Interviews were conducted to evaluate perceived barriers and strategies for overcoming these barriers to implementation of evidence-based concepts in the curriculum. Interviews were explored qualitatively through open and axial coding. Established themes and categories were triangulated and member checked to determine trustworthiness. Results: Educators identified 3 categories of need for EBP instruction: respect for the athletic training profession, use of EBP as part of the decision-making toolbox, and third-party reimbursement. Barriers to incorporating EBP concepts included time, role strain, knowledge, and the gap between clinical and educational practices. Suggested strategies for surmounting barriers included identifying a starting point for inclusion and approaching inclusion from a faculty perspective. Conclusions: Educators must transition toward instruction of EBP, regardless of barriers present in their academic programs, in order to maintain progress with other health professions' clinical practices and educational standards. Because today's students are tomorrow's clinicians, we need to include EBP concepts in entry-level education to promote critical thinking, inspire potential research interest, and further develop the available body of knowledge in our growing clinical practice. PMID:22488139
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Manspeaker, Sarah; Van Lunen, Bonnie
2011-01-01
The need to include evidence-based practice (EBP) concepts in entry-level athletic training education is evident as the profession transitions toward using evidence to inform clinical decision making. To evaluate athletic training educators' experience with implementation of EBP concepts in Commission on Accreditation of Athletic Training Education (CAATE)-accredited entry-level athletic training education programs in reference to educational barriers and strategies for overcoming these barriers. Qualitative interviews of emergent design with grounded theory. Undergraduate CAATE-accredited athletic training education programs. Eleven educators (3 men, 8 women). The average number of years teaching was 14.73 ± 7.06. Interviews were conducted to evaluate perceived barriers and strategies for overcoming these barriers to implementation of evidence-based concepts in the curriculum. Interviews were explored qualitatively through open and axial coding. Established themes and categories were triangulated and member checked to determine trustworthiness. Educators identified 3 categories of need for EBP instruction: respect for the athletic training profession, use of EBP as part of the decision-making toolbox, and third-party reimbursement. Barriers to incorporating EBP concepts included time, role strain, knowledge, and the gap between clinical and educational practices. Suggested strategies for surmounting barriers included identifying a starting point for inclusion and approaching inclusion from a faculty perspective. Educators must transition toward instruction of EBP, regardless of barriers present in their academic programs, in order to maintain progress with other health professions' clinical practices and educational standards. Because today's students are tomorrow's clinicians, we need to include EBP concepts in entry-level education to promote critical thinking, inspire potential research interest, and further develop the available body of knowledge in our growing clinical practice.
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Gutierrez, Dennis; Kaplan, Sandra L
2016-01-01
A hospital-based pediatric outpatient center, wanting to weave evidence into practice, initiated an update of knowledge, skills, and documentation patterns with its staff physical therapists and occupational therapists who treat people with congenital muscular torticollis (CMT). This case report describes 2 cycles of implementation: (1) the facilitators and barriers to implementation and (2) selected quality improvement outcomes aligned with published clinical practice guidelines (CPGs). The Pediatric Therapy Services of St Joseph's Regional Medical Center in New Jersey has 4 full-time, 1 part-time, and 3 per diem staff. Chart audits in 2012 revealed variations in measurement, interventions, and documentation that led to quality improvement initiatives. An iterative process, loosely following the knowledge-to-action cycle, included a series of in-service training sessions to review the basic anatomy, pathokinesiology, and treatment strategies for CMT; reading assignments of the available CPGs; journal review; documentation revisions; and training on the recommended measurements to implement 2 published CPGs and measure outcomes. A previous 1-page generic narrative became a 3-page CMT-specific form aligned with the American Physical Therapy Association Section on Pediatrics CMT CPG recommendations. Staff training on the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, classification of severity, type of CMT, prognostication, measures of cervical range of motion, and developmental progression improved documentation consistency from 0% to 81.9% to 100%. Clinicians responded positively to using the longer initial evaluation form. Successful implementation of both clinical and documentation practices were facilitated by a multifaceted approach to knowledge translation that included a culture supportive of evidence-based practice, administrative support for training and documentation redesign, commitment by clinicians to embrace changes aimed at improved care, and clinical guidelines that provide implementable recommendations. © 2016 American Physical Therapy Association.
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[Diagnostic radiology in the technological era. Comparison between two models].
Andrade-Barreto, O A; Villa-Caballero, Leonel
2005-01-01
Diagnostic Radiology is a medical specialty that has played a dynamic role in the medical arena during the last three decades of the XX century. As a part of the evolution of this specialty, medicine and society at large have received diverse benefits in areas of diagnosis and for the decision making process in the clinical practice. Modern radiology has provided numerous advances and refined tools that give more convenience speed and precise diagnosis in the current medical practice. At the present time, these technologies are part of the standard of care in the US and other industrialized countries, representing the ultimate desire or goal to reach for other healthcare systems in developing countries as well. Unfortunately, many of the clinical skills in the health care personal have not evolved at the same pace of those modern technologies, conditioning a reduction in the performance of sensitive areas to the patient's interest, such as the caring, compassion and quality of health care. It is unquestionable the value and benefits that technologies such as CAT and MRI scans have brought to the standard practice in the recent time. Nonetheless, it is desirable to maintain the highest possible level of clinical skills despite the extended use of modern technologies by the health personnel, without compromising the quality of care. Yet is pending the future role and rational use for those technologies in radiology, especially in times when delivering good, reliable health care have become a priority for many health institutions worldwide. This approach would be the ultimate goal to reach in times and circumstances where health for all is the highest precious value to obtain at global level.
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The motivation to teach as a registrar in general practice.
Thampy, Harish; Agius, Steven; Allery, Lynne A
2013-07-01
The General Medical Council (GMC) states that teaching should be an integral part of the doctor's role and the Royal College of General Practitioners (RCGP) have incorporated teaching outcomes into the GP training curriculum. However, there are suggestions that the teaching role of a GP trainee declines as they move from hospital posts to the registrar community year. Using doctors in training as near-peer tutors offers multiple advantages. Trainees themselves benefit as teaching others is a strong driver of the tutor's own learning. In addition there are also practical incentives to mobilising this under-utilised pool of primary care clinical teachers given the continuing shift of focusing medical education in the community. This study forms part of a larger body of work exploring the attitudes and perceived learning needs of GP registrars with regards to developing a teaching role. A primary area of investigation was trainees' motivation to teach. This paper describes our attempts to establish: a) how strongly motivated are GP registrars to take on teaching roles? b) in consequence how strongly motivated are they to learn more about teaching? c) what are the factors which affect motivation to teach? Three themes emerged from the data. First, teaching was felt to be of low priority in comparison to competing clinical learning needs. Secondly, the clinical dominance to both formative and summative assessment during training further compounded this situation. Thirdly, registrars identified a number of practical barriers and incentives that influenced their teaching engagement. This included potential negative views from trainers as to their trainee's ability and requirement to be involved with teaching activities.
By understanding and addressing these issues, it is hoped that GP trainees' engagement with teaching activities can be better engendered with subsequent benefits for both the trainee and those they teach. -
[Added value of family practitioners' supervision of junior doctors in a walk-in clinic].
Perdrix, J; Gubser, R; Gilgien, W; Bischoff, T
2011-05-18
The pending workforce crisis in family medicine has triggered various initiatives. This article describes the PMU-FLON walk-in clinic, a project of the Institute of General Medicine University of Lausanne. The working conditions in this clinic are close to that of a family practice. Doctors in training are supervised by family doctors who work part-time in the clinic. The objective is to improve training in the various fields of family medicine, from technical skills (improving optimal use of diagnostic tools), to integrating patients' requests in a more global patient-centered approach. This new educational model allows doctors in training to benefit from the specific approaches of different trainers. It will contribute to promoting quality family medicine in the future.
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ERIC Educational Resources Information Center
Burns, Caroline
2012-01-01
Radiologic science is an essential part of the healthcare continuum and preparing radiologic science students with experiential learning is essential. It is from this experience working with the patient that students begin to prepare for entry-level practice. The purpose of the study was to examine the attitudes of current radiologic science…
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Preparing for disasters: education and management strategies explored.
Alfred, Danita; Chilton, Jenifer; Connor, Della; Deal, Belinda; Fountain, Rebecca; Hensarling, Janice; Klotz, Linda
2015-01-01
During the last half of the 20th century, the focus of nursing changed from home and field to high-tech clinics and hospitals. Nursing in the absence of technology due to man-made or natural disasters almost disappeared from the curriculum of many nursing schools. Numerous disaster events and threats in the early 21st century caused educators and practitioners to increase the emphasis on disaster nursing and those principles that guide the nurse's practice in response to disasters. This article chronicles tools used by nurse educators to integrate disaster nursing into the didactic and clinical experiences of baccalaureate nursing students. We represent two nursing schools about 90 miles apart that collaborated to provide students with practical application of disaster nursing concepts. Part 1: An educational journey toward disaster nursing competencies: A curriculum in action provides an overview of the curricular tools used to insure adequate coverage of disaster nursing concepts across the curriculum. Part 2: Collaborative learning in Community Health Nursing for emergency preparedness relates the steps taken to plan, implement, and evaluate two different collaborative disaster simulation events. In this manuscript we have attempted transparency so that others can learn from our successes and our failures. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Variation in Point-of-Care Testing of HbA1c in Diabetes Care in General Practice.
Kristensen, Troels; Waldorff, Frans Boch; Nexøe, Jørgen; Skovsgaard, Christian Volmar; Olsen, Kim Rose
2017-11-09
Background: Point-of-care testing (POCT) of HbA1c may result in improved diabetic control, better patient outcomes, and enhanced clinical efficiency with fewer patient visits and subsequent reductions in costs. In 2008, the Danish regulators created a framework agreement regarding a new fee-for-service fee for the remuneration of POCT of HbA1c in general practice. According to secondary research, only the Capital Region of Denmark has allowed GPs to use this new incentive for POCT. The aim of this study is to use patient data to characterize patients with diabetes who have received POCT of HbA1c and analyze the variation in the use of POCT of HbA1c among patients with diabetes in Danish general practice. Methods: We use register data from the Danish Drug Register, the Danish Health Service Register and the National Patient Register from the year 2011 to define a population of 44,981 patients with diabetes (type 1 and type 2 but not patients with gestational diabetes) from the Capital Region. The POCT fee is used to measure the amount of POCT of HbA1c among patients with diabetes. Next, we apply descriptive statistics and multilevel logistic regression to analyze variation in the prevalence of POCT at the patient and clinic level. We include patient characteristics such as gender, age, socioeconomic markers, health care utilization, case mix markers, and municipality classifications. Results: The proportion of patients who received POCT was 14.1% and the proportion of clinics which were "POCT clinics" was 26.9%. There were variations in the use of POCT across clinics and patients. A part of the described variation can be explained by patient characteristics. Male gender, age differences (older age), short education, and other ethnicity imply significantly higher odds for POCT. High patient costs in general practice and other parts of primary care also imply higher odds for POCT. In contrast, high patient costs for drugs and/or morbidity in terms of the Charlson Comorbidity index mean lower odds for POCT. The frequency of patients with diabetes per 1000 patients was larger in POCT clinics than Non-POCT clinics. A total of 22.5% of the unexplained variability was related to GP clinics. Conclusions: This study demonstrates variation in the use of POCT which can be explained by patient characteristics such as demographic, socioeconomic, and case mix markers. However, it appears relevant to reassess the system for POCT. Further studies are warranted in order to assess the impacts of POCT of HbA1c on health care outcomes.
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Medical Biochemistry as Subdiscipline of Laboratory Medicine in Serbia.
Jovičić, Snežana; Majkić-Singh, Nada
2017-04-01
Medical biochemistry is the usual name for clinical biochemistry or clinical chemistry in Serbia, and medical biochemist is the official name for the clinical chemist (or clinical biochemist). This is the largest sub-discipline of the laboratory medicine in Serbia. It includes all aspects of clinical chemistry, and also laboratory hematology with coagulation, immunology, etc. Medical biochemistry laboratories in Serbia and medical biochemists as a profession are part of Health Care System and their activities are regulated through: the Health Care Law and rules issued by the Chamber of Medical Biochemists of Serbia. The first continuous and organized education for Medical Biochemists (Clinical Chemists) in Serbia dates from 1945, when the Department of Medical Biochemistry was established at the Pharmaceutical Faculty in Belgrade. In 1987 at the same Faculty a five years undergraduate study program was established, educating Medical Biochemists under a special program. Since the academic year 2006/2007 the new five year undergraduate (according to Bologna Declaration) and four-year postgraduate program according to EC4 European Syllabus for Postgraduate Training in Clinical Chemistry and Laboratory Medicine has been established. The Ministry of Education and Ministry of Public Health accredited these programs. There are four requirements for practicing medical biochemistry in the Health Care System: University Diploma of the Faculty of Pharmacy (Study of Medical Biochemistry), successful completion of the professional exam at the Ministry of Health after completion of one additional year of obligatory practical training in the medical biochemistry laboratories, membership in the Serbian Chamber of Medical Biochemists and licence for skilled work issued by the Serbian Chamber of Medical Biochemists. In order to present laboratory medical biochemistry practice in Serbia this paper will be focused on the following: Serbian national legislation, healthcare services organization, sub-disciplines of laboratory medicine and medical biochemistry as the most significant, education in medical biochemistry, conditions for professional practice in medical biochemistry, continuous quality improvement, and accreditation. Serbian healthcare is based on fundamental principles of universal health coverage and solidarity between all citizens.
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Ten tips for receiving feedback effectively in clinical practice
Algiraigri, Ali H.
2014-01-01
Background Despite being recognized as a fundamental part of the educational process and emphasized for several decades in medical education, the influence of the feedback process is still suboptimal. This may not be surprising, because the focus is primarily centered on only one half of the process – the teachers. The learners are the targets of the feedback process and improvement needs to be shifted. Learners need to be empowered with the skills needed to receive and utilize feedback and compensate for less than ideal feedback delivery due to the busy clinical environment. Methods Based on the available feedback literature and clinical experience regarding feedback, the author developed 10 tips to empower learners with the necessary skills to seek, receive, and handle feedback effectively, regardless of how it is delivered. Although, most of the tips are directed at the individual clinical trainee, this model can be utilized by clinical educators involved in learner development and serve as a framework for educational workshops or curriculum. Results Ten practical tips are identified that specifically address the learner's role in the feedback process. These tips not only help the learner to ask, receive, and handle the feedback, but will also ease the process for the teachers. Collectively, these tips help to overcome most, if not all, of the barriers to feedback and bridge the gaps in busy clinical practices. Conclusions Feedback is a crucial element in the educational process and it is shown that we are still behind in the optimal use of it; thus, learners need to be taught how to better receive and utilize feedback. The focus in medical education needs to balance the two sides of the feedback process. It is time now to invest on the learner's development of skills that can be utilized in a busy day-to-day clinical practice. PMID:25079664
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Shaw-Battista, Jenna; Young-Lin, Nichole; Bearman, Sage; Dau, Kim; Vargas, Juan
2015-01-01
Ultrasound is an important aid in the clinical diagnosis and management of normal and complicated pregnancy and childbirth. The technology is widely applied to maternity care in the United States, where comprehensive standard ultrasound examinations are routine. Targeted scans are common and used for an increasing number of clinical indications due to emerging research and a greater availability of equipment with better image resolution at lower cost. These factors contribute to an increased demand for obstetric ultrasound education among students and providers of maternity care, despite a paucity of data to inform education program design and evaluation. To meet this demand, from 2012 to 2015 the University of California, San Francisco nurse-midwifery education program developed and implemented an interprofessional obstetric ultrasound course focused on clinical applications commonly managed by maternity care providers from different professions and disciplines. The course included matriculating students in nursing and medicine, as well as licensed practitioners such as registered and advanced practice nurses, midwives, and physicians and residents in obstetrics and gynecology and family medicine. After completing 10 online modules with a pre- and posttest of knowledge and interprofessional competencies related to teamwork and communication, trainees attended a case-based seminar and hands-on skills practicum with pregnant volunteers. The course aimed to establish a foundation for further supervised clinical training prior to independent practice of obstetric ultrasound. Course development was informed by professional guidelines and clinical and education research literature. This article describes the foundations, with a review of the challenges and solutions encountered in obstetric ultrasound education development and implementation. Our experience will inform educators who wish to facilitate obstetric ultrasound competency development among new and experienced maternity care providers in academic and clinical settings. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. © 2015 by the American College of Nurse-Midwives.
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Tasma, M; Liemburg, E J; Knegtering, H; Delespaul, P A E G; Boonstra, A; Castelein, S
2017-05-01
Routine Outcome Monitoring (ROM) has become part of the treatment process in mental health care. However, studies have indicated that few clinicians in psychiatry use the outcome of ROM in their daily work. The aim of this study was to explore the degree of ROM use in clinical practice as well as the explanatory factors of this use. In the Northern Netherlands, a ROM-protocol (ROM-Phamous) for patients with a psychotic disorder has been implemented. To establish the degree of ROM-Phamous use in clinical practice, the ROM results of patients (n=204) were compared to the treatment goals formulated in their treatment plans. To investigate factors that might influence ROM use, clinicians (n=32) were asked to fill out a questionnaire about ROM-Phamous. Care domains that were problematic according to the ROM-Phamous results were mentioned in the treatment plan in 28% of cases on average (range 5-45%). The use of ROM-Phamous in the treatment process varies considerably among clinicians. Most of the clinicians find ROM-Phamous both useful and important for good clinical practice. In contrast, the perceived ease-of-use is low and most clinicians report insufficient time to use ROM-Phamous. More frequent ROM use should be facilitated in clinicians. This could be achieved by improving the fit with clinical routines and the ease-of-use of ROM systems. It is important for all stakeholders to invest in integrating ROM in clinical practice. Eventually, this might improve the diagnostics and treatment of patients in mental health care. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
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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
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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.
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[Prescribed drug use for bipolar disorder type I and II in clinical practice].
Persson, Charlotte; Kardell, Mathias; Karanti, Alina; Isgren, Anniella; Annerbrink, Kristina; Landen, Mikael
2017-01-10
Prescribed drug use for bipolar disorder type I and II in clinical practice Practice guidelines based on available evidence and clinical consensus are available for the treatment of bipolar disorder. We surveyed to which extent those guidelines are implemented in clinical practice in Sweden. We analysed pharmacological treatment in patients with bipolar disorder in 2015 using the national quality register for bipolar disorder (BipoläR). We compared bipolar disorder type I (BDI) with type bipolar disorder type II (BDII). The vast majority of patients were prescribed a mood stabilizer either as monotherapy or as a part of combination therapy (BDI 87%, BDII 83%, p<0.001). Whereas lithium was the most common mood stabilizer in type I (BDI 65%, BDII 40%, p<0.001), lamotrigine was the most common mood stabilizer in type II (BDI 18%, BDII 42%, p<0.001). Antidepressants were less common in BDI than BDII (35% vs. 53%, p<0.001). Antipsychotic drugs (first or second generation) were more frequently used in BDI than BDII (49% vs 35%, p<0.001). Central stimulants were rarely used (BDI 3.1%, BDII 6.6%, p<0.001). Combining a mood stabilizer with an antipsychotic drug was more common in BDI than BDII (27% vs. 12%, p<0.001), whereas combining a mood stabilizer with an antidepressant was less common in BDI than BDII (16% vs 28%, p<0.001). We conclude that most patients are prescribed mood stabilizers and that the differences between BDI and BDII are rational given the differences in clinical manifestations. The use of antidepressants is surprisingly high given the long-standing debate about the risk and effectiveness of this class in bipolar disorder.
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Park, Yong-Geun; Han, Seung Beom; Song, Sang Jun; Kim, Tae Jin
2012-01-01
Platelet-rich plasma (PRP) is a concentrate extract of platelets from autologous blood, and represents a possible treatment option for the stimulation and acceleration of soft-tissue healing and regeneration in orthopedics. Currently, the availability of devices for outpatient preparation and delivery contributes to the increase in the clinical use of PRP therapy in practical setting of orthopedic fields. However, there is still paucity of scientific evidence in the literature to prove efficacy of PRP therapy for the treatment of ligament or tendon problems around the knee joint. Moreover, strong evidence from well-designed clinical trials to support the PRP therapy for osteoarthritis of the knee joint is yet scanty in the literature. Scientific studies need to be performed to assess clinical indications, efficacy, and safety of PRP, and this will require high powered randomized controlled trials. Nonetheless, some hospitals exaggeratedly advertise PRP procedures as the ultimate treatment and a novel technology with abundant scientific evidence for the treatment of knee problems. As a matter of fact, PRP protocols are currently approved only for use in clinical trials and research, and are not allowed for treatment purpose by any institutions in Korea. At present, clinical use of PRP therapy for ligament or tendon problems or osteoarthritis of knee joint is defined as illegal medical practice, regardless of whether it is performed as a sole procedure or as a part of prolotherapy, because the safety and validity are not yet approved by the Ministry of Health and Welfare and Health Insurance Review and Assessment Service. Practicing physicians should remember that injection of PRP to patients by imposing medical charge is still illegal as per the current medical law in Korea. PMID:22708106
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The US pediatric nephrology workforce: a report commissioned by the American Academy of Pediatrics.
Primack, William A; Meyers, Kevin E; Kirkwood, Suzanne J; Ruch-Ross, Holly S; Radabaugh, Carrie L; Greenbaum, Larry A
2015-07-01
The US pediatric nephrology workforce is poorly characterized. This report describes clinical and nonclinical activities, motivations and disincentives to a career in pediatric nephrology, future workforce needs, trainee recruitment, and possible explanations for personnel shortages. An e-mail survey was sent in 2013 to all identified US-trained or -practicing pediatric nephrologists. Of 504 respondents, 51% are men, 66% are US graduates, and 73% work in an academic setting. About 20% of trained pediatric nephrologists no longer practice pediatric nephrology. Among the 384 respondents practicing pediatric nephrology full or part-time in the United States, the mean work week was 56.1±14.3 hours, with time divided between patient care (59%), administration (13%), teaching (10%), clinical research (9%), basic research (6%), and other medical activities (3%). Most (>85%) care for dialysis and transplantation patients. The median number of weeks annually on call is 16, and 29% work with one or no partner. One-third of US pediatric nephrologists (n=126) plan to reduce or stop clinical nephrology practice in the next 5 years, and 53% plan to fully or partially retire. Almost half the division chiefs (47%) report inadequate physician staffing. Ongoing efforts to monitor and address pediatric nephrology workforce issues are needed. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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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.
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-11-28
...This final rule with comment period addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It also addresses, implements or discusses certain statutory provisions including provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. In addition, this final rule with comment period discusses payments for Part B drugs; Clinical Laboratory Fee Schedule: Signature on Requisition; Physician Quality Reporting System; the Electronic Prescribing (eRx) Incentive Program; the Physician Resource-Use Feedback Program and the value modifier; productivity adjustment for ambulatory surgical center payment system and the ambulance, clinical laboratory, and durable medical equipment prosthetics orthotics and supplies (DMEPOS) fee schedules; and other Part B related issues.
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Racial and ethnic disparities in the clinical practice of emergency medicine.
Richardson, Lynne D; Babcock Irvin, Charlene; Tamayo-Sarver, Joshua H
2003-11-01
There is convincing evidence that racial and ethnic disparities exist in the provision of health care, including the provision of emergency care; and that stereotyping, biases, and uncertainty on the part of health care providers all contribute to unequal treatment. Situations, such as the emergency department (ED), that are characterized by time pressure, incomplete information, and high demands on attention and cognitive resources increase the likelihood that stereotypes and bias will affect diagnostic and treatment decisions. It is likely that there are many as-yet-undocumented disparities in clinical emergency practice. Racial and ethnic disparities may arise in decisions made by out-of-hospital personnel regarding ambulance destination, triage assessments made by nursing personnel, diagnostic testing ordered by physicians or physician-extenders, and in disposition decisions. The potential for disparate treatment includes the timing and intensity of ED therapy as well as patterns of referral, prescription choices, and priority for hospital admission and bed assignment. At a national roundtable discussion, strategies suggested to address these disparities included: increased use of evidence-based clinical guidelines; use of continuous quality improvement methods to document individual and institutional disparities in performance; zero tolerance for stereotypical remarks in the workplace; cultural competence training for emergency providers; increased workforce diversity; and increased epidemiologic, clinical, and services research. Careful scrutiny of the clinical practice of emergency medicine and diligent implementation of strategies to prevent disparities will be required to eliminate the individual behaviors and systemic processes that result in the delivery of disparate care in EDs.
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Biomarkers in Cardiology - Part 2: In Coronary Heart Disease, Valve Disease and Special Situations
2015-01-01
Cardiovascular diseases are the main causes of mortality and morbidity in Brazil. Their primary and secondary preventions are a priority for the health system and require multiple approaches for increased effectiveness. Biomarkers are tools used to identify with greater accuracy high-risk individuals, establish a faster diagnosis, guide treatment, and determine prognosis. This review aims to highlight the importance of biomarkers in clinical cardiology practice and raise relevant points regarding their application and perspectives for the next few years. This document was divided into two parts. This second part addresses the application of biomarkers in coronary heart disease, valvular diseases, cardio-oncology, pulmonary embolism, and cardiorenal syndrome. PMID:26083777
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International nursing students and what impacts their clinical learning: literature review.
Edgecombe, Kay; Jennings, Michele; Bowden, Margaret
2013-02-01
This paper reviews the sparse literature about international nursing students' clinical learning experiences, and also draws on the literature about international higher education students' learning experiences across disciplines as well as nursing students' experiences when undertaking international clinical placements. The paper aims to identify factors that may impact international nursing students' clinical learning with a view to initiating further research into these students' attributes and how to work with these to enhance the students' clinical learning. Issues commonly cited as affecting international students are socialisation, communication, culture, relationships, and unmet expectations and aspirations. International student attributes tend to be included by implication rather than as part of the literature's focus. The review concludes that recognition and valuing of international nursing students' attributes in academic and clinical contexts are needed to facilitate effective strategies to support their clinical practice in new environments. Copyright © 2012. Published by Elsevier Ltd.
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Why we should understand the patient experience: clinical empathy and medicines optimisation.
Jubraj, Barry; Barnett, Nina L; Grimes, Lesley; Varia, Sneha; Chater, Angel; Auyeung, Vivian
2016-10-01
To critically discuss the need for pharmacists to underpin their consultations with appropriate 'clinical empathy' as part of effective medicines optimisation. Use of literature around empathy, consultation and pharmacy practice to develop a case for greater clinical empathy in pharmacy consultations. Clinical empathy is defined from the literature and applied to pharmacy consultations, with a comparison to empathy in other clinical professions. Historical barriers to the embedding of clinical empathy into pharmacy consultations are also explored. We challenge the pharmacy profession to consider how clinical empathy should underpin consultations with a series of introspective questions and provide some sample questions to support pharmacy consultations. We also make the case for appropriate education and professional development of consultation skills at undergraduate and postgraduate level. We contend that patients' relationships with practitioners are critical, and a lack of empathy can impact the effectiveness of care. © 2016 Royal Pharmaceutical Society.
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The implication of transcultural psychiatry for clinical practice.
Moldavsky, Daniel
2003-01-01
This article deals with the main concepts of Transcultural Psychiatry and their applications to everyday psychiatric practice. Transcultural psychiatry has undergone a conceptual reformulation in the last two decades. Having started with a comparative approach, which focused on the diverse manifestations of mental disorders among different societies, it broadened its scope, aiming at present to incorporate social and cultural aspects of illness into the clinical framework. Therefore, transcultural psychiatry now focuses more on what is called the illness experience than on the disease process, the latter understood as illness as it is viewed by health practitioners. Western medicine, of which psychiatry is a part, is grounded in positivist epistemological principles that stress the biological processes of disease. The intention of the paper is to develop an interest in alternative but also complementary ways of thinking. Modern transcultural psychiatry interprets some epidemiological and clinical aspects of major mental disorders (such as schizophrenia and depression) in a different light. However, it also distances itself from the absolute relativism of antipsychiatry, centering on clinical facts and helping clinicians in their primary task of alleviating suffering. An important contribution in addressing this task is the formulation of a cultural axis within the DSM model of multiaxial evaluation. A clinical vignette of a cultural formulation applied to a clinical discussion of a case is described.
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Solheim, Elisabeth; Plathe, Hilde Syvertsen; Eide, Hilde
2017-11-01
Clinical skills training is an important part of nurses' education programmes. Clinical skills are complex. A common understanding of what characterizes clinical skills and learning outcomes needs to be established. The aim of the study was to develop and evaluate a new reflection and feedback tool for formative assessment. The study has a descriptive quantitative design. 129 students participated who were at the end of the first year of a Bachelor degree in nursing. After highfidelity simulation, data were collected using a questionnaire with 19 closed-ended and 2 open-ended questions. The tool stimulated peer assessment, and enabled students to be more thorough in what to assess as an observer in clinical skills. The tool provided a structure for selfassessment and made visible items that are important to be aware of in clinical skills. This article adds to simulation literature and provides a tool that is useful in enhancing peer learning, which is essential for nurses in practice. The tool has potential for enabling students to learn about reflection and developing skills for guiding others in practice after they have graduated. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Pechak, Celia M; Black, Jill D
2014-02-01
Increasingly physical therapist students complete part of their clinical training outside of their home country. This trend is understudied. The purposes of this study were to: (1) explore, in depth, various international clinical education (ICE) programs; and (2) determine whether the Conceptual Model of Optimal International Service-Learning (ISL) could be applied or adapted to represent ICE. Qualitative content analysis was used to analyze ICE programs and consider modification of an existing ISL conceptual model for ICE. Fifteen faculty in the United States currently involved in ICE were interviewed. The interview transcriptions were systematically analyzed by two researchers. Three models of ICE practices emerged: (1) a traditional clinical education model where local clinical instructors (CIs) focus on the development of clinical skills; (2) a global health model where US-based CIs provide the supervision in the international setting, and learning outcomes emphasized global health and cultural competency; and (3) an ICE/ISL hybrid where US-based CIs supervise the students, and the foci includes community service. Additionally the data supported revising the ISL model's essential core conditions, components and consequence for ICE. The ICE conceptual model may provide a useful framework for future ICE program development and research.
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A physiotherapy perspective of musculoskeletal imaging in sport.
Callaghan, M J
2012-08-01
This paper presents a physiotherapy perspective on the role that imaging is now playing in the diagnosis and management of musculoskeletal and sporting injuries. Although the Royal College of Radiologists and the UK Chartered Society of Physiotherapy were founded in the latter part of the nineteenth century, it is 100 years later that developments in the UK NHS have led to increased roles for non-medical healthcare professionals and allied health professionals, such as physiotherapists, in an extended clinical role. Physiotherapists, perhaps because of their knowledge of clinical and applied anatomy, have keenly taken up the opportunities offered to request and interpret imaging in its various forms; the most commonly available are plain radiography, musculoskeletal ultrasound and MRI. This has meant taking formal courses under the auspices of universities with mentorship and tutoring within the clinical setting, which are part of a continuing professional development. The ability to request several forms of imaging has enhanced physiotherapy practice and has increased the appreciation of the responsibilities which accompany this new role.