QIN. Early experiences in establishing a regional quantitative imaging network for PET/CT clinical trials

PubMed Central

Doot, Robert K.; Thompson, Tove; Greer, Benjamin E.; Allberg, Keith C.; Linden, Hannah M.; Mankoff, David A.; Kinahan, Paul E.

2012-01-01

The Seattle Cancer Care Alliance (SCCA) is a Pacific Northwest regional network that enables patients from community cancer centers to participate in multicenter oncology clinical trials where patients can receive some trial-related procedures at their local center. Results of positron emission tomography (PET) scans performed at community cancer centers are not currently used in SCCA Network trials since clinical trials customarily accept results from only trial-accredited PET imaging centers located at academic and large hospitals. Oncologists would prefer the option of using standard clinical PET scans from Network sites in multicenter clinical trials to increase accrual of patients for whom additional travel requirements for imaging is a barrier to recruitment. In an effort to increase accrual of rural and other underserved populations to Network trials, researchers and clinicians at the University of Washington, SCCA and its Network are assessing feasibility of using PET scans from all Network sites in their oncology clinical trials. A feasibility study is required because the reproducibility of multicenter PET measurements ranges from approximately 3% to 40% at national academic centers. Early experiences from both national and local PET phantom imaging trials are discussed and next steps are proposed for including patient PET scans from the emerging regional quantitative imaging network in clinical trials. There are feasible methods to determine and characterize PET quantitation errors and improve data quality by either prospective scanner calibration or retrospective post hoc corrections. These methods should be developed and implemented in multicenter clinical trials employing quantitative PET imaging of patients. PMID:22795929

Nursing students' early exposure to clinical practice: an innovation in curriculum development.

PubMed

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.

VA OpenNotes: exploring the experiences of early patient adopters with access to clinical notes.

PubMed

Nazi, Kim M; Turvey, Carolyn L; Klein, Dawn M; Hogan, Timothy P; Woods, Susan S

2015-03-01

To explore the experience of early patient adopters who accessed their clinical notes online using the Blue Button feature of the My HealtheVet portal. A web-based survey of VA patient portal users from June 22 to September 15, 2013. 33.5% of respondents knew that clinical notes could be viewed, and nearly one in four (23.5%) said that they had viewed their notes at least once. The majority of VA Notes users agreed that accessing their notes will help them to do a better job of taking medications as prescribed (80.1%) and be better prepared for clinic visits (88.6%). Nine out of 10 users agreed that use of visit notes will help them understand their conditions better (91.8%), and better remember the plan for their care (91.9%). In contrast, 87% disagreed that VA Notes will make them worry more, and 88.4% disagreed that access to VA Notes will be more confusing than helpful. Users who had either contacted their provider or healthcare team (11.9%) or planned to (13.5%) primarily wanted to learn more about a health issue, medication, or test results (53.7%). Initial assessment of the patient experience within the first 9 months of availability provides evidence that patients both value and benefit from online access to clinical notes. These findings are congruent with OpenNotes study findings on a broader scale. Additional outreach and education is needed to enhance patient awareness. Healthcare professionals should author notes keeping in mind the opportunity patient access presents for enhanced communication. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Brachytherapy in early prostate cancer--early experience.

PubMed

Jose, B O; Bailen, J L; Albrink, F H; Steinbock, G S; Cornett, M S; Benson, D C; Schmied, W K; Medley, R N; Spanos, W J; Paris, K J; Koerner, P D; Gatenby, R A; Wilson, D L; Meyer, R

1999-01-01

Use of brachytherapy with radioactive seeds in the management of early prostate cancer is commonly used in the United States. The early experience has been reported from the prostate treatment centers in Seattle for the last 10 years. In this manuscript we are reporting our early experience of 150 radioactive seed implantations in early stage prostate cancer using either Iodine 125 or Palladium 103 seeds. The average age of the patient is 66 years and the median Gleason score is 5.4 with a median PSA of 6. A brief description of the evolution of the treatment of prostate cancer as well as the preparation for the seed implantation using the volume study with ultrasound of the prostate, pubic arch study using CT scan of the pelvis and the complete planning using the treatment planning computers are discussed. We also have described the current technique which is used in our experience based on the Seattle guidelines. We plan a follow-up report with the results of the studies with longer follow-up.

Practical considerations on the introduction of sacubitril/valsartan in clinical practice: Current evidence and early experience.

PubMed

Farmakis, Dimitrios; Bistola, Vassiliki; Karavidas, Apostolos; Parissis, John

2016-11-15

The combination of neprilysin inhibitor sacubitril with the angiotensin II receptor 1 blocker valsartan is the first agent from the angiotensin receptor neprilysin inhibitors (ARNI) class authorized for clinical use in heart failure (HF) patients with reduced ejection fraction (HFrEF). Sacubitril/valsartan resulted in 20% reduction in the incidence rate of death or HF hospitalization compared to enalapril in symptomatic HFrEF patients in the seminal PARADIGM-HF trial. As a result, the recently updated European and American HF guidelines granted this agent a class IB indication for the treatment of ambulatory/chronic symptomatic HFrEF patients. However, translating the positive results of trials into true clinical benefit is often challenging. This is particularly true in the case of sacubitril/valsartan, as HF is a heterogeneous syndrome including many severely ill patients who are prone to decompensation, while this new agent comes to replace a cornerstone of current evidence-based HF therapy. In the present paper, we address a number of practical issues regarding the introduction of sacubitril/valsartan and propose an algorithm based on available evidence and early clinical experience. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Challenges and perspective of drug repurposing strategies in early phase clinical trials.

PubMed

Kato, Shumei; Moulder, Stacy L; Ueno, Naoto T; Wheler, Jennifer J; Meric-Bernstam, Funda; Kurzrock, Razelle; Janku, Filip

2015-01-01

Despite significant investments in the development of new agents only 5% of cancer drugs entering Phase I clinical trials are ultimately approved for routine clinical cancer care. Drug repurposing strategies using novel combinations of previously tested anticancer agents could reduce the cost and improve treatment outcomes. At MD Anderson Cancer Center, early phase clinical trials with drug repurposing strategies demonstrated promising outcomes in patients with both rare and common treatment refractory advanced cancers. Despite clinical efficacy advancing drug repurposing strategies in the clinical trial trajectory beyond early phase studies has been challenging mainly due to lack of funding and interest from the pharmaceutical industry. In this review, we delineate our experience and challenges with drug repurposing strategies.

Utilisation of the healthcare system for authentic early experience placements.

PubMed

Hays, Richard B

2013-01-01

Authentic early experience in clinical contexts adds interest and relevance to basic medical education, and is regarded positively by both learners and teachers. However, with the recent expansion of medical education, the healthcare system appears close to reaching its capacity for student supervision. This study explores the utilisation of the healthcare system for early clinical placements. A secondary analysis was conducted of data from the Medical Schools Outcomes Database, collected from the 2010 annual questionnaire, focusing on the timing, duration and location of clinical placements during 2009 within the first half of basic medical education programs in Australia. Data was received for 67% of Australian medical students, reporting a total of 16 812 early clinical placements that occupied 97 319 days of supervised time in a wide variety of hospital, general practice and Indigenous health contexts, both urban and rural, across the Australian healthcare system. These early placements occupied about 16% of total clinical placement time for all students in all training years during 2009. The majority of these placements were for only a few hours or days; exceptions were longitudinal placements in regional and rural communities at a minority of schools. Early clinical placements may pose significant resource costs for placement providers, particularly supervision time and expertise. As medical education expands and the teaching capacity of the Australian healthcare system appears to reach its limits, it may be necessary to allocate placements according to their specific learning outcomes, prioritise more acute settings for more senior students, and increase capacity in less acute health and social care settings.

Starflo glaucoma implant: early experience in Hungary

PubMed Central

István, Cseke; Péter, Vámosi; Mária, Bausz

2016-01-01

Aim: To present the early experience with the implantation technique, safety and efficiency of STARflo™ device for open angle glaucoma (OAG). Methods: referring intra- and postoperative clinical experience with a series of seven cases in three glaucoma centers in Hungary. Results: No intraoperative complications were observed. Postoperative inflammatory signs disappeared rapidly. The mean IOP reduction was from 27,6 ± 5,0 mmHg to 18,9±3,4 mmHg (32% reduction/ patient) at six months postoperatively. Conclusion: STARflo™ implant was safe and (except for one case with neovascular glaucoma) effective in our cases. The learning curve for experienced anterior segment surgeons was short. PMID:27220226

Relationships between Childhood Traumatic Experiences, Early Maladaptive Schemas and Interpersonal Styles

PubMed Central

KAYA TEZEL, Fulya; TUTAREL KIŞLAK, Şennur; BOYSAN, Murat

2015-01-01

Introduction Cognitive theories of psychopathology have generally proposed that early experiences of childhood abuse and neglect may result in the development of early maladaptive self-schemas. Maladaptive core schemas are central in the development and maintenance of psychological symptoms in a schema-focused approach. Psychosocial dysfunction in individuals with psychological problems has been consistently found to be associated with symptom severity. However, till date, linkages between psychosocial functioning, early traumatic experiences and core schemas have received little attention. The aim of the present study was to explore the relations among maladaptive interpersonal styles, negative experiences in childhood and core self-schemas in non-clinical adults. Methods A total of 300 adults (58% women) participated in the study. The participants completed a socio-demographic questionnaire, Young Schema Questionnaire, Childhood Trauma Questionnaire and Interpersonal Style Scale. Results Hierarchical regression analyses revealed that the Disconnection and Rejection and Impaired Limits schema domains were significant antecedents of maladaptive interpersonal styles after controlling for demographic characteristics and childhood abuse and neglect. Associations of child sexual abuse with Emotionally Avoidant, Manipulative and Abusive interpersonal styles were mediated by early maladaptive schemas. Early maladaptive schemas mediated the relations of emotional abuse with Emotionally Avoidant and Avoidant interpersonal styles as well as the relations of physical abuse with Avoidant and Abusive interpersonal styles. Conclusion Interpersonal styles in adulthood are significantly associated with childhood traumatic experiences. Significant relations between early traumatic experiences and maladaptive interpersonal styles are mediated by early maladaptive schemas. PMID:28360715

Relationships between Childhood Traumatic Experiences, Early Maladaptive Schemas and Interpersonal Styles.

PubMed

Kaya Tezel, Fulya; Tutarel Kişlak, Şennur; Boysan, Murat

2015-09-01

Cognitive theories of psychopathology have generally proposed that early experiences of childhood abuse and neglect may result in the development of early maladaptive self-schemas. Maladaptive core schemas are central in the development and maintenance of psychological symptoms in a schema-focused approach. Psychosocial dysfunction in individuals with psychological problems has been consistently found to be associated with symptom severity. However, till date, linkages between psychosocial functioning, early traumatic experiences and core schemas have received little attention. The aim of the present study was to explore the relations among maladaptive interpersonal styles, negative experiences in childhood and core self-schemas in non-clinical adults. A total of 300 adults (58% women) participated in the study. The participants completed a socio-demographic questionnaire, Young Schema Questionnaire, Childhood Trauma Questionnaire and Interpersonal Style Scale. Hierarchical regression analyses revealed that the Disconnection and Rejection and Impaired Limits schema domains were significant antecedents of maladaptive interpersonal styles after controlling for demographic characteristics and childhood abuse and neglect. Associations of child sexual abuse with Emotionally Avoidant, Manipulative and Abusive interpersonal styles were mediated by early maladaptive schemas. Early maladaptive schemas mediated the relations of emotional abuse with Emotionally Avoidant and Avoidant interpersonal styles as well as the relations of physical abuse with Avoidant and Abusive interpersonal styles. Interpersonal styles in adulthood are significantly associated with childhood traumatic experiences. Significant relations between early traumatic experiences and maladaptive interpersonal styles are mediated by early maladaptive schemas.

The early evolution of Jean Piaget's clinical method.

PubMed

Mayer, Susan Jean

2005-11-01

This article analyzes the early evolution of Jean Piaget's renowned "clinical method" in order to investigate the method's strikingly original and generative character. Throughout his 1st decade in the field, Piaget frequently discussed and justified the many different approaches to data collection he used. Analysis of his methodological progression during this period reveals that Piaget's determination to access the genuine convictions of children eventually led him to combine 3 distinct traditions in which he had been trained-naturalistic observation, psychometrics, and the psychiatric clinical examination. It was in this amalgam, first evident in his 4th text, that Piaget discovered the clinical dynamic that would drive the classic experiments for which he is most well known.

Experiences from an interprofessional student-assisted chronic disease clinic.

PubMed

Frakes, Kerrie-Anne; Brownie, Sharon; Davies, Lauren; Thomas, Janelle; Miller, Mary-Ellen; Tyack, Zephanie

2014-11-01

Faced with significant health and workforce challenges in the region, the Central Queensland Health Service District (CQHSD) commenced a student-assisted clinical service. The Capricornia Allied Health Partnership (CAHP) is an interprofessional clinical placement program in which pre-entry students from exercise physiology, nutrition and dietetics, occupational therapy, pharmacy, podiatry and social work are embedded in a collaborative chronic disease service delivery model. The model coordinates multiple student clinical placements to: address service delivery gaps for previously underserved people with chronic disease in need of early intervention and management; provide an attractive clinical placement opportunity for students that will potentially lead to future recruitment success, and demonstrate leadership in developing future health workforce trainees to attain appropriate levels of interprofessional capacity. The CAHP clinic commenced student placements and client services in February 2010. This report provides early evaluative information regarding student experiences included self-reported changes in practice.

Innovative strategies for early clinical R&D.

PubMed

Butz, Robert F; Morelli, Gaetano

2008-01-01

Developments in translational medicine and regulatory initiatives associated with the FDA's Critical Path Initiative are creating new opportunities for innovation in early clinical R&D. The introduction of the exploratory IND process allows small, 'phase 0' clinical trials to be conducted prior to traditional phase I trials - sometimes requiring considerably less chemistry, manufacturing and controls, or preclinical support. Phase 0 clinical trials involving subtherapeutic, yet pharmacologically active, dose levels can provide an early demonstration of clinical proof of concept; such demonstration is of particular importance to small pharmaceutical and early-stage biotechnology companies. However, these opportunities for rapid entry into the clinic must be balanced by a consideration of the unique risks associated with first-in-human clinical trials, and by accounting for public concerns regarding drug safety in general. This feature review discusses how innovative clinical strategies can be used effectively in early drug development.

Characteristics of Effective Clinical Teachers in Simulated Clinical Experiences Compared to Traditional Clinical Experiences

ERIC Educational Resources Information Center

Sieh-Bliss, Selina

2014-01-01

While there is evidence in the literature measuring effective clinical teacher characteristics in traditional experiences, little is known of effective characteristics expected from clinical teachers during simulated clinical experiences. This study examined which clinical teaching behaviors and characteristics are perceived by nursing students'…

Early Practicum Experiences: Preservice Early Childhood Students' Perceptions and Sense of Efficacy

ERIC Educational Resources Information Center

Van Schagen Johnson, Amy; La Paro, Karen M.; Crosby, Danielle A.

2017-01-01

The current study explored early practicum experiences (those occurring before student teaching) in an early childhood birth to kindergarten teacher education program. Undergraduates enrolled in practicum courses completed questionnaires about their overall practicum experience including: socio-emotional components (their perceived fit with their…

A Light at the End of the Tunnel: The Impact of Early Clinical Experiences on Medical Students.

ERIC Educational Resources Information Center

Mann, Mary Pat

This paper describes the impact of early clinical contact (ECC) on medical students. The concepts emerged from a grounded theory analysis of interviews with students and faculty in the ECC program at Ohio University College of Osteopathic Medicine, which places first-year and second-year students in a variety of clinical settings in ambulatory…

Correlates of Bulimia Nervosa: Early Family Mealtime Experiences.

ERIC Educational Resources Information Center

Miller, Debra A. F.; And Others

1993-01-01

Examined relationship of early mealtime experiences to later bulimia in 128 female college students. Found significant group differences among bulimics, nonbulimics, and repeat dieters on early meal experience questionnaire, with bulimic group reporting most negative and unusual experiences. Found significant differences among groups on depression…

The Legacy of Early Experiences in Development: Formalizing Alternative Models of How Early Experiences Are Carried Forward over Time

ERIC Educational Resources Information Center

Fraley, R. Chris; Roisman, Glenn I.; Haltigan, John D.

2013-01-01

Psychologists have long debated the role of early experience in social and cognitive development. However, traditional approaches to studying this issue are not well positioned to address this debate. The authors present simulations that indicate that the associations between early experiences and later outcomes should approach different…

Early clinical outcomes following laparoscopic inguinal hernia repair.

PubMed

Tolver, Mette Astrup

2013-07-01

Laparoscopic inguinal hernia repair (TAPP) has gained increasing popularity because of less post-operative pain and a shorter duration of convalescence compared with open hernia repair technique (Lichtenstein). However, investigation of duration of convalescence with non-restrictive recommendations, and a procedure-specific characterization of the early clinical outcomes after TAPP was lacking. Furthermore, optimization of the post-operative period with fibrin sealant versus tacks for fixation of mesh, and the glucocorticoid dexamethasone versus placebo needed to be investigated in randomized clinical trials. The objective of this PhD thesis was to characterize the early clinical outcomes after TAPP and optimize the post-operative period. The four studies included in this thesis have investigated duration of convalescence and procedure-specific post-operative pain and other early clinical outcomes after TAPP. Furthermore, it has been shown that fibrin sealant can improve the early post-operative period compared with tacks, while dexamethasone showed no advantages apart from reduced use of antiemetics compared with placebo. Based on these findings, and the existing knowledge, 3-5 days of convalescence should be expected when 1 day of convalescence is recommended and future studies should focus on reducing intraabdominal pain after TAPP. Fibrin sealant can optimize the early clinical outcomes but the risk of hernia recurrence and chronic pain needs to be evaluated. Dexamethasone should be investigated in higher doses.

Biological Perspectives on the Effects of Early Psychosocial Experience

ERIC Educational Resources Information Center

Marshall, Peter J.; Kenney, Justin W.

2009-01-01

There is much current interest in how adverse experiences early in life might affect certain elements of physiological, behavioral, and psychological functioning across the lifespan. Recent conceptual frameworks for studying the effects of early experience have involved constructs such as experience-expectant, experience-dependent, and…

Early Experience with a Brief, Multimodal, Multidisciplinary Treatment Program for Fibromyalgia

PubMed Central

Vincent, Ann; Whipple, Mary O.; Oh, Terry H.; Guderian, Janet A.; Barton, Debra L.; Luedtke, Connie A.

2014-01-01

Fibromyalgia is a complex, heterogeneous disorder for which a multidisciplinary individualized approach is currently advocated. We executed a 1 week multidisciplinary fibromyalgia clinical program with 7 patients, based on our previous experience with our existing 1.5 day multidisciplinary fibromyalgia program that has demonstrated both short- and long-term benefits. The current expanded program was not designed as a clinical study, but rather as a clinical feasibility assessment and was multidisciplinary in nature, with cognitive behavioral therapy, activity pacing and graded exercise therapy as major components. We assessed changes in individual patients at 1 week and 3 months following the program utilizing validated self-report measures of pain, fatigue, and self-efficacy. All patients indicated at least small improvements in pain and physical symptoms both at 1 week and 3 months and all but one patient showed improvement in self-efficacy at 1 week and 3 months. Similar trends were observed for fatigue. Based on our early clinical experience, we conclude that the 1 week multidisciplinary fibromyalgia program is logistically feasible and has potential for clinical efficacy. Further research is needed and is planned to test the clinical efficacy of this program and compare it with other interventions. PMID:24315246

The Educational Impact of Exposure to Clinical Psychiatry Early in an Undergraduate Medical Curriculum.

PubMed

Brown, Menna; Barnes, Jacob; Silver, Katie; Williams, Nicholas; Newton, Philip M

2016-04-01

The medical school at Swansea University provides compulsory early exposure to clinical education through short learning opportunities in the clinical setting (LOCS). These are 3-4-h sessions chosen by students from a list of over 900. Students are required to complete ten LOCS in each of their first 2 years of medical school, with at least one per year being in psychiatry. The objective of this study was to evaluate the educational experience of students undertaking LOCS in psychiatry, in part to understand whether this experience affects student understanding of psychiatry and the likelihood that they will pursue it as a career. A mixed methods approach was used. Qualitative focus group discussions were conducted with medical students to explore perceptions of psychiatry and experiences of psychiatry LOCS. Findings informed the development of a structured quantitative survey aimed at a larger sample of students. Six qualitative themes emerged: (1) limited exposure to psychiatry, (2) organizational issues, (3) positive LOCS experiences, (4) stigma, (5) anticipated emotional burden, (6) psychiatry at odds with current understanding of medicine. Questionnaire data showed that psychiatry is not a popular future career choice when compared to other specialties. Psychiatry LOCS are extremely popular with students and have a positive effect on their understanding of the specialty but did little to influence their stated likelihood of pursuing psychiatry as a career. Early exposure to clinical psychiatry through LOCS gives students positive experiences, which improve understanding and awareness of psychiatry. They do not, however, affect stated career intentions for psychiatry as a profession.

Dissociation mediates the relationship between peer victimization and hallucinatory experiences among early adolescents.

PubMed

Yamasaki, Syudo; Ando, Shuntaro; Koike, Shinsuke; Usami, Satoshi; Endo, Kaori; French, Paul; Sasaki, Tsukasa; Furukawa, Toshi A; Hasegawa-Hiraiwa, Mariko; Kasai, Kiyoto; Nishida, Atsushi

2016-06-01

Peer victimization increases the risk of experiencing psychotic symptoms among clinical and general populations, but the mechanism underlying this association remains unclear. Dissociation, which is related to peer victimization and hallucinatory experiences, has been demonstrated as a significant mediator in the relation between childhood victimization and hallucinatory experience among adult patients with psychosis. However, no studies have examined the mediating effect of dissociation in a general early adolescent population. We examined whether dissociation mediates the relationship between peer victimization and hallucinatory experiences among 10-year-old adolescents using a population-based cross-sectional survey of early adolescents and their main parent (Tokyo Early Adolescence Survey; N  = 4478). We examined the mediating effect of dissociation, as well as external locus of control and depressive symptoms, on the relationship between peer victimization and hallucinatory experiences using path analysis. The model assuming mediation effects indicated good model fit (comparative fit index = .999; root mean square error of approximation = .015). The mediation effect between peer victimization and hallucination via dissociation (standardized indirect effect = .038, p  < .001) was statistically significant, whereas the mediation effects of depressive symptoms (standardized indirect effect = -.0066, p  = 0.318) and external locus of control (standardized indirect effect = .0024, p  = 0.321) were not significant. These results suggest that dissociation is a mediator in the relation between peer victimization and hallucinatory experiences in early adolescence. For appropriate intervention strategies, assessing dissociation and peer victimization as they affect hallucinatory experiences is necessary.

What has changed in the evidence for early experience? Update of a BEME systematic review.

PubMed

Yardley, Sarah; Littlewood, Sonia; Margolis, Stephen A; Scherpbier, Albert; Spencer, John; Ypinazar, Valmae; Dornan, Tim

2010-01-01

We previously reviewed evidence published from 1992 to 2001 concerning early experience for healthcare undergraduates (Dornan T, Littlewood S, Margolis S, Scherpbier A, Spencer J, Ypinazar V. 2006. How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Med Teach 28:3-18). This subsequent study reviews evidence published from 2002 to 2008. Identify changes in the evidence base; determine the value of re-reviewing; set a future research agenda. The same search strategy as in the original review was repeated. Newly identified publications were critically appraised against the same benchmarks of strength and educational importance. Twenty-four new empirical studies of early authentic experience in education of health professionals met our inclusion criteria, yielding 96 outcomes. Sixty five outcomes (from 22 studies) were both educationally important and based on strong evidence. A new significant theme was found: the use of early experience to help students understand and align themselves with patient and community perspectives on illness and healthcare. More publications were now from outside Europe and North America. In addition to supporting the findings of our original review, this update shows an expansion in research sources, and a shift in research content focus. There are still questions, however, about how early authentic experience leads to particular learning outcomes and what will make it most educationally effective.

[Emotional experience of early traumatic experiences and relationship-specific attachment styles in alcohol-dependent patients].

PubMed

Hebein, Ursula; Quantschnig, Bettina; Andreas, Sylke

2018-03-01

Emotional experience of early traumatic experiences and relationship-specific attachment styles in alcohol-dependent patients Objectives: The present investigation studied the differences in emotional experiences among alcohol-dependent patients in inpatient psychotherapy, taking into account their traumatic experiences and relationship-specific attachment styles. Three standardized instruments were used on this clinical sample of 70 patients in inpatient psychotherapy: (1) Scales for Experiencing Emotions (SEE), (2) Childhood Trauma Questionnaire (CTQ), (3) Relationship-Specific Attachment Scales for Adults (RASA). The results showed that traumatic experiences in childhood and adolescence as well as relationship-specific attachment styles were indeed associated with deficits in emotional experience and regulation. Especially emotional abuse was associated with deficits in emotional experience. An insecure attachment style was associated with a lower level of acceptance of emotions, a lower level of self-control, and dysfunctional emotion regulation. In particular, the attachment style to the mother seems to be important. These results suggest that a distinction of alcohol-addicted patients, with respect to attachment styles and traumatic experiences in childhood and adolescent, seems to be important in order to define specific interventions to improve the ability to regulate emotions.

Footprints of "experiment" in early Arabic optics.

PubMed

Kheirandish, Elaheh

2009-01-01

This study traces the early developments of the concept of experiment with a view of extending the subject in both content and approach. It extends the content of the subject slightly backward, prior to the methodological breakthroughs of the Optics of Ibn al-Haytham (Alhazen or Alhacen, d. ca. 1040), which are credited as a "significant landmark in the history of experimental science." And it extends the approach to the subject slightly forward, from the premise that early science was "largely carried out in books," to a close examination of the books through which the footprints of'experiment' may be traced. The point of departure is the Optics of Ahmad ibn 'Isă, a revealing text for the early developments of concepts such as 'demonstration' and 'experiment', and one through which some modern discussions are examined and extended with reference to this and other historical sources.

Medical students' and facilitators' experiences of an Early Professional Contact course: active and motivated students, strained facilitators.

PubMed

von Below, Bernhard; Hellquist, Gunilla; Rödjer, Stig; Gunnarsson, Ronny; Björkelund, Cecilia; Wahlqvist, Mats

2008-12-02

Today, medical students are introduced to patient contact, communication skills, and clinical examination in the preclinical years of the curriculum with the purpose of gaining clinical experience. These courses are often evaluated from the student perspective. Reports with an additional emphasis on the facilitator perspective are scarce. According to constructive alignment, an influential concept from research in higher education, the learning climate between students and teachers is also of great importance. In this paper, we approach the learning climate by studying both students' and facilitators' course experiences.In 2001, a new "Early Professional Contact" longitudinal strand through term 1-4, was introduced at the Sahlgrenska Academy, University of Gothenburg, Sweden. General practitioners and hospital specialists were facilitators.The aim of this study was to assess and analyse students' and clinical facilitators' experiences of the Early Professional Contact course and to illuminate facilitators' working conditions. Inspired by a Swedish adaptation of the Course Experience Questionnaire, an Early Professional Contact Questionnaire was constructed. In 2003, on the completion of the first longitudinal strand, a student and facilitator version was distributed to 86 students and 21 facilitators. In the analysis, both Chi-square and the Mann-Whitney tests were used. Sixty students (70%) and 15 facilitators (71%) completed the questionnaire. Both students and facilitators were satisfied with the course. Students reported gaining iiration for their future work as doctors along with increased confidence in meeting patients. They also reported increased motivation for biomedical studies. Differences in attitudes between facilitators and students were found. Facilitators experienced a greater workload, less reasonable demands and less support, than students. In this project, a new Early Professional Contact course was analysed from both student and facilitator

ABCs of Early Mathematics Experiences

ERIC Educational Resources Information Center

Hensen, Laurie E.

2005-01-01

Children begin to develop mathematical thinking before they enter school. Art, baking, playing with blocks, counting numbers, games, puzzles, singing, playing with pretend money, water play all these early mathematical experiences help the children to learn in the elementary school years.

Clinical abnormalities, early intervention program of Down syndrome children: Queen Sirikit National Institute of Child Health experience.

PubMed

Fuengfoo, Adidsuda; Sakulnoom, Kim

2014-06-01

Queen Sirikit National Institute of Child Health is a tertiary institute of children in Thailand, where early intervention programs have been provided since 1990 by multidisciplinary approach especially in Down syndrome children. This aim of the present study is to follow the impact of early intervention on the outcome of Down syndrome children. The school attendance number of Down syndrome children was compared between regular early intervention and non-regular early intervention. The present study group consists of 210 Down syndrome children who attended early intervention programs at Queen Sirikit National Institute of Child Health between June 2008 and January 2012. Data include clinical features, school attendance developmental quotient (DQ) at 3 years of age using Capute Scales Cognitive Adaptive Test/Scale (CAT/CLAMS). Developmental milestones have been recorded as to the time of appearance of gross motor, fine motor, language, personal-social development compared to those non-regular intervention patients. Of 210 Down syndrome children, 117 were boys and 93 were girls. About 87% received regular intervention, 68% attended speech training. Mean DQ at 3 years of age was 65. Of the 184 children who still did follow-up at developmental department, 124 children (59%) attended school: mainstream school children 78 (63%) and special school children 46 (37%). The mean age at entrance to school was 5.8 ± 1.4 years. The school attendance was correlated with maternal education and regular early intervention attendance. Regular early intervention starts have proven to have a positive effect on development. The school attendance number of Down syndrome children receiving regular early intervention was statistically and significantly higher than the number of Down syndrome children receiving non-regular early intervention was. School attendance correlated with maternal education and attended regularly early intervention. Regular early intervention together with maternal

Preclinical students’ experiences in early clerkships after skills training partly offered in primary health care centers: a qualitative study from Indonesia

PubMed Central

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

Characteristics of Early Work Experiences and Their Association with Future Employment

ERIC Educational Resources Information Center

McDonnall, Michele Capella; O'Mally, Jamie

2012-01-01

Introduction: Early work experiences are a key predictor of future employment for transition-age youths with visual impairments. We investigated how specific characteristics of early work experiences influence future employment and whether the receipt of Supplemental Security Income (SSI) benefits is associated with early work experiences among…

Studying the Effects of Early Experiences on Women's Career Achievement.

ERIC Educational Resources Information Center

Lykes, M. Brinton; Stewart, Abigail J.

Virtually all psychological theories assume that early life experiences have an impact on later life choices. However, increasing doubts have been expressed about the universality and permanence of the relationship between women's work and family lives. To explore how early family experiences and early adult decisions affect women's later career…

Concerns of Teacher Candidates in an Early Field Experience

ERIC Educational Resources Information Center

Chang, Sau Hou

2009-01-01

The present study examined the concerns of teacher candidates in an early field experience. Thirty-five teacher candidates completed the Teacher Concerns Checklist (TCC, Fuller & Borich, 2000) at the beginning, middle and end of their early field experiences. Results showed that teacher candidates ranked impact as the highest concern, self as…

Factors associated with early detection of choroidal neovascularization in age-related macular degeneration in the clinic setting.

PubMed

Lichtinger, Alejandro; Caraza, Mauricio; Galbinur, Tural; Chowers, Itay

2012-06-01

Delayed diagnosis of choroidal neovas cularization (CNV) in age-related macular degeneration (AMD) adversely affects visual outcome. To identify factors associated with early detection of CNV in the clinic setting. Demographic and clinical data and lesion characteristics were retrospectively collected from 76 consecutive AMD patients who had a history of CNV in one eye and presented with CNV in the second eye. These data were evaluated for association with visual acuity (VA) at the time of presentation. Better VA was associated with a history of CNV in the fellow eye (P < 0.0001), adherence to follow-up every 4 months (P = 0.015), younger age (P = 0.03), smaller lesion (P < 0.0001), and non-subfoveal location (P = 0.048). VA of the fellow eye did not correlate with VA at presentation with CNV. These data suggest that patients' experience of CNV, regardless of VA, facilitates early diagnosis in the fellow eye. Adherence to follow-up in the routine clinic setting also facilitates early detection of CNV.

brief report: Burnout Among Early Career Clinical Investigators

PubMed Central

Primack, Brian A.; Dilmore, Terri C.; Switzer, Galen E.; Bryce, Cindy L.; Seltzer, Deborah L.; Li, Jie; Landsittel, Douglas P.; Kapoor, Wishwa N.; Rubio, Doris M.

2010-01-01

Abstract Burnout is a pervasive problem among clinicians. However, little is known about burnout among early career clinical investigators, who must balance clinical responsibilities with challenges related to research. We aimed to determine the prevalence of and demographic associations with burnout in a cohort of early career clinical investigators. A cross‐sectional questionnaire was administered to 179 trainees at the University of Pittsburgh Institute for Clinical Research Education in 2007–2008. We used chi‐square analyses and Fisher’s exact test to determine whether associations between demographic characteristics and burnout were significant. Of the participants, 29 (16%) reported feeling burned out. Burnout was more prevalent among those over 35 years of age relative to their younger counterparts (29% vs. 13%, p= 0.01) and among females relative to males (22% vs. 10%, p= 0.03). With regard to race and ethnicity, burnout was most common among underrepresented minorities (30%) followed by Caucasians (18%) and Asians (3%); these differences were significant (p= 0.02). Considering the early career status of these research trainees, rates of burnout were concerning. Certain demographic subgroups—including older trainees, females, and underrepresented minorities—had particularly high rates of burnout and may benefit from interventions that provide them with skills needed to sustain successful clinical research careers. Clin Trans Sci 2010; Volume 3: 186–188 PMID:20718821

Assessing student clinical learning experiences.

PubMed

Nehyba, Katrine; Miller, Susan; Connaughton, Joanne; Singer, Barbara

2017-08-01

This article describes the use of an activity worksheet and questionnaire to investigate the learning experience of students on clinical placement. The worksheet measures the amount of time students spend in different learning activities, and the questionnaire explores student satisfaction and preferred learning activities. An activity worksheet and questionnaire … investigate[d] the learning experiences of students on clinical placement METHODS: The activity worksheet and questionnaire were used in a cohort pilot study of physiotherapy students on clinical placement. The activity worksheet provides details of the amount of time students engage in a range of clinical and non-clinical tasks while on placement, such as time spent treating patients, working individually, working with their peers and engaging in reflective practice. In combination with the questionnaire results, it allows clinicians to gain an understanding of the clinical learning environment experienced by their students. The data collected using these tools provide a description of the students' activities while undertaking the clinical placement. This information may guide the refinement of the clinical experience, and offers an opportunity to individualise learning activities to match students' needs and preferences. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Predicting Readmission at Early Hospitalization Using Electronic Clinical Data: An Early Readmission Risk Score.

PubMed

Tabak, Ying P; Sun, Xiaowu; Nunez, Carlos M; Gupta, Vikas; Johannes, Richard S

2017-03-01

Identifying patients at high risk for readmission early during hospitalization may aid efforts in reducing readmissions. We sought to develop an early readmission risk predictive model using automated clinical data available at hospital admission. We developed an early readmission risk model using a derivation cohort and validated the model with a validation cohort. We used a published Acute Laboratory Risk of Mortality Score as an aggregated measure of clinical severity at admission and the number of hospital discharges in the previous 90 days as a measure of disease progression. We then evaluated the administrative data-enhanced model by adding principal and secondary diagnoses and other variables. We examined the c-statistic change when additional variables were added to the model. There were 1,195,640 adult discharges from 70 hospitals with 39.8% male and the median age of 63 years (first and third quartile: 43, 78). The 30-day readmission rate was 11.9% (n=142,211). The early readmission model yielded a graded relationship of readmission and the Acute Laboratory Risk of Mortality Score and the number of previous discharges within 90 days. The model c-statistic was 0.697 with good calibration. When administrative variables were added to the model, the c-statistic increased to 0.722. Automated clinical data can generate a readmission risk score early at hospitalization with fair discrimination. It may have applied value to aid early care transition. Adding administrative data increases predictive accuracy. The administrative data-enhanced model may be used for hospital comparison and outcome research.

Precedents of perceived social support: personality and early life experiences.

PubMed

Kitamura, T; Kijima, N; Watanabe, K; Takezaki, Y; Tanaka, E

1999-12-01

In order to examine the effects of personality and early life experiences on perceived social support, a total of 97 young Japanese women were investigated. Current interpersonal relationships were measured by an interview modified from Henderson et al.'s Interview Schedule for Social Interaction (ISSI). Personality was measured by Cloninger et al.'s Temperament and Character Inventory. Early life experiences at home and outside of home were also identified in the interview. The number of sources of perceived support was correlated with self-directness, while satisfaction with perceived support was correlated with novelty seeking and with low harm avoidance. No early life experiences--early loss of a parent, perceived parenting, childhood abuse experiences, experiences of being bullied and/or other life events--showed significant correlations with the number or satisfaction of supportive people. The quantity and quality of perception of social support differ in their link to personality, and perceived social support may, to some extent, be explainable in terms of personality.

Pharmacogenomics in early-phase clinical development

PubMed Central

Burt, Tal; Dhillon, Savita

2015-01-01

Pharmacogenomics (PGx) offers the promise of utilizing genetic fingerprints to predict individual responses to drugs in terms of safety, efficacy and pharmacokinetics. Early-phase clinical trial PGx applications can identify human genome variations that are meaningful to study design, selection of participants, allocation of resources and clinical research ethics. Results can inform later-phase study design and pipeline developmental decisions. Nevertheless, our review of the clinicaltrials.gov database demonstrates that PGx is rarely used by drug developers. Of the total 323 trials that included PGx as an outcome, 80% have been conducted by academic institutions after initial regulatory approval. Barriers for the application of PGx are discussed. We propose a framework for the role of PGx in early-phase drug development and recommend PGx be universally considered in study design, result interpretation and hypothesis generation for later-phase studies, but PGx results from underpowered studies should not be used by themselves to terminate drug-development programs. PMID:23837482

Music Experiences in Early Childhood.

ERIC Educational Resources Information Center

Andress, Barbara

This book presents a program of music experiences for young children (3-5-year-olds) which focuses on an experiential discovery approach to music, rather than on imposing ideas and a repertoire on the child. Early sections of the book discuss the importance of the child-centered music program, its process and characteristics, and the role of the…

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

PubMed Central

2014-01-01

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

Early traumatic experiences in those at clinical high risk for psychosis.

PubMed

Addington, Jean; Stowkowy, Jacqueline; Cadenhead, Kristin S; Cornblatt, Barbara A; McGlashan, Thomas H; Perkins, Diana O; Seidman, Larry J; Tsuang, Ming T; Walker, Elaine F; Woods, Scott W; Cannon, Tyrone D

2013-08-01

Several lines of evidence suggest a possible association between a history of trauma in childhood and later psychosis or psychotic-like experiences. The purpose of this study was to determine the extent of childhood trauma and bullying in young people at clinical high risk (CHR) of developing psychosis. The sample consisted of 360 individuals who were at CHR of developing psychosis and 180 age- and gender-matched healthy controls. All participants were assessed on past trauma and bullying. The CHR participants were also assessed on a range of psychopathology and functioning. Individuals at CHR reported significantly more trauma and bullying than healthy controls. Those who had experienced past trauma and bullying were more likely to have increased levels of depression and anxiety and a poorer sense of self. These results offer preliminary support for an association between a history of trauma and later subthreshold symptoms. © 2013 Wiley Publishing Asia Pty Ltd.

77 FR 9947 - Guidance for Industry: Early Clinical Trials With Live Biotherapeutic Products: Chemistry...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-21

...] Guidance for Industry: Early Clinical Trials With Live Biotherapeutic Products: Chemistry, Manufacturing... ``Guidance for Industry: Early Clinical Trials With Live Biotherapeutic Products: Chemistry, Manufacturing... for Industry: Early Clinical Trials With Live Biotherapeutic Products: Chemistry, Manufacturing, and...

BRIEF REPORT: Beyond Clinical Experience: Features of Data Collection and Interpretation That Contribute to Diagnostic Accuracy

PubMed Central

Nendaz, Mathieu R; Gut, Anne M; Perrier, Arnaud; Louis-Simonet, Martine; Blondon-Choa, Katherine; Herrmann, François R; Junod, Alain F; Vu, Nu V

2006-01-01

BACKGROUND Clinical experience, features of data collection process, or both, affect diagnostic accuracy, but their respective role is unclear. OBJECTIVE, DESIGN Prospective, observational study, to determine the respective contribution of clinical experience and data collection features to diagnostic accuracy. METHODS Six Internists, 6 second year internal medicine residents, and 6 senior medical students worked up the same 7 cases with a standardized patient. Each encounter was audiotaped and immediately assessed by the subjects who indicated the reasons underlying their data collection. We analyzed the encounters according to diagnostic accuracy, information collected, organ systems explored, diagnoses evaluated, and final decisions made, and we determined predictors of diagnostic accuracy by logistic regression models. RESULTS Several features significantly predicted diagnostic accuracy after correction for clinical experience: early exploration of correct diagnosis (odds ratio [OR] 24.35) or of relevant diagnostic hypotheses (OR 2.22) to frame clinical data collection, larger number of diagnostic hypotheses evaluated (OR 1.08), and collection of relevant clinical data (OR 1.19). CONCLUSION Some features of data collection and interpretation are related to diagnostic accuracy beyond clinical experience and should be explicitly included in clinical training and modeled by clinical teachers. Thoroughness in data collection should not be considered a privileged way to diagnostic success. PMID:17105525

Early discharge of patients with pulmonary embolism in daily clinical practice: A prospective observational study comparing clinical gestalt and clinical rules.

PubMed

Vanni, Simone; Becattini, Cecilia; Nazerian, Peiman; Bova, Carlo; Stefanone, Valerio Teodoro; Cimini, Ludovica Anna; Viviani, Gabriele; Caviglioli, Cosimo; Sanna, Michela; Pepe, Giuseppe; Grifoni, Stefano

2018-05-08

To estimate the efficiency and safety of clinicians' gestalt in the identification of patients with pulmonary embolism (PE) candidates for early discharge and to compare the efficiency and safety of clinical gestalt with that of the Pulmonary Embolism Severity Index (PESI), the simplified PESI (sPESI) and the Hestia criteria (HC). Consecutive adult patients presenting to the emergency department of four Italian hospitals with confirmed diagnosis of PE were included. Data for PESI, sPESI and HC assessment were prospectively collected. Patients were managed according to the clinical gestalt of the attending physician, independent of the results of PESI, sPESI and HC. Efficiency was defined as the prevalence of candidates to early discharge. The primary safety measure was the incidence of a composite of venous thromboembolic recurrence, major haemorrhage or all-cause mortality within 30 days. Out of 547 included patients, 178 (32.5%) were judged to be at low risk and discharged within 48 h from presentation. HC identified a higher proportion (41.7%) whereas both PESI (24.1%) and sPESI (18.3%) identified a lower proportion of candidates for early discharge when compared to clinical gestalt (P < 0.01 for all). The incidence of the safety outcome was 2.8% in early-discharged patients according to clinical gestalt and 2.3%, 3.0% and 2.6% in candidates to early discharge according to PESI, sPESI and HC, without differences between strategies. In our cohort, clinical gestalt identified one-third of PE patients for early discharge. Among different strategies HC showed the highest efficiency sharing similar safety with the other strategies. Copyright © 2018 Elsevier Ltd. All rights reserved.

Clinical and Other Risk Indicators for Early Periodontitis in Adults

PubMed Central

Tanner, Anne C.R.; Kent, Ralph; Van Dyke, Thomas; Sonis, Steven T.; Murray, Lora A.

2005-01-01

Background Periodontal diseases affect over half the adults in the U.S., disproportionately affecting minority populations. Periodontitis can be treated in early stages, but it is not clear what features indicate, or could be risk factors for, early stages of periodontal attachment loss. This study aimed to evaluate associations between clinical and other risk indicators of early periodontitis. Methods A cross-sectional evaluation of 225 healthy and early periodontitis adults aged 20 to 40 years was performed. Clinical measurements, demographic information, and smoking histories were recorded. Analyses evaluated demographic and clinical associations with health and early periodontitis disease categories and periodontal attachment loss. Patterns of attachment loss at interproximal and buccal/lingual sites were evaluated. Results Subject age, plaque, and measures of gingivitis exhibited associations with attachment loss and probing depth. More periodontal attachment loss was detected in African-American and Hispanic subjects compared to Asian and Caucasian subjects. Smoking history was associated with attachment loss. At interproximal sites, lower molars most frequently had attachment loss, whereas at buccal/lingual sites, higher proportions of lower bicuspid teeth demonstrated attachment loss compared with other sites. Conclusions In this study of subjects with minimal attachment loss, gingival inflammation was associated with early periodontitis. Lower molar interproximal sites were frequently associated with interproximal attachment loss, whereas lower bicuspid teeth were at risk for gingival recession on buccal surfaces. PMID:15857098

Reaching their potential: Perceived impact of a collaborative academic-clinical partnership programme for early career nurses in New Zealand.

PubMed

McKillop, Ann; Doughty, Lesley; Atherfold, Cheryl; Shaw, Kathy

2016-01-01

The dynamic nature of healthcare ensures that early career nurses enter an uncertain and complex world of practice and consequently require support to develop their practice, build confidence and reach their potential. The New Zealand Nurse Entry to Practice programme for registered nurses in their first year of practice has been operating since 2005 to enable safe and confident practice, improve the quality of care, and positively impact on recruitment and retention. This academic and clinical programme was offered as a partnership between a university and a clinical provider with postgraduate academic credits gained. The aim of this study was to explore the perceived impact of postgraduate university education for early career nurses in one regional health area of New Zealand. Participants were registered nurses who had completed the early career nurse programme and their clinical preceptors. The research was conducted via an online survey of 248 nurses and three focus groups to explore how the programme was experienced and its impact on knowledge and practice. Early career nurses and their preceptors found that the programme enables improved knowledge and skills of patient assessment, application of critical thinking to clinical practice, perceived improvement in patient care delivery and outcomes, enhanced interprofessional communication and knowledge sharing, and had a positive impact on professional awareness and career planning. This clinical-academic partnership positively impacted on the clinical practice and transition experience of early career nurses and was closely aligned to an organization's strategic plan for nursing workforce development. Copyright © 2015 Elsevier Ltd. All rights reserved.

Early clinical experience with Guidezilla for transradial interventions in China.

PubMed

Ma, Min; Diao, Kai-Yue; Liu, Xiao-Jing; He, Yong

2018-04-03

Anatomic variations, calcified, tortuous, angulated lesions, and lack of support to increase the complexity of transradial intervention (TRI). Guidezilla is a mother-and-child catheter enabling increased support during complex interventions. As there are few published reports of its use, we describe our experience using this device to assist TRI in Chinese patients. The aim of this study was to investigate the efficacy and safety of the Guidezilla guide extension catheter in complex coronary interventions. Thirty-two patients' clinical characteristics, angiographic details, and in-hospital outcome retrospectively collected between June 2015 and August 2017. Patients were 59.44 ± 10.48 years of age and 26 (81%) were men. The most frequent target vessels were the RCA (34%) and LAD (31%), patients had complex type C (53%) or B (47%) lesions, severely tortuous (41%) and angulated (22%).With the use of Guidezilla, technique success was 100%, and procedural success was 94%. The mean diameter of the deployed stents was 2.97 ± 0.37 mm, and the length was 27.19 ± 8.14 mm. The estimated mean distance of Guidezilla intubation into the target vessel was 7.66 ± 2.29 cm.The Guidezilla catheter extension safely facilitated successful completion of TRI in complex coronary artery lesions. This device can help interventionalists successfully perform difficult procedures.

Important first encounter: Service user experience of pathways to care and early detection in first-episode psychosis.

PubMed

Jansen, Jens Einar; Pedersen, Marlene Buch; Hastrup, Lene Halling; Haahr, Ulrik Helt; Simonsen, Erik

2018-04-01

Long duration of untreated psychosis is associated with poor clinical and functional outcomes. However, few systematic attempts have been made to reduce this delay and little is known of service users' experience of early detection efforts. We explored service users' experience of an early detection service and transition to specialized treatment service, including pathway to care, understanding of illness and barriers to adequate assessment and treatment. In-depth interviews were conducted with 10 service users (median age 21, range 18-27, five males and five females) who were diagnosed with a first-episode non-affective psychosis and who were seen by an early detection team (TOP) and currently enrolled in a specialized early intervention service for this disorder (OPUS). Stigma and fear of the 'psychiatric system' were reported as significant barriers to help seeking, while family members were seen as a crucial support. Moreover, the impact of traumatic events on the experience and development of psychosis was highlighted. Finally, participants were relieved by the prospect of receiving help and the early detection team seemed to create a trusting relationship by offering a friendly, 'anti-stigmatized' space, where long-term symptomatology could be disclosed through accurate and validating questioning. Early detection services have two important functions. One is to make accurate assessments and referrals. The other is to instil hope and trust, and to facilitate further treatment by forming an early therapeutic alliance. The findings in this study provide important insights into the way in which early detection efforts and pathways to care are experienced by service users, with direct implications for improving psychiatric services. © 2015 Wiley Publishing Asia Pty Ltd.

Comparing early signs and basic symptoms as methods for predicting psychotic relapse in clinical practice.

PubMed

Eisner, Emily; Drake, Richard; Lobban, Fiona; Bucci, Sandra; Emsley, Richard; Barrowclough, Christine

2018-02-01

Early signs interventions show promise but could be further developed. A recent review suggested that 'basic symptoms' should be added to conventional early signs to improve relapse prediction. This study builds on preliminary evidence that basic symptoms predict relapse and aimed to: 1. examine which phenomena participants report prior to relapse and how they describe them; 2. determine the best way of identifying pre-relapse basic symptoms; 3. assess current practice by comparing self- and casenote-reported pre-relapse experiences. Participants with non-affective psychosis were recruited from UK mental health services. In-depth interviews (n=23), verbal checklists of basic symptoms (n=23) and casenote extracts (n=208) were analysed using directed content analysis and non-parametric statistical tests. Three-quarters of interviewees reported basic symptoms and all reported conventional early signs and 'other' pre-relapse experiences. Interviewees provided rich descriptions of basic symptoms. Verbal checklist interviews asking specifically about basic symptoms identified these experiences more readily than open questions during in-depth interviews. Only 5% of casenotes recorded basic symptoms; interviewees were 16 times more likely to report basic symptoms than their casenotes did. The majority of interviewees self-reported pre-relapse basic symptoms when asked specifically about these experiences but very few casenotes reported these symptoms. Basic symptoms may be potent predictors of relapse that clinicians miss. A self-report measure would aid monitoring of basic symptoms in routine clinical practice and would facilitate a prospective investigation comparing basic symptoms and conventional early signs as predictors of relapse. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Clinical Placement Before or After Simulated Learning Environments?: A Naturalistic Study of Clinical Skills Acquisition Among Early-Stage Paramedicine Students.

PubMed

Mills, Brennen W; Carter, Owen B J; Rudd, Cobie J; Ross, Nathan P; Claxton, Louise A

2015-10-01

There is conflicting evidence surrounding the merit of clinical placements (CPs) for early-stage health-profession students. Some contend that early-stage CPs facilitate contextualization of a subsequently learned theory. Others argue that training in simulated-learning experiences (SLEs) should occur before CP to ensure that students possess at least basic competency. We sought to investigate both claims. First-year paramedicine students (n = 85) undertook 3 days of CP and SLEs as part of course requirements. Students undertook CP either before or after participation in SLEs creating 2 groups (Clin → Sim/Sim → Clin). Clinical skills acquisition was measured via direct scenario-based clinical assessments with expert observers conducted at 4 intervals during the semester. Perceptions of difficulty of CP and SLE were measured via the National Aeronautics and Space Administration Task Load Index. Students' clinical assessment scores in both groups improved significantly from beginning to end of semester (P < 0.001). However, at semester's end, clinical assessment scores for the Sim → Clin group were statistically significantly greater than those of the Clin → Sim group (P = 0.021). Both groups found SLEs more demanding than CP (P < 0.001). However, compared with the Sim → Clin group, the Clin → Sim group rated SLE as substantially more time-demanding than CP (P = 0.003). Differences in temporal demand suggest that the Clin → Sim students had fewer opportunities to practice clinical skills during CP than the Sim → Clin students due to a more limited scope of practice. The Sim → Clin students contextualized SLE within subsequent CP resulting in greater improvement in clinical competency by semester's end in comparison with the Clin → Sim students who were forced to contextualize skills retrospectively.

Working in partnership with the voluntary sector: early explorer clinics.

PubMed

Coe, Chris; Barlow, Jane

2010-11-01

The first three years of life have been identified as key to promoting children's later wellbeing, and partnership working across the statutory and voluntary sectors has been proposed as one of the best ways to meet the needs of families. Child health clinics are attended by parents seeking reassurance or help and advice from a health professional regarding child health and development. They have been used in Oxford to develop Early Explorer clinics, in which the statutory health visiting service and voluntary sector Peers Early Education Programme work together with the aim of improving outcomes for children and families. These Early Explorer clinics provide the opportunity to engage parents in supporting their child's development through interaction and non-directed exploratory play. They also offer opportunities to identify vulnerable families, who are provided with additional support. This paper examines a model of partnership working between statutory and voluntary sectors aimed at maximising opportunities to promote the health and wellbeing of infants and their families.

The Early Experiments

NASA Astrophysics Data System (ADS)

Garvey, Gerald

2013-04-01

Stuart Freedman obtained his PhD at Berkley with an experimental thesis providing very strong evidence against theories requiring local hidden variables. He then came to Princeton in 1972 and began collaboration on a search for second-class currents. These measurements are quite difficult as the effects are the order of 1%, demonstrating Freedman's drive to take on hard but important experiments. After carrying out some relatively standard nuclear physics measurements he moved on to Stanford in 1976. There, Freedman was involved in identifying measurements sensitive to the existence of light axions. He also carried out searches for various exotica that might be produced from cosmic rays or the SLAC beam stop. During this time he was collaborating with us at Argonne investigating nuclear parity violation and time-like axial beta decay. In 1982 Freedman came to Argonne where he worked on fundamental issues in neutron beta decay. He also initiated what was to become one of his trademarks, demonstrating that surprising peaks in the e^+-e^- spectrum observed in very heavy ion collisions were spurious. He further launched his first neutrino oscillation experiment. This period of early research was marked by a remarkable diversity of subject matter and approach.

Early Intervention for Children with Disabilities: The Australian Experience.

ERIC Educational Resources Information Center

Pieterse, Moira, Ed.; And Others

A collection of papers on the Australian experience with early intervention for children with disabilities gives regional overviews, describes specific intervention programs, and discusses a variety of issues. Overviews are given of early intervention in Australia in general, New South Wales, Victoria, Queensland, South Australia, Western…

Early-Onset Bipolar Disorder: Characteristics and Outcomes in the Clinic.

PubMed

Connor, Daniel F; Ford, Julian D; Pearson, Geraldine S; Scranton, Victoria L; Dusad, Asha

2017-12-01

To assess patient characteristics and clinician-rated outcomes for children diagnosed with early-onset bipolar disorder in comparison to a depressive disorders cohort from a single clinic site. To assess predictors of bipolar treatment response. Medical records from 714 consecutive pediatric patients evaluated and treated at an academic tertiary child and adolescent psychiatry clinic between 2006 and 2012 were reviewed. Charts of bipolar children (n = 49) and children with depressive disorders (n = 58) meeting study inclusion/exclusion criteria were compared on variables assessing clinical characteristics, treatments, and outcomes. Outcomes were assessed by using pre- and post-Clinical Global Impressions (CGI)-Severity and Children's Global Assessment Scale (CGAS) scores, and a CGI-Improvement score ≤2 at final visit determined responder status. Bipolar outcome predictors were assessed by using multiple linear regression. Clinic prevalence rates were 6.9% for early-onset bipolar disorder and 1.5% for very early-onset bipolar disorder. High rates of comorbid diagnoses, symptom severity, parental stress, and child high-risk behaviors were found in both groups. The bipolar cohort had higher rates of aggression and higher lifetime systems of care utilization. The final CGI and CGAS outcomes for unipolar depression patients differed statistically significantly from those for the bipolar cohort, reflecting better clinical status and more improvement at outcome for the depression patients. Both parent-reported Child Behavior Checklist total T-score at clinic admission and the number of lifetime systems-of-care for the child were significantly and inversely associated with improvement for the bipolar cohort. Early-onset bipolar disorder is a complex and heterogeneous psychiatric disorder. Evidence-based treatment should emphasize psychopharmacology with adjunctive family and individual psychotherapy. Strategies to improve engagement in treatment may be especially

Effectiveness of a clinical practice intervention in early rheumatoid arthritis.

PubMed

Descalzo, Miguel Ángel; Carbonell, Jordi; González-Álvaro, Isidoro; Sanmartí, Raimon; Balsa, Alejandro; Hernandez-Barrera, Valentín; Román-Ivorra, José Andrés; Ivorra-Cortés, José; Lisbona, Pilar; Alperi, Mercedes; Jiménez-Garcia, Rodrigo; Carmona, Loreto

2012-03-01

To compare the outcome of early rheumatoid arthritis (RA) patients in a country where early clinics were established versus the outcome of patients in nonprotocolized clinics. We compared 2 multicenter cohorts: an RA cohort derived from an early arthritis registry set in 36 reference hospitals in which a specific intervention was established (Evaluation of a Model for Arthritis Care in Spain [SERAP]), and a historical control cohort of patients with early RA attending 34 rheumatology departments (Prognosis in Rheumatoid Arthritis [PROAR] cohort). Effectiveness was tested by comparing the change in the Disease Activity Score in 28 joints (DAS28), the change in the Health Assessment Questionnaire (HAQ), and the change in the Sharp/van der Heijde radiologic score using marginal structural models. A total of 161 early RA patients were recruited in the PROAR cohort and 447 in the SERAP cohort. Being a SERAP patient was inversely correlated with activity, resulting in a decrease of -0.24 (95% confidence interval [95% CI] -0.39, -0.08) units in the population average of the DAS28 after adjustment was made. Moreover, intervention may be seen as a protective factor of radiologic damage, with a decrease of -0.05 (95% CI -0.09, -0.01) units in the logarithm of the total Sharp/van der Heijde score. On the other hand, a decrease in functional impairment was detected, but intervention was not statistically associated with HAQ changes. Preventing major radiographic progression in a 2-year term inside structured and organized special programs for the management of disease, such as early arthritis clinics, are effective compared to nonprotocolized referrals, treatment, and followup. Copyright © 2012 by the American College of Rheumatology.

Renal Tumors: Technical Success and Early Clinical Experience with Radiofrequency Ablation of 18 Tumors

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

Sabharwal, Rohan, E-mail: rohan50000@yahoo.com; Vladica, Philip

2006-04-15

Purpose. To evaluate the feasibility, safety, and technical efficacy of image-guided radiofrequency ablation (RFA) for the treatment of small peripheral renal tumors and to report our early results with this treatment modality. Methods. Twenty-two RFA sessions for 18 tumors were performed in 11 patients with renal tumors. Indications included coexistent morbidity, high surgical or anesthetic risk, solitary kidney, and hereditary predisposition to renal cell carcinoma. Ten patients had CT-guided percutaneous RFA performed on an outpatient basis. One patient had open intraoperative ultrasound-guided RFA. Technical success was defined as elimination of areas that enhanced at imaging within the entire tumor. Withmore » the exception of one patient with renal insufficiency who required gadolinium-enhanced MRI, the remaining patients underwent contrast-enhanced CT for post-treatment follow-up assessment. Follow-up was performed after 2-4 weeks and then at 3, 6, 12 months, and every 12 months thereafter. Results. Fourteen (78%) of 18 tumors were successfully ablated with one session. Three of the remaining four tumors required two sessions for successful ablation. One tumor will require a third session for areas of persistent enhancement. Mean patient age was 72.82 {+-} 10.43 years. Mean tumor size was 1.95 {+-} 0.79 cm. Mean follow-up time was 10.91 months. All procedures were performed without any major complications. Conclusions. Our early experience with percutaneous image-guided radiofrequency ablation demonstrates it to be a feasible, safe, noninvasive, and effective treatment of small peripheral renal tumors.« less

Clinical symptoms predict concurrent social and global functioning in an early psychosis sample.

PubMed

Cacciotti-Saija, Cristina; Langdon, Robyn; Ward, Philip B; Hickie, Ian B; Guastella, Adam J

2018-04-01

Although well established in chronic schizophrenia, the key determinants of functioning remain unknown during the early phase of a psychotic disorder. The aim of this study was to comprehensively examine the social cognitive, basic neurocognitive and clinical predictors of concurrent social functioning and global functioning in an early psychosis sample. This study examined the relationship between social cognition, basic neurocognition and clinical symptoms with concurrent functioning in 51 early psychosis individuals. Assessments included a range of self-report, observational and clinician-rated measures of cognitive, symptom severity and functioning domains. Results revealed a significant association between self-reported social function and lower levels of both social interaction anxiety and negative psychotic symptoms. A significant association was also observed between lower levels of negative psychotic symptoms and observed social functioning. Lastly, results demonstrated a significant association between reduced negative psychotic symptoms and clinician-rated global functioning. Clinical domains such as negative symptoms and social interaction anxiety significantly contribute to an optimal model predicting outcome during the early phase of a psychotic disorder. These clinical features may also provide useful markers of an individual's capacity for social participation. Clinical implications include the need for early targeted intervention to address social anxiety and negative psychotic symptoms to facilitate optimum patient outcome. © 2015 Wiley Publishing Asia Pty Ltd.

Designing a Curriculum for Clinical Experiences

ERIC Educational Resources Information Center

Henning, John E.; Erb, Dorothy J.; Randles, Halle Schoener; Fults, Nanette; Webb, Kathy

2016-01-01

The purpose of this article is to describe a collaborative effort among five teacher preparation programs to create a conceptual tool designed to put clinical experiences at the center of our programs. The authors refer to the resulting product as a clinical curriculum. The clinical curriculum describes a developmental sequence of clinical…

Effectiveness of a Clinic-Based Early Literacy Program in Changing Parent-Child Early Literacy Habits.

PubMed

Fricke, Jonathan; Navsaria, Dipesh; Mahony, Karin

2016-12-01

Reach Out and Read (ROR) improves children's development and kindergarten readiness by encouraging parents to routinely share books with their children. Primary care providers give age-appropriate books and anticipatory guidance on reading at each well-child visit. This study evaluated parent attitudes and behaviors of early literacy related to ROR participation in Wisconsin clinics. A survey of early literacy attitudes and behaviors was administered to parents of children ages 6 months to 5 years in 36 Wisconsin clinics. Ten clinics were established ROR sites (intervention group) and 26 clinics had applied to become ROR programs but had not yet initiated the program (control group). Parents at clinics with ROR programs were more likely to read with a child under the age of 6 months (OR=1.58, 95% CI, 1.05-2.38). Other literacy metrics trended toward improvement but none reached statistical significance. Paradoxically, the odds of parents reporting reading as a bedtime habit were decreased among those who participated in ROR. Our study finds mixed support of the effectiveness of ROR outside of academic settings. The apparent discrepancy between these results and those from national studies on ROR may be related to differences in respondent demographics and educational attainment or differences in program implementation and fidelity. We believe that the results will become clearer with future study as clinics are prospectively evaluated over time rather than being compared to non-ROR clinics in a cross-sectional snapshot.

Evaluation with mTHPC of early squamous cell carcinomas of the cheek pouch mucosa of Golden Syrian hamsters as a model for clinical PDT of early cancers in the upper aerodigestive tract, the esophag

NASA Astrophysics Data System (ADS)

Glanzmann, Thomas M.; Theumann, Jean-Francois; Forrer, Martin; Braichotte, Daniel; Wagnieres, Georges A.; van den Bergh, Hubert; Andrejevic-Blant, Snezana; Savary, Jean-Francois; Monnier, Philippe

1995-03-01

Golden Syrian hamsters are evaluated as an animal model for light induced fluorescence (LIF) photodetection and phototherapy of early squamous cell carcinomas of the upper aerodigestive tract, the esophagus, and the traecheo-bronchial tree. Carcinomas of this type are induced on the hamster cheek pouch mucosa by the application of the carcinogen 7,12-DMBA. For phototherapeutic experiments on the animals we utilized meso-(tetrahydoxyphenyl) chlorin (mTHPC). This drug is currently in phase I and II clinical trials for ENT patients presenting superficial `early' squamous cell carcinomas. By means of LIF we measured in vivo the kinetics of the uptake and removal of mTHPC in the normal and tumoral cheek mucosa and in the skin. The photodynamic therapy (PDT) reaction of the tissue after excitation of the photosensitizer with laser light at 652 nm was studied. Both pharmacokinetics and PDT efficacy are compared between animal model and clinical results with special emphasis on selectivity between normal and tumoral mucosa. These first experiments show that this tumor model in the hamster cheek pouch seems to be suitable for testing new photosensitizers preceding their clinical application as well as for optimization of the multiple parameters of clinical PDT.

The Influence of Technology-Rich Early Childhood Field Experiences on Preservice Teachers

ERIC Educational Resources Information Center

Lux, Nicholas; Lux, Christine

2015-01-01

Despite a comprehensive body of research on field experiences in teacher education, technology-rich early field experiences in early childhood environments is one particular area of inquiry lacking substantive current research. Therefore, this study was conducted to better understand how preservice teachers' perceptions of global concepts related…

Coupled plasma filtration adsorption: rationale, technical development and early clinical experience.

PubMed

Ronco, Claudio; Brendolan, Alessandra; d'Intini, Vincenzo; Ricci, Zaccaria; Wratten, Mary Lou; Bellomo, Rinaldo

2003-01-01

The adjuvant treatment of sepsis remains a major therapeutic challenge. Blood purification is theoretically appealing if the humoral theory of sepsis is accepted as the basis for intervention. In this setting, blood purification would provide a broad-based restoration of humoral homeostasis thereby avoiding both excessive inflammation and counterinflammation. Several techniques of blood purification have been tried or are under active investigation. One of these is the so-called coupled plasma filtration adsorption (CPFA). CPFA is a novel extracorporeal blood purification therapy aimed at nonselectively reducing the circulating levels and activities of both pro- and anti-inflammatory mediators during sepsis and multiorgan failure. In vitro studies have shown CPFA to be effective in binding a broad range of such mediators proving its technical efficacy. Subsequent animal models have shown a beneficial effect on survival in endotoxemia. These studies have provided the necessary technical developments and biologic rationale for initial human studies. Two phase I/IIa clinical studies have now been performed. Both studies have shown that CPFA improves blood pressure and restores immune function in patients with severe sepsis and multiorgan dysfunction. In this article, we will discuss some of the basic principles involved in sorbent technology, and how these may contribute to treatment efficacy, review animal experiments with CPFA and finally discuss the results of recent human studies and their implications. Copyright 2003 S. Karger AG, Basel

The Interplay between Inflammation, Coagulation and Endothelial Injury in the Early Phase of Acute Pancreatitis: Clinical Implications

PubMed Central

Dumnicka, Paulina; Maduzia, Dawid; Ceranowicz, Piotr; Olszanecki, Rafał; Drożdż, Ryszard; Kuśnierz-Cabala, Beata

2017-01-01

Acute pancreatitis (AP) is an inflammatory disease with varied severity, ranging from mild local inflammation to severe systemic involvement resulting in substantial mortality. Early pathologic events in AP, both local and systemic, are associated with vascular derangements, including endothelial activation and injury, dysregulation of vasomotor tone, increased vascular permeability, increased leukocyte migration to tissues, and activation of coagulation. The purpose of the review was to summarize current evidence regarding the interplay between inflammation, coagulation and endothelial dysfunction in the early phase of AP. Practical aspects were emphasized: (1) we summarized available data on diagnostic usefulness of the markers of endothelial dysfunction and activated coagulation in early prediction of severe AP; (2) we reviewed in detail the results of experimental studies and clinical trials targeting coagulation-inflammation interactions in severe AP. Among laboratory tests, d-dimer and angiopoietin-2 measurements seem the most useful in early prediction of severe AP. Although most clinical trials evaluating anticoagulants in treatment of severe AP did not show benefits, they also did not show significantly increased bleeding risk. Promising results of human trials were published for low molecular weight heparin treatment. Several anticoagulants that proved beneficial in animal experiments are thus worth testing in patients. PMID:28208708

Mirrors in early clinical photography (1862-1882): a descriptive study.

PubMed

Horgmo, Øystein H

2015-01-01

In the mid-nineteenth century, photographers used mirrors to document different views of a patient in the same image. The first clinical photographs were taken by portrait photographers. As conventions for clinical photography were not yet established, early clinical photographs resemble contemporary portraits. The use of mirrors in clinical photography probably originated from the portrait studios, as several renowned photographers employed mirrors in their studio portraits. Clinical photographs taken for the US Army Medical Museum between 1862 and 1882 show different ways of employing this mirror technique.

How the Timing and Quality of Early Experiences Influence the Development of Brain Architecture

PubMed Central

Fox, Sharon E.; Levitt, Pat; Nelson, Charles A.

2009-01-01

Early life events can exert a powerful influence on both the pattern of brain architecture and behavioral development. In this paper a conceptual framework is provided for considering how the structure of early experience gets “under the skin.” The paper begins with a description of the genetic framework that lays the foundation for brain development, and then to the ways experience interacts with and modifies the structures and functions of the developing brain. Much of the attention is focused on early experience and sensitive periods, although it is made clear that later experience also plays an important role in maintaining and elaborating this early wiring diagram, which is critical to establishing a solid footing for development beyond the early years. PMID:20331653

Music Experience in Early Childhood: Potential for Emotion Knowledge?

ERIC Educational Resources Information Center

Vist, Torill

2011-01-01

Most cultures carry an idea of music being connected to emotion. New research suggests that we may also acquire emotion knowledge from our music experiences. This article investigates music experience as a mediating tool for emotion knowledge in early childhood, as revealed through qualitative interviews of adults. The interviewees describe music…

Examining the Content of Preservice Teachers' Reflections of Early Field Experiences

ERIC Educational Resources Information Center

Subramaniam, Karthigeyan

2013-01-01

This paper describes an exploratory study that examined the content of preservice elementary teachers' reflections of their documented early field experiences of science teaching in authentic contexts. The study used an early field experience model that was focused on the objective of profiling an elementary science teacher as the practical…

Early experimental and clinical experience with a focal implant for lower extremity post-angioplasty dissection.

PubMed

Schneider, Peter A; Giasolli, Robert; Ebner, Adrian; Virmani, Renu; Granada, Juan F

2015-02-01

This study provides preliminary data on the safety and feasibility of the use of a novel focal implant for managing post-percutaneous transluminal balloon angioplasty (post-PTA) dissection. Post-PTA dissection of the lower extremity arteries is managed with stent placement. This provides an acceptable post-intervention result but has long-term disadvantages, such as in-stent restenosis. Focal treatment of post-PTA dissection and avoidance of stents are the objectives of the Tack-It (Intact Vascular, Inc., Wayne, Pennsylvania) device. A preclinical study and first-in-human data are presented. Seven swine underwent superficial femoral artery device placement, with a self-expanding nitinol stent on 1 side and a series of 4 Tack-It devices on the other side. Specimens were harvested at 28 days. The clinical study included 15 limbs that underwent revascularization for critical limb ischemia (n = 9) or claudication (n = 6). Twenty-five lesions were treated in the superficial femoral (n = 8), popliteal (n = 7), and tibial (n = 10) arteries. The preclinical study demonstrated a reduction in stenosis with the Tack-It (16.8 ± 2.6%) compared with stents (46.4 ± 9.8%). Neointimal thickness and injury score decreased with the Tack-It. Clinically, Tack-It placement resulted in acute technical success with resolution of the post-PTA dissection in 100% of lesions. There were no device-related complications or major amputations. Eighteen of the 25 lesions were available for angiographic follow-up at 1-year, and patency was 83.3%. Preclinical data suggest that the Tack-It device causes minimal vessel injury. Clinical use of the Tack-It to manage post-PTA dissection was safe and feasible in this early study and resulted in apposition of dissection flaps without stent placement. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Sepsis in Obstetrics: Clinical Features and Early Warning Tools.

PubMed

Parfitt, Sheryl E; Bogat, Mary L; Hering, Sandra L; Ottley, Charlotte; Roth, Cheryl

Morbidity and mortality associated with sepsis has gained widespread attention on a local, state, and national level, yet, it remains a complicated disorder that can be difficult to identify in a timely manner. Sepsis in obstetric patients further complicates the diagnosis as alterations in physiology related to pregnancy can mask sepsis indicators normally seen in the general population. If early signs of sepsis go unrecognized, septic shock can develop, leading to organ dysfunction and potential death. Maternal early warning tools have been designed to assist clinicians in recognizing early indications of illness. Through use of clinical pathway-specific tools, disease processes may be detected early, subsequently benefitting patients with aggressive treatment management and intervention.This article is the second in a series of three that discuss the importance of sepsis and septic shock in pregnancy. Risk factors, causes of sepsis, signs and symptoms, and maternal early warning tools are discussed.

Webcam delivery of the Lidcombe program for early stuttering: a phase I clinical trial.

PubMed

O'Brian, Sue; Smith, Kylie; Onslow, Mark

2014-06-01

The Lidcombe Program is an operant treatment for early stuttering shown with meta-analysis to have a favorable odds ratio. However, many clients are unable to access the treatment because of distance and lifestyle factors. In this Phase I trial, we explored the potential efficacy, practicality, and viability of an Internet webcam Lidcombe Program service delivery model. Participants were 3 preschool children who stuttered and their parents, all of whom received assessment and treatment using webcam in their homes with no clinic attendance. At 6 months post-Stage 1 completion, all children were stuttering below 1.0% syllables stuttered. The webcam intervention was acceptable to the parents and appeared to be practical and viable, with only occasional audiovisual problems. At present, there is no reason to doubt that a webcam-delivered Lidcombe Program will be shown with clinical trials to have comparable efficacy with the clinic version. Webcam-delivered Lidcombe Program intervention is potentially efficacious, is practical and viable, and requires further exploration with comparative clinical trials and a qualitative study of parent and caregiver experiences.

Using Skype to support remote clinical supervision for health professionals delivering a sustained maternal early childhood programme: a phenomenographical study.

PubMed

Bruce, Tracey; Byrne, Fiona; Kemp, Lynn

2018-02-01

Skype technology was implemented by the Australian Maternal Early Childhood Sustained Home-visiting (MECSH) Support Service as a tool for the remote provision of clinical supervision for clinicians working in the MECSH program in Seoul, South Korea. To gain a better understanding of the processes underpinning sustainable delivery of remote clinical supervision using digital technologies. A phenomenographical study. Recorded notes and reflections on each supervision session, noting exemplars and characteristics of the experience were read and re-read to derive the characterizations of the experience. The experience has provided learnings in three domains: (1) the processes in using Skype; (2) supervisory processes; and (3) language translation, including managing clarity of, and time for translation. Skype has potential for use in remote provision of clinical supervision, including where translation is required. Further research evaluating the benefit of telesupervision from supervisor and supervisee perspectives is necessary to determine if it is a sustainable process.

Coral Reef Early Warning System (CREWS) RPC Experiment

NASA Technical Reports Server (NTRS)

Estep, Leland; Spruce, Joseph P.; Hall, Callie

2007-01-01

This viewgraph document reviews the background, objectives, methodology, validation, and present status of the Coral Reef Early Warning System (CREWS) Rapid Prototyping Capability (RPC) experiment. The potential NASA contribution to CREWS Decision Support Tool (DST) centers on remotely sensed imagery products.

Early Experience with Technology-Based Eye Care Services (TECS): A Novel Ophthalmologic Telemedicine Initiative.

PubMed

Maa, April Y; Wojciechowski, Barbara; Hunt, Kelly J; Dismuke, Clara; Shyu, Jason; Janjua, Rabeea; Lu, Xiaoqin; Medert, Charles M; Lynch, Mary G

2017-04-01

The aging population is at risk of common eye diseases, and routine eye examinations are recommended to prevent visual impairment. Unfortunately, patients are less likely to seek care as they age, which may be the result of significant travel and time burdens associated with going to an eye clinic in person. A new method of eye-care delivery that mitigates distance barriers and improves access was developed to improve screening for potentially blinding conditions. We present the quality data from the early experience (first 13 months) of Technology-Based Eye Care Services (TECS), a novel ophthalmologic telemedicine program. With TECS, a trained ophthalmology technician is stationed in a primary care clinic away from the main hospital. The ophthalmology technician follows a detailed protocol that collects information about the patient's eyes. The information then is interpreted remotely. Patients with possible abnormal findings are scheduled for a face-to-face examination in the eye clinic. Any patient with no known ocular disease who desires a routine eye screening examination is eligible. Technology-Based Eye Care Services was established in 5 primary care clinics in Georgia surrounding the Atlanta Veterans Affairs hospital. Four program operation metrics (patient satisfaction, eyeglass remakes, disease detection, and visit length) and 2 access-to-care metrics (appointment wait time and no-show rate) were tracked. Care was rendered to 2690 patients over the first 13 months of TECS. The program has been met with high patient satisfaction (4.95 of 5). Eyeglass remake rate was 0.59%. Abnormal findings were noted in 36.8% of patients and there was >90% agreement between the TECS reading and the face-to-face findings of the physician. TECS saved both patient (25% less) and physician time (50% less), and access to care substantially improved with 99% of patients seen within 14 days of contacting the eye clinic, with a TECS no-show rate of 5.2%. The early experience with

Trajectories of Early Childhood Developmental Skills and Early Adolescent Psychotic Experiences: Findings from the ALSPAC UK Birth Cohort.

PubMed

Hameed, Mohajer A; Lingam, Raghu; Zammit, Stanley; Salvi, Giovanni; Sullivan, Sarah; Lewis, Andrew J

2017-01-01

Objective: The aim of this study was to use prospective data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to examine association between trajectories of early childhood developmental skills and psychotic experiences (PEs) in early adolescence. Method: This study examined data from n = 6790 children from the ALSPAC cohort who participated in a semi-structured interview to assess PEs at age 12. Child development was measured using parental report at 6, 18, 30, and 42 months of age using a questionnaire of items adapted from the Denver Developmental Screening Test - II. Latent class growth analysis was used to generate trajectories over time for measures of fine and gross motor development, social, and communication skills. Logistic regression was used to investigate associations between developmental trajectories in each of these early developmental domains and PEs at age 12. Results: The results provided evidence that decline rather than enduringly poor social (adjusted OR = 1.28, 95% CI = 1.10-1.92, p = 0.044) and communication skills (adjusted OR 1.12, 95% CI = 1.03-1.22, p = 0.010) is predictive of suspected or definite PEs in early adolescence, than those with stable and/or improving skills. Motor skills did not display the same pattern of association; although gender specific effects provided evidence that only declining pattern of fine motor skills was associated with suspected and definite PEs in males compared to females (interaction OR = 1.47, 95% CI = 1.09-1.97, p = 0.012). Conclusion: Findings suggest that decline rather than persistent impairment in social and communication skills were most predictive of PEs in early adolescence. Findings are discussed in terms of study's strengths, limitations, and clinical implications.

Trajectories of Early Childhood Developmental Skills and Early Adolescent Psychotic Experiences: Findings from the ALSPAC UK Birth Cohort

PubMed Central

Hameed, Mohajer A.; Lingam, Raghu; Zammit, Stanley; Salvi, Giovanni; Sullivan, Sarah; Lewis, Andrew J.

2018-01-01

Objective: The aim of this study was to use prospective data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to examine association between trajectories of early childhood developmental skills and psychotic experiences (PEs) in early adolescence. Method: This study examined data from n = 6790 children from the ALSPAC cohort who participated in a semi-structured interview to assess PEs at age 12. Child development was measured using parental report at 6, 18, 30, and 42 months of age using a questionnaire of items adapted from the Denver Developmental Screening Test – II. Latent class growth analysis was used to generate trajectories over time for measures of fine and gross motor development, social, and communication skills. Logistic regression was used to investigate associations between developmental trajectories in each of these early developmental domains and PEs at age 12. Results: The results provided evidence that decline rather than enduringly poor social (adjusted OR = 1.28, 95% CI = 1.10–1.92, p = 0.044) and communication skills (adjusted OR 1.12, 95% CI = 1.03–1.22, p = 0.010) is predictive of suspected or definite PEs in early adolescence, than those with stable and/or improving skills. Motor skills did not display the same pattern of association; although gender specific effects provided evidence that only declining pattern of fine motor skills was associated with suspected and definite PEs in males compared to females (interaction OR = 1.47, 95% CI = 1.09–1.97, p = 0.012). Conclusion: Findings suggest that decline rather than persistent impairment in social and communication skills were most predictive of PEs in early adolescence. Findings are discussed in terms of study’s strengths, limitations, and clinical implications. PMID:29375433

Students' clinical experience on outreach placements.

PubMed

Smith, M; Lennon, M A; Robinson, P G

2010-02-01

Primary care outreach placements increasingly feature in UK undergraduate dental curricula. The profile of clinical work undertaken on placement may differ from traditional hospital-based programmes and between outreach settings. An appreciation of any differences could inform curriculum development. To compare the profiles of clinical work experienced on a traditional hospital-based programme and outreach placements in different settings. One dental hospital and eight existing primary care block placements in England. Subjects were four cohorts of senior dental students in one UK dental school. Departmental records provided data on students' clinical experience in different settings and their achievement of placement learning objectives. Descriptive statistics for groups were compared. (1) Counts of patients encountered and of clinical procedures completed in the following categories: simple plastic restorations, endodontics, cast restorations, dentures, extractions and children's dentistry. (2) Student perceptions of placement learning reported via Likert scales. Outreach students encountered twice as many patients and typically completed about three times as much clinical work as students in the hospital, e.g. 44 cf 16 simple plastic restorations, seven cf two endodontic procedures. There were variations in profiles by setting. For example, amalgam being more likely to be used on outreach especially in the General Dental Service; more children's dentistry in community services and more extractions in Dental Access Centres. Students reported learning outcomes generally being achieved (average 94%) although with some variation by setting. Dental outreach training greatly increases the quantity of students' clinical experience in everyday dentistry compared to a hospital-based programme. Placements also increase awareness of service delivery and develop clinical skills. There are appreciable variations between outreach settings possibly reflecting their purposes

[Clinical relevant procedures for early pregnancy diagnosis in the mare].

PubMed

Bostedt, H; Sieme, H; Bartmann, C-P; Handler, J; Sobiraj, A; Wehrend, A

2014-01-01

This review describes stepwise the recto-manual and transrectal ultrasonographic evidence of early pregnancy detection in the horse. The morphological and physiological conditions in the individual phases of early pregnancy are presented in correlation to the potential clinical findings. The importance of embryonic and early foetal losses is presented. Communication and documentation of findings are also addressed. The final section is devoted to the evaluation of the examination effort. In this regard, it is emphasized that the gynaecological examination for the evaluation of the pregnancy status represents a service contract.

Review of clinical and laboratory experiences with molindone hydrochloride.

PubMed

Claghorn, J L

1985-08-01

The literature concerning the pharmacokinetics, pharmacodynamics, receptor physiology, and clinical use of molindone is reviewed. Unanswered questions about the drug are addressed. Although molindone is reputed to have a short half-life (1.5 hours), clinical observations report a prolonged effect from a once-daily dose. Early in treatment, some patients show intolerance due to akathisia or extrapyramidal symptoms. This may be withdrawal dyskinesia due to discontinuation of another drug or an early adverse effect of molindone. Different effects on dopamine receptors have been described, but the significance of these properties for the development of tardive dyskinesia remains unclear.

Two functions of early language experience.

PubMed

Arshavsky, Yuri I

2009-05-01

The unique human ability of linguistic communication, defined as the ability to produce a practically infinite number of meaningful messages using a finite number of lexical items, is determined by an array of "linguistic" genes, which are expressed in neurons forming domain-specific linguistic centers in the brain. In this review, I discuss the idea that infants' early language experience performs two complementary functions. In addition to allowing infants to assimilate the words and grammar rules of their mother language, early language experience initiates genetic programs underlying language production and comprehension. This hypothesis explains many puzzling characteristics of language acquisition, such as the existence of a critical period for acquiring the first language and the absence of a critical period for the acquisition of additional language(s), a similar timetable for language acquisition in children belonging to families of different social and cultural status, the strikingly similar timetables in the acquisition of oral and sign languages, and the surprisingly small correlation between individuals' final linguistic competence and the intensity of their training. Based on the studies of microcephalic individuals, I argue that genetic factors determine not only the number of neurons and organization of interneural connections within linguistic centers, but also the putative internal properties of neurons that are not limited to their electrophysiological and synaptic properties.

Behavioral and neural plasticity caused by early social experiences: the case of the honeybee

PubMed Central

Arenas, Andrés; Ramírez, Gabriela P.; Balbuena, María Sol; Farina, Walter M.

2013-01-01

Cognitive experiences during the early stages of life play an important role in shaping future behavior. Behavioral and neural long-term changes after early sensory and associative experiences have been recently reported in the honeybee. This invertebrate is an excellent model for assessing the role of precocious experiences on later behavior due to its extraordinarily tuned division of labor based on age polyethism. These studies are mainly focused on the role and importance of experiences occurred during the first days of the adult lifespan, their impact on foraging decisions, and their contribution to coordinate food gathering. Odor-rewarded experiences during the first days of honeybee adulthood alter the responsiveness to sucrose, making young hive bees more sensitive to assess gustatory features about the nectar brought back to the hive and affecting the dynamic of the food transfers and the propagation of food-related information within the colony. Early olfactory experiences lead to stable and long-term associative memories that can be successfully recalled after many days, even at foraging ages. Also they improve memorizing of new associative learning events later in life. The establishment of early memories promotes stable reorganization of the olfactory circuits inducing structural and functional changes in the antennal lobe (AL). Early rewarded experiences have relevant consequences at the social level too, biasing dance and trophallaxis partner choice and affecting recruitment. Here, we revised recent results in bees' physiology, behavior, and sociobiology to depict how the early experiences affect their cognition abilities and neural-related circuits. PMID:23986708

Early thinning experiments established by the Fort Valley Experimental Forest

Treesearch

Benjamin P. De Blois; Alex. J. Finkral; Andrew J. Sanchez Meador; Margaret M. Moore

2008-01-01

Between 1925 and 1936, the Fort Valley Experimental Forest (FVEF) scientists initiated a study to examine a series of forest thinning experiments in second growth ponderosa pine stands in Arizona and New Mexico. These early thinning plots furnished much of the early background for the development of methods used in forest management in the Southwest. The plots ranged...

New Directions in the Study of Early Experience.

ERIC Educational Resources Information Center

Bertenthal, Bennett I; Campos, Joseph J.

1987-01-01

Reviews Greenough, Black, and Wallace's (1987) conceptual framework for understanding the effects of early experience and sensitive periods on development, and illustrates the applicability of their model with recent data on the consequences for animals and human infants of the acquistion of self-produced locomotion. (BN)

Systemic rapamycin to prevent in-stent stenosis in peripheral pulmonary arterial disease: early clinical experience.

PubMed

Hallbergson, Anna; Esch, Jesse J; Tran, Trang X; Lock, James E; Marshall, Audrey C

2016-10-01

We have taken a novel approach using oral rapamycin - sirolimus - as a medical adjunct to percutaneous therapy in patients with in-stent stenosis and high risk of right ventricular failure. Peripheral pulmonary artery stenosis can result in right ventricular hypertension, dysfunction, and death. Percutaneous pulmonary artery angioplasty and stent placement acutely relieve obstructions, but patients frequently require re-interventions due to re-stenosis. In patients with tetralogy of Fallot or arteriopathy, the problem of in-stent stenosis contributes to the rapidly recurrent disease. Rapamycin was administered to 10 patients (1.5-18 years) with peripheral pulmonary stenosis and in-stent stenosis and either right ventricular hypertension, pulmonary blood flow maldistribution, or segmental pulmonary hypertension. Treatment was initiated around the time of catheterisation and continued for 1-3 months. Potential side-effects were monitored by clinical review and blood tests. Target serum rapamycin level (6-10 ng/ml) was accomplished in all patients; eight of the nine patients who returned for clinically indicated catheterisations demonstrated reduction in in-stent stenosis, and eight of the 10 patients experienced no significant side-effects. Among all, one patient developed diarrhoea requiring drug discontinuation, and one patient experienced gastrointestinal bleeding while on therapy that was likely due to an indwelling feeding tube and this patient tolerated rapamycin well following tube removal. Our initial clinical experience supports that patients with peripheral pulmonary artery stenosis can be safely treated with rapamycin. Systemic rapamycin may provide a novel medical approach to reduce in-stent stenosis.

Early Workplace Learning Experiences: What Are the Pedagogical Possibilities beyond Retention and Employability?

ERIC Educational Resources Information Center

Trede, Franziska; McEwen, Celina

2015-01-01

With this paper, we explore early placement experiences and their pedagogical potential, including ways of keeping students enrolled and persisting with their studies. Few university courses offer early placements because traditionally placement experiences have a focus on employability and work readiness of graduates, hence occur towards the end…

"I couldn't do this with opposition from my colleagues": A qualitative study of physicians' experiences as clinical tutors

PubMed Central

2011-01-01

Background Clinical contact in the early curriculum and workplace learning with active tutorship are important parts of modern medical education. In a previously published study, we found that medical students' tutors experienced a heavier workload, less reasonable demands and less encouragement, than students. The aim of this interview study was to further illuminate physicians' experiences as clinical tutors. Methods Twelve tutors in the Early Professional Contact course were interviewed. In the explorative interviews, they were asked to reflect upon their experiences of working as tutors in this course. Systematic text condensation was used as the analysis method. Results In the analysis, five main themes of physicians' experiences as clinical tutors in the medical education emerged: (a) Pleasure and stimulation. Informants appreciated tutorship and meeting both students and fellow tutors, (b) Disappointment and stagnation. Occasionally, tutors were frustrated and expressed negative feelings, (c) Demands and duty. Informants articulated an ambition to give students their best; a desire to provide better medical education but also a duty to meet demands of the course management, (d) Impact of workplace relations. Tutoring was made easier when the clinic's management provided active support and colleagues accepted students at the clinic, and (e) Multitasking difficulties. Combining several duties with those of a tutorship was often reported as difficult. Conclusions It is important that tutors' tasks are given adequate time, support and preparation. Accordingly, it appears highly important to avoid multitasking and too heavy a workload among tutors in order to facilitate tutoring. A crucial factor is acceptance and active organizational support from the clinic's management. This implies that tutoring by workplace learning in medical education should play an integrated and accepted role in the healthcare system. PMID:21975057

Incidence of early-onset sepsis in infants born to women with clinical chorioamnionitis.

PubMed

Randis, Tara M; Rice, Madeline Murguia; Myatt, Leslie; Tita, Alan T N; Leveno, Kenneth J; Reddy, Uma M; Varner, Michael W; Thorp, John M; Mercer, Brian M; Dinsmoor, Mara J; Ramin, Susan M; Carpenter, Marshall W; Samuels, Philip; Sciscione, Anthony; Tolosa, Jorge E; Saade, George; Sorokin, Yoram

2018-05-23

To determine the frequency of sepsis and other adverse neonatal outcomes in women with a clinical diagnosis of chorioamnionitis. We performed a secondary analysis of a multi-center placebo-controlled trial of vitamins C/E to prevent preeclampsia in low risk nulliparous women. Clinical chorioamnionitis was defined as either the "clinical diagnosis" of chorioamnionitis or antibiotic administration during labor because of an elevated temperature or uterine tenderness in the absence of another cause. Early-onset neonatal sepsis was categorized as "suspected" or "confirmed" based on a clinical diagnosis with negative or positive blood, urine or cerebral spinal fluid cultures, respectively, within 72 h of birth. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression. Data from 9391 mother-infant pairs were analyzed. The frequency of chorioamnionitis was 10.3%. Overall, 6.6% of the neonates were diagnosed with confirmed (0.2%) or suspected (6.4%) early-onset sepsis. Only 0.7% of infants born in the setting of chorioamnionitis had culture-proven early-onset sepsis versus 0.1% if chorioamnionitis was not present. Clinical chorioamnionitis was associated with both suspected [OR 4.01 (3.16-5.08)] and confirmed [OR 4.93 (1.65-14.74)] early-onset neonatal sepsis, a need for resuscitation within the first 30 min after birth [OR 2.10 (1.70-2.61)], respiratory distress [OR 3.14 (2.16-4.56)], 1 min Apgar score of ≤3 [OR 2.69 (2.01-3.60)] and 4-7 [OR 1.71 (1.43-2.04)] and 5 min Apgar score of 4-7 [OR 1.67 (1.17-2.37)] (vs. 8-10). Clinical chorioamnionitis is common and is associated with neonatal morbidities. However, the vast majority of exposed infants (99.3%) do not have confirmed early-onset sepsis.

Early onset marfan syndrome: Atypical clinical presentation of two cases

PubMed Central

Ozyurt, A; Baykan, A; Argun, M; Pamukcu, O; Halis, H; Korkut, S; Yuksel, Z; Gunes, T; Narin, N

2015-01-01

Early onset Marfan Syndrome (eoMFS) is a rare, severe form of Marfan Syndrome (MFS). The disease has a poor prognosis and most patients present with resistance to heart failure treatment during the newborn period. This report presents two cases of eoMFS with similar clinical features diagnosed in the newborn period and who died at an early age due to the complications related to the involvement of the cardiovascular system. PMID:26929908

Clinical Experiences in Athletic Training.

ERIC Educational Resources Information Center

Knight, Kenneth L.

This book offers a systematic approach to teaching athletic training. Modules are separated into 10 content areas: direct clinical experience; policies and procedures; emergency procedures; modality operation; advanced modality operation; taping, wrapping, bracing, and padding; management of specific injuries; examination; supervision; and…

Opportunity to discuss ethical issues during clinical learning experience.

PubMed

Palese, Alvisa; Gonella, Silvia; Destrebecq, Anne; Mansutti, Irene; Terzoni, Stefano; Morsanutto, Michela; Altini, Pietro; Bevilacqua, Anita; Brugnolli, Anna; Canzan, Federica; Ponte, Adriana Dal; De Biasio, Laura; Fascì, Adriana; Grosso, Silvia; Mantovan, Franco; Marognolli, Oliva; Nicotera, Raffaela; Randon, Giulia; Tollini, Morena; Saiani, Luisa; Grassetti, Luca; Dimonte, Valerio

2018-01-01

Undergraduate nursing students have been documented to experience ethical distress during their clinical training and felt poorly supported in discussing the ethical issues they encountered. Research aims: This study was aimed at exploring nursing students' perceived opportunity to discuss ethical issues that emerged during their clinical learning experience and associated factors. An Italian national cross-sectional study design was performed in 2015-2016. Participants were invited to answer a questionnaire composed of four sections regarding: (1) socio-demographic data, (2) previous clinical learning experiences, (3) current clinical learning experience quality and outcomes, and (4) the opportunity to discuss ethical issues with nurses in the last clinical learning experience (from 0 - 'never' to 3 - 'very much'). Participants and research context: Participants were 9607 undergraduate nursing students who were attending 95 different three-year Italian baccalaureate nursing programmes, located at 27 universities in 15 Italian regions. Ethical considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after the research protocol was approved by an ethics committee. Overall, 4707 (49%) perceived to have discussed ethical issues 'much' or 'very much'; among the remaining, 3683 (38.3%) and 1217 (12.7%) students reported the perception of having discussed, respectively, 'enough' or 'never' ethical issues emerged in the clinical practice. At the multivariate logistic regression analysis explaining 38.1% of the overall variance, the factors promoting ethical discussion were mainly set at the clinical learning environment levels (i.e. increased learning opportunities, self-directed learning, safety and nursing care quality, quality of the tutorial strategies, competences learned and supervision by a clinical nurse). In contrast, being male was associated with a perception of less opportunity to discuss ethical issues

Aesthetic Experience and Early Language and Literacy Development

ERIC Educational Resources Information Center

Johnson, Helen L.

2007-01-01

The present paper explores the connections between theory and research in language development and aesthetic education and their implications for early childhood classroom practice. The present paper posits that arts experiences make a unique and vital contribution to the child's development of language and literacy, as well as to the sense of…

Clinical learning experiences of nursing students using an innovative clinical partnership model: A non-randomized controlled trial.

PubMed

Chan, Aileen W K; Tang, Fiona W K; Choi, Kai Chow; Liu, Ting; Taylor-Piliae, Ruth E

2018-06-05

Clinical practicum is a major learning component for pre-registration nursing students. Various clinical practicum models have been used to facilitate students' clinical learning experiences, employing both university-based and hospital-based clinical teachers. Considering the strengths and limitations of these clinical practicum models, along with nursing workforce shortages, we developed and tested an innovative clinical partnership model (CPM) in Hong Kong. To evaluate an innovative CPM among nursing students actual and preferred clinical learning environment, compared with a conventional facilitation model (CFM). A non-randomized controlled trial examining students' clinical experiences, comparing the CPM (supervised by hospital clinical teacher) with the CFM (supervised by university clinical teacher). One university in Hong Kong. Pre-registration nursing students (N = 331), including bachelor of nursing (n = 246 year three-BN) and masters-entry nursing (n = 85 year one-MNSP). Students were assigned to either the CPM (n = 48 BN plus n = 85 MNSP students) or the CFM (n = 198 BN students) for their clinical practice experiences in an acute medical-surgical ward. Clinical teachers supervised between 6 and 8 students at a time, during these clinical practicums (duration = 4-6 weeks). At the end of the clinical practicum, students were invited to complete the Clinical Learning Environment Inventory (CLEI). Analysis of covariance was used to compare groups; adjusted for age, gender and prior work experience. A total of 259 students (mean age = 22 years, 76% female, 81% prior work experience) completed the CLEI (78% response rate). Students had higher scores on preferred versus actual experiences, in all domains of the CLEI. CPM student experiences indicated a higher preferred task orientation (p = 0.004), while CFM student experiences indicated a higher actual (p < 0.001) and preferred individualization (p = 0

Development and Evaluation of a New Technological Way of Engaging Patients and Enhancing Understanding of Drug Tolerability in Early Clinical Development: PROACT.

PubMed

Hughes, Andrew; Landers, Donal; Arkenau, Hendrik-Tobias; Shah, Saj; Stephens, Richard; Mahal, Amrik; Simmons, Matthew; Lemech, Charlotte; Royle, Jennifer

2016-06-01

During early clinical testing of a new medication, it is critical to understand and characterise patient tolerability. However, in early clinical studies, it is difficult for patients to contribute directly to the sponsors' understanding of a new compound. Patient reported opinions about clinical tolerability (PROACT) provides a new, simple and innovative way in which patients can collaborate using an application downloaded to a mobile computer or smartphone. PROACT was designed with special consideration given to patient confidentiality, patient engagement and data security. A pilot study was conducted to investigate patient uptake of PROACT and to characterize clinical trial information it captured. Patients recruited to Phase I oncology trials at a UK center were eligible to participate but were required to have a tablet computer or smartphone. Patients used PROACT to upload audio/video messages that became available instantly to their clinical team, who were able to reply to the patient within PROACT. The patient's message was also analyzed, personally-identifiable information removed and anonymized information then made available to the sponsor in an analytics module for decision-making. In parallel, a patient focus group was engaged to provide feedback on communication needs during early clinical trials and the PROACT concept. Of the 16 patients informed of PROACT, 8 had a smart device and consented to take part. Use of PROACT varied and all messages volunteered were relevant and informative for drug development. Topics disclosed included tolerability impacts, study design, and drug formulation. Alignment with the clinical study data provided a richer understanding of tolerability and treatment consequences. This information was available to be shared among the clinical team and the sponsor, to improve patient support and experience. Patient forum feedback endorsed the concept and provided further information to enhance the application. Overall, PROACT

The impact of arthritis on the early employment experiences of young adults: A literature review.

PubMed

Jetha, Arif

2015-07-01

Young adulthood is an important transitional life phase that can determine a person's career trajectory. To date, little research has examined the influence of arthritis on early work experiences. This literature review aims at examining the impact of arthritis on the early career phase of young adults and identifying the barriers to employment. Two independent reviewers searched bibliographic databases for arthritis conditions and a series of employment-related keywords and subject headings. Information on authors, publication year; study design, sample characteristics (e.g., number of participants, age, gender, arthritis type); work outcomes measured; and specific barriers to employment was recorded. Nine studies were uncovered in the review. All studies examined young people with juvenile arthritis (9 of 9 studies) and consisted of sample sizes with less then 150 participants (6 of 9 studies) who were primarily recruited from clinics (7 of 9 studies). All were cross-sectional designs. Employment status was primarily examined and ranged from 11% to 71%. Although not always statistically significant, young adults with arthritis were less likely to be employed when compared to their healthy peers. Greater disease severity, less educational attainment and being female were related to not participating in paid work. This review brings to light the paucity of studies examining the early employment experiences of young adults with arthritis. There is a need to expand research to contribute to recommendations for sustained and productive employment across the working life course. Copyright © 2015 Elsevier Inc. All rights reserved.

A Quantitative Model of Early Atherosclerotic Plaques Parameterized Using In Vitro Experiments.

PubMed

Thon, Moritz P; Ford, Hugh Z; Gee, Michael W; Myerscough, Mary R

2018-01-01

There are a growing number of studies that model immunological processes in the artery wall that lead to the development of atherosclerotic plaques. However, few of these models use parameters that are obtained from experimental data even though data-driven models are vital if mathematical models are to become clinically relevant. We present the development and analysis of a quantitative mathematical model for the coupled inflammatory, lipid and macrophage dynamics in early atherosclerotic plaques. Our modeling approach is similar to the biologists' experimental approach where the bigger picture of atherosclerosis is put together from many smaller observations and findings from in vitro experiments. We first develop a series of three simpler submodels which are least-squares fitted to various in vitro experimental results from the literature. Subsequently, we use these three submodels to construct a quantitative model of the development of early atherosclerotic plaques. We perform a local sensitivity analysis of the model with respect to its parameters that identifies critical parameters and processes. Further, we present a systematic analysis of the long-term outcome of the model which produces a characterization of the stability of model plaques based on the rates of recruitment of low-density lipoproteins, high-density lipoproteins and macrophages. The analysis of the model suggests that further experimental work quantifying the different fates of macrophages as a function of cholesterol load and the balance between free cholesterol and cholesterol ester inside macrophages may give valuable insight into long-term atherosclerotic plaque outcomes. This model is an important step toward models applicable in a clinical setting.

Learning community health nursing concepts from clinical experience.

PubMed

Lasater, Kathie; Luce, Linda; Volpin, Miriam; Terwilliger, Allison; Wild, Jackson

2007-01-01

Clinical faculty often struggle to design competency demonstrations that promote quality learning experiences. A nursing program in Oregon combined mental health and community health nursing practica and required well-planned, integrated competency demonstrations. This requirement became the impetus for students to promote the health of clients and learn clinical concepts that are difficult to experience in a typical term. Faculty coached students to make a significant contribution that would last beyond their clinical practica. A case study in competency demonstration design is described, and implications for curriculum development are presented.

The Early Use of Blinding in Therapeutic Clinical Research of Neurological Disorders

PubMed Central

Jensen, Matthew B.; Janik, Erika L.; Waclawik, Andrew J.

2016-01-01

We sought to identify early uses of blinding in therapeutic clinical trials of neurological disorders by multiple search methods. A 1784 report by Benjamin Franklin and others described the evaluation of the use of Mesmerism to treat neurological and other syndromes including headache and epilepsy, using blindfolds and screens. This report demonstrated the usefulness of blinding to reduce bias in clinical research, yet despite this early discovery, blinding was not widely accepted or routinely used until the 20th century. Blinded clinical trials began to be used for various neurological syndromes in the 1950s, sporadically at first and then increasing in frequency in subsequent years. The reason for this delay is unclear, but we propose several hypotheses. PMID:27617324

Evaluating cardiac risk: exposure response analysis in early clinical drug development.

PubMed

Grenier, Julie; Paglialunga, Sabina; Morimoto, Bruce H; Lester, Robert M

2018-01-01

The assessment of a drug's cardiac liability has undergone considerable metamorphosis by regulators since International Council for Harmonization of Technical Requirement for Pharmaceuticals for Human Use E14 guideline was introduced in 2005. Drug developers now have a choice in how proarrhythmia risk can be evaluated; the options include a dedicated thorough QT (TQT) study or exposure response (ER) modeling of intensive electrocardiogram (ECG) captured in early clinical development. The alternative approach of ER modeling was incorporated into a guidance document in 2015 as a primary analysis tool which could be utilized in early phase dose escalation studies as an option to perform a dedicated TQT trial. This review will describe the current state of ER modeling of intensive ECG data collected during early clinical drug development; the requirements with regard to the use of a positive control; and address the challenges and opportunities of this alternative approach to assessing QT liability.

The Medina Embolic Device: early clinical experience from a single center

PubMed Central

Aguilar Perez, Marta; Bhogal, Pervinder; Martinez Moreno, Rosa; Bäzner, Hansjörg; Ganslandt, Oliver; Henkes, Hans

2017-01-01

Objective To report our initial experience with the Medina Embolic Device (MED) in unruptured intracranial aneurysms either as sole treatment or in conjunction with additional devices. Methods 15 consecutive patients (6 women, 9 men) with unruptured aneurysms were treated between September 2015 and April 2016. The aneurysm fundus measured at least 5 mm. We evaluated the angiographic appearances of treated aneurysms at the end of the procedure and at follow-up, the clinical status, complications, and requirement for adjunctive devices. Results The MED was successfully deployed in all but one case and adjunctive devices were required in 10 cases. Aneurysm locations were middle cerebral artery bifurcation (n=3), internal carotid artery (ICA) bifurcation (n=1), supraclinoid ICA (n=5), posterior communicating artery (n=1), anterior communicating artery (n=2), cavernous ICA (n=2), distal basilar sidewall (n=1), basilar tip (n=1). Three patients had complications although none could be attributed to the MED. Immediate angiographic results were modified Raymond-Roy classification (mRRC) I=1, mRRC II=5, mRRC IIIa=3, mRRC IIIb=5, and one patient showed contrast stasis within the fundus of the aneurysm. Follow-up angiography was available in 11 patients, with four showing complete aneurysm exclusion, six with stable remnants and one patient with an enlarging neck remnant. Conclusions The MED represents a major step forward in the treatment of intracranial aneurysms. It can result in rapid exclusion of an aneurysm from the circulation and has a good safety profile. We believe that the true value of the MED will be in combining its use with adjunctive devices such as endoluminal flow diverters that will result in rapid aneurysmal exclusion. PMID:27484746

Vertigo in childhood: proposal for a diagnostic algorithm based upon clinical experience.

PubMed

Casani, A P; Dallan, I; Navari, E; Sellari Franceschini, S; Cerchiai, N

2015-06-01

The aim of this paper is to analyse, after clinical experience with a series of patients with established diagnoses and review of the literature, all relevant anamnestic features in order to build a simple diagnostic algorithm for vertigo in childhood. This study is a retrospective chart review. A series of 37 children underwent complete clinical and instrumental vestibular examination. Only neurological disorders or genetic diseases represented exclusion criteria. All diagnoses were reviewed after applying the most recent diagnostic guidelines. In our experience, the most common aetiology for dizziness is vestibular migraine (38%), followed by acute labyrinthitis/neuritis (16%) and somatoform vertigo (16%). Benign paroxysmal vertigo was diagnosed in 4 patients (11%) and paroxysmal torticollis was diagnosed in a 1-year-old child. In 8% (3 patients) of cases, the dizziness had a post-traumatic origin: 1 canalolithiasis of the posterior semicircular canal and 2 labyrinthine concussions, respectively. Menière's disease was diagnosed in 2 cases. A bilateral vestibular failure of unknown origin caused chronic dizziness in 1 patient. In conclusion, this algorithm could represent a good tool for guiding clinical suspicion to correct diagnostic assessment in dizzy children where no neurological findings are detectable. The algorithm has just a few simple steps, based mainly on two aspects to be investigated early: temporal features of vertigo and presence of hearing impairment. A different algorithm has been proposed for cases in which a traumatic origin is suspected.

First-time mothers' experiences of early labour in Italian maternity care services.

PubMed

Cappelletti, Giulia; Nespoli, Antonella; Fumagalli, Simona; Borrelli, Sara E

2016-03-01

The aim of this study is to explore first-time mothers' experiences of early labour in Italian maternity care services when admitted to hospital or advised to return home after maternity triage assessment. The study was conducted in a second-level maternity hospital in northern Italy with an obstetric unit for both low- and high-risk women. The participants included 15 first-time mothers in good general health with spontaneous labour at term of a low-risk pregnancy who accessed maternity triage during early labour, and were either admitted to hospital or advised to return home. A qualitative interpretive phenomenological study was conducted. A face-to-face recorded semi-structured interview was conducted with each participant 48-72h after birth. Four key themes emerged from the interviews: (a) recognising signs of early labour; (b) coping with pain at home; (c) seeking reassurance from healthcare professionals; and (d) being admitted to hospital versus returning home. Uncertainty about the progression of labour and the need for reassurance were cited by women as the main reasons for hospital visit in early labour. An ambivalent feeling was reported by the participants when admitted to hospital in early labour. In fact, while the women felt reassured in the first instance, some women subsequently felt dissatisfied due to the absence of one-to-one dedicated care during early labour. When advised to return home, a number of women reported feelings of disappointment, anger, fear, discouragement and anxiety about not being admitted to hospital; however, some of these women reported a subsequent feeling of comfort due to being at home and putting in place the suggestions made by the midwives during the maternity triage assessment. The guidance provided by midwives during triage assessment seemed to be the key factor influencing women׳s satisfaction when advised either to return home or to stay at the hospital during early labour. During antenatal classes and clinics

[Ethic review on clinical experiments of medical devices in medical institutions].

PubMed

Shuai, Wanjun; Chao, Yong; Wang, Ning; Xu, Shining

2011-07-01

Clinical experiments are always used to evaluate the safety and validity of medical devices. The experiments have two types of clinical trying and testing. Ethic review must be done by the ethics committee of the medical department with the qualification of clinical research, and the approval must be made before the experiments. In order to ensure the safety and validity of clinical experiments of medical devices in medical institutions, the contents, process and approval criterions of the ethic review were analyzed and discussed.

Early experience shapes vocal neural coding and perception in songbirds

PubMed Central

Woolley, Sarah M. N.

2012-01-01

Songbirds, like humans, are highly accomplished vocal learners. The many parallels between speech and birdsong and conserved features of mammalian and avian auditory systems have led to the emergence of the songbird as a model system for studying the perceptual mechanisms of vocal communication. Laboratory research on songbirds allows the careful control of early life experience and high-resolution analysis of brain function during vocal learning, production and perception. Here, I review what songbird studies have revealed about the role of early experience in the development of vocal behavior, auditory perception and the processing of learned vocalizations by auditory neurons. The findings of these studies suggest general principles for how exposure to vocalizations during development and into adulthood influences the perception of learned vocal signals. PMID:22711657

78 FR 5816 - Guidance for Industry on Clinical Pharmacogenomics: Premarket Evaluation in Early-Phase Clinical...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-28

.... The guidance provides recommendations on when and how genomic principles should be considered and... recommendations on when and how genomic principles should be considered and applied in early-phase clinical... the larger, later adequate, and well-controlled trials (phase 3) that are needed to support marketing...

Making Visible Teacher Reports of Their Teaching Experiences: The Early Childhood Teacher Experiences Scale

ERIC Educational Resources Information Center

Fantuzzo, John; Perlman, Staci; Sproul, Faith; Minney, Ashley; Perry, Marlo A.; Li, Feifei

2012-01-01

The study developed multiple independent scales of early childhood teacher experiences (ECTES). ECTES was co-constructed with preschool, kindergarten, and first grade teachers in a large urban school district. Demographic, ECTES, and teaching practices data were collected from 584 teachers. Factor analyses documented three teacher experience…

Clinicians' experiences of becoming a clinical manager: a qualitative study.

PubMed

Spehar, Ivan; Frich, Jan C; Kjekshus, Lars Erik

2012-11-22

There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals' decisions to engage in management. The aim of this study is to explore clinicians' journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. We found that there were three phases in clinicians' journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants' experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management "on the fly". Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Path dependency and social pressure seems to influence clinicians' decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary support functions are available locally, especially

Clinicians’ experiences of becoming a clinical manager: a qualitative study

PubMed Central

2012-01-01

Background There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals’ decisions to engage in management. The aim of this study is to explore clinicians’ journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. Methods We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. Results We found that there were three phases in clinicians’ journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants’ experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management “on the fly”. Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Conclusions Path dependency and social pressure seems to influence clinicians’ decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary

Emotional Intelligence in Intensive Clinical Experiences for Nursing Students

ERIC Educational Resources Information Center

Zoromski, Lorraine M.

2017-01-01

This study looked for associations between measures of emotional intelligence in an intensive clinical experience for nursing students in their final semester of an associate's degree program. The theory of emotional labor was used to make connections between nursing clinical experience and emotional intelligence. Twenty nursing students from a…

Starting Smart: How Early Experiences Affect Brain Development. An Ounce of Prevention Fund Paper.

ERIC Educational Resources Information Center

Ounce of Prevention Fund.

Recent research has provided great insight into the impact of early experience on brain development. It is now believed that brain growth is highly dependent upon early experiences. Neurons allow communication and coordinated functioning among various brain areas. Brain development after birth consists of an ongoing process of wiring and rewiring…

A qualitative study evaluating causality attribution for serious adverse events during early phase oncology clinical trials.

PubMed

Mukherjee, Som D; Coombes, Megan E; Levine, Mitch; Cosby, Jarold; Kowaleski, Brenda; Arnold, Andrew

2011-10-01

In early phase oncology trials, novel targeted therapies are increasingly being tested in combination with traditional agents creating greater potential for enhanced and new toxicities. When a patient experiences a serious adverse event (SAE), investigators must determine whether the event is attributable to the investigational drug or not. This study seeks to understand the clinical reasoning, tools used and challenges faced by the researchers who assign causality to SAE's. Thirty-two semi-structured interviews were conducted with medical oncologists and trial coordinators at six Canadian academic cancer centres. Interviews were recorded and transcribed verbatim. Individual interview content analysis was followed by thematic analysis across the interview set. Our study found that causality assessment tends to be a rather complex process, often without complete clinical and investigational data at hand. Researchers described using a common processing strategy whereby they gather pertinent information, eliminate alternative explanations, and consider whether or not the study drug resulted in the SAE. Many of the interviewed participants voiced concern that causality assessments are often conducted quickly and tend to be highly subjective. Many participants were unable to identify any useful tools to help in assigning causality and welcomed more objectivity in the overall process. Attributing causality to SAE's is a complex process. Clinical trial researchers apply a logical system of reasoning, but feel that the current method of assigning causality could be improved. Based on these findings, future research involving the development of a new causality assessment tool specifically for use in early phase oncology clinical trials may be useful.

Integrating partner professionals. The Early Explorers project: Peers Early Education Partnership and the health visiting service.

PubMed

Barlow, J; Coe, C

2013-01-01

  A range of voluntary sector organizations are involved in the delivery of services to children, particularly within the Early Year's sector and children's centres. Peers Early Education Partnership (PEEP) Early Explorers project is one example of the way in which explicit partnerships are being forged across statutory and voluntary sectors with the aim of improving outcomes for children and families. This paper reports an exploration of stakeholder views and experiences of two Early Explorer clinics located in areas of high deprivation.   Semi-structured interviews were conducted with a purposive sample of stakeholders (n= 25) from children's centres, PEEP, the health visiting service and service users. Data were fully transcribed and analysed using a thematic approach.   The data suggest that the two key groups of stakeholders providing Early Explorer clinics (i.e. health visitors and PEEP practitioners) had quite different objectives in terms of their early goals for the clinic, but that despite these differences good progress was achieved in terms of working together effectively. All stakeholders including service users referred to the presence of PEEP as having improved the quality of the clinic environment, and participating mothers identified a wide range of benefits from the enhanced service. However, somewhat restricted views about the role of practitioners within the clinics were identified by users, and the findings suggest that although the early goals for the clinic had been exceeded, these may have been limited in terms of true 'partnership' working.   Early Explorer clinics appeared to have enhanced the service provided within traditional child health clinics and to have provided practitioners with access to hard-to-reach families and parents with access to services that are consistent with the broader policy aims of improving parent-infant interaction. However, questions remain as to whether the benefit of 'partnership' working was fully

Components of the Early Apollo Scientific Experiments Package (EASEP)

NASA Image and Video Library

1969-07-20

AS11-37-5551 (20 July 1969) --- Two components of the Early Apollo Scientific Experiments Package (EASEP) are seen deployed on the lunar surface in this view photographed from inside the Lunar Module (LM). In the far background is the Passive Seismic Experiment Package (PSEP); and to the right and closer to the camera is the Laser Ranging Retro-Reflector (LR-3). The footprints of Apollo 11 astronauts Neil A. Armstrong and Edwin E. Aldrin Jr. are very distinct in the lunar soil.

Supporting Learning to Teach in Early Field Experiences: The UTE Model

ERIC Educational Resources Information Center

Bieda, Kristen N.; Dillman, Brittany; Gundlach, Michael; Voogt, Kevin

2017-01-01

Most teacher preparation programs require prospective teachers (PTs) to engage in early field experiences (EFEs) prior to completing required coursework. These EFEs, however, may lack meaningful connections to course content and provide limited opportunities to experience the demands of classroom teaching. In this paper, we share evidence from the…

Challenges in early clinical development of adjuvanted vaccines.

PubMed

Della Cioppa, Giovanni; Jonsdottir, Ingileif; Lewis, David

2015-06-08

A three-step approach to the early development of adjuvanted vaccine candidates is proposed, the goal of which is to allow ample space for exploratory and hypothesis-generating human experiments and to select dose(s) and dosing schedule(s) to bring into full development. Although the proposed approach is more extensive than the traditional early development program, the authors suggest that by addressing key questions upfront the overall time, size and cost of development will be reduced and the probability of public health advancement enhanced. The immunogenicity end-points chosen for early development should be critically selected: an established immunological parameter with a well characterized assay should be selected as primary end-point for dose and schedule finding; exploratory information-rich end-points should be limited in number and based on pre-defined hypothesis generating plans, including system biology and pathway analyses. Building a pharmacodynamic profile is an important aspect of early development: to this end, multiple early (within 24h) and late (up to one year) sampling is necessary, which can be accomplished by sampling subgroups of subjects at different time points. In most cases the final target population, even if vulnerable, should be considered for inclusion in early development. In order to obtain the multiple formulations necessary for the dose and schedule finding, "bed-side mixing" of various components of the vaccine is often necessary: this is a complex and underestimated area that deserves serious research and logistical support. Copyright © 2015 Elsevier Ltd. All rights reserved.

Early- versus late-onset obsessive-compulsive disorder: investigating genetic and clinical correlates.

PubMed

Hemmings, Sîan M J; Kinnear, Craig J; Lochner, Christine; Niehaus, Dana J H; Knowles, James A; Moolman-Smook, Johanna C; Corfield, Valerie A; Stein, Dan J

2004-09-30

There is increasing evidence that obsessive-compulsive disorder (OCD) is mediated by genetic factors. Although the precise mechanism of inheritance is unclear, recent evidence has pointed towards the involvement of the serotonergic and dopaminergic systems in the disorder's development. Furthermore, early-onset OCD appears to be a subtype that exhibits distinct clinical features and that is associated with greater familial loading. In the present investigation, South African OCD patients (n=252) were stratified according to age of onset and were clinically assessed. Additionally, selected variants in genes encoding serotonergic and dopaminergic components were investigated in a Caucasian OCD subset (n=180). This subgroup was further stratified to evaluate the role that these candidate genes may play in the genetically homogeneous Afrikaner subset (n=80). Analysis of the clinical data revealed an association between early age of onset and an increased frequency of tics, Tourette's disorder, and trichotillomania (TTM). The genetic studies yielded statistically significant results when the allelic distributions of genetic variants in the dopamine receptor type 4 gene (DRD4) were analysed in the Caucasian OCD cohort. These data support a role for the dopaminergic system, which may be relevant to the development of early-onset OCD.

[Early detection of autism in children. Review of literature].

PubMed

Pisula, E

1997-01-01

The difficulties with early detection of autistic disorder in children are discussed. DSM-IV diagnostic criteria are presented. Usefulness of clinical interview and clinical experiment in diagnosing autistic disorder are analyzed.

Incremental Validity in the Clinical Assessment of Early Childhood Development

ERIC Educational Resources Information Center

Liu, Xin; Zhou, Xiaobin; Lackaff, Julie

2013-01-01

The authors demonstrate the increment of clinical validity in early childhood assessment of physical impairment (PI), developmental delay (DD), and autism (AUT) using multiple standardized developmental screening measures such as performance measures and parent and teacher rating scales. Hierarchical regression and sensitivity/specificity analyses…

A Road Like No Other: Mothers' Experiences with Early Intervention Professionals

ERIC Educational Resources Information Center

Piper, Amy Wickizer

2010-01-01

This dual case study utilizes qualitative research methods to examine the experiences of two mothers of young children with special needs. Over the course of ten months, the researcher spent many hours interviewing both mothers about their experiences with Early Intervention (EI) professionals. Observations of medical appointments, team meetings,…

Anything but Shadowing! Early Clinical Reasoning in Emergency Department Improves Clinical Skills

PubMed Central

Royan, Regina; Wu, Christine; Theyyunni, Nik; Montas, Sacha; Cranford, James A.; House, Joseph B.; Lukela, Michael P.; Santen, Sally A.

2018-01-01

Introduction Transitioning from the pre-clinical environment to clerkships poses a challenge to students and educators alike. Students along with faculty developed the Clinical Reasoning Elective (CRE) to provide pre-clinical students exposure to patients in the emergency department and the opportunity to build illness scripts and practice clinical skills with longitudinal mentorship in a low-stakes environment before entering clerkships. It is a voluntary program. Each year, the CRE has received overwhelming positive feedback from students. The objective of this study is to determine if the CRE improved students’ clinical skills and reported comfort in their skills. Methods We examined the relationships between students’ self-reported participation in the CRE and their individual scores on a comprehensive clinical assessment (CCA) at the end of the pre-clerkship period. A total of 178 students took the CCA exam in 2016. Of these, 113 participated in the CRE and 65 did not. Seven students who participated in CRE did not complete the exit survey and were omitted from analysis. We performed regression analysis and dichotomous (participants/nonparticipants) comparisons of means with t-tests. Survey of student reactions was collected. Results Participants completed an average of 10 sessions over the course of the program (range=1–20). Involvement in the CRE was associated with significantly increased scores on Abdominal History; Pulmonary Physical Exam; Overall History-Taking; Overall Communication; and Overall Physical Exam (p<0.05). Nearly all students (97%) reported that the program offered opportunities to enhance clinical skills, increased their comfort with patients, and better prepared them for their clinical years. Conclusion There were measurable improvements in clinical skills performance for students who participated in CRE. As many schools seek to incorporate early clinical exposure to their curricula, this program provides a successful framework to

The variable clinical presentation of tuberculosis otitis media and the importance of early detection.

PubMed

Abes, Generoso T; Abes, Franco Louie L B; Jamir, Joselito C

2011-06-01

Tuberculosis (TB) is a rare cause of otitis media. This study aims to increase awareness on the clinical presentation of TB otitis media and illustrate how early detection affects treatment outcome. Chart review of 12 patients (13 ears) from a tertiary hospital in Manila, Philippines, seen from 2004 to 2009. Clinical predictors of the disease were summarized. Clinical, radiologic, and audiometric outcomes after treatment were compared between treatment groups. The 5 otoscopic presentations were multiple perforations, single perforation with refractory otorrhea and exuberant granulation tissue formation, single perforation with minimal otorrhea and no granulation tissue formation, intact tympanic membrane with middle ear effusion, and intact tympanic membrane with tumorlike tissue in the middle ear. Clinical predictors of the disease were history of pulmonary TB, work-related contamination of the infection, positive purified protein derivative test, positive chest radiographic finding and intraoperative granulation tissue with cheesy material, and temporal bone computed tomographic scan findings. Patients who had no middle ear surgery showed significantly better clinical, radiologic, and audiometric outcomes than those who were diagnosed late and had more complicated surgical procedure. The clinical presentation of TB otitis media is variable. Early detection of the early forms entail less surgical intervention and favors better treatment results.

Modification of visual function by early visual experience.

PubMed

Blakemore, C

1976-07-01

Physiological experiments, involving recording from the visual cortex in young kittens and monkeys, have given new insight into human developmental disorders. In the visual cortex of normal cats and monkeys most neurones are selectively sensitive to the orientation of moving edges and they receive very similar signals from both eyes. Even in very young kittens without visual experience, most neurones are binocularly driven and a small proportion of them are genuinely orientation selective. There is no passive maturation of the system in the absence of visual experience, but even very brief exposure to patterned images produces rapid emergence of the adult organization. These results are compared to observations on humans who have "recovered" from early blindness. Covering one eye in a kitten or a monkey, during a sensitive period early in life, produces a virtually complete loss of input from that eye in the cortex. These results can be correlated with the production of "stimulus deprivation amblyopia" in infants who have had one eye patched. Induction of a strabismus causes a loss of binocularity in the visual cortex, and in humans it leads to a loss of stereoscopic vision and binocular fusion. Exposing kittens to lines of one orientation modifies the preferred orientations of cortical cells and there is an analogous "meridional amblyopia" in astigmatic humans. The existence of a sensitive period in human vision is discussed, as well as the possibility of designing remedial and preventive treatments for human developmental disorders.

Early treatment of posterior crossbite - a randomised clinical trial

PubMed Central

2013-01-01

Background The aim of this randomised clinical trial was to assess the effect of early orthodontic treatment in contrast to normal growth effects for functional unilateral posterior crossbite in the late deciduous and early mixed dentition by means of three-dimensional digital model analysis. Methods This randomised clinical trial was assessed to analyse the orthodontic treatment effects for patients with functional unilateral posterior crossbite in the late deciduous and early mixed dentition using a two-step procedure: initial maxillary expansion followed by a U-bow activator therapy. In the treatment group 31 patients and in the control group 35 patients with a mean age of 7.3 years (SD 2.1) were monitored. The time between the initial assessment (T1) and the follow-up (T2) was one year. The orthodontic analysis was done by a three-dimensional digital model analysis. Using the ‘Digimodel’ software, the orthodontic measurements in the maxilla and mandible and for the midline deviation, the overjet and overbite were recorded. Results Significant differences between the control and the therapy group at T2 were detected for the anterior, median and posterior transversal dimensions of the maxilla, the palatal depth, the palatal base arch length, the maxillary arch length and inclination, the midline deviation, the overjet and the overbite. Conclusions Orthodontic treatment of a functional unilateral posterior crossbite with a bonded maxillary expansion device followed by U-bow activator therapy in the late deciduous and early mixed dentition is an effective therapeutic method, as evidenced by the results of this RCT. It leads to three-dimensional therapeutically induced maxillary growth effects. Dental occlusion is significantly improved, and the prognosis for normal craniofacial growth is enhanced. Trial registration Registration trial DRKS00003497 on DRKS PMID:23339736

Outcomes of transoral robotic surgery: a preliminary clinical experience.

PubMed

Hurtuk, Agnes; Agrawal, Amit; Old, Matthew; Teknos, Theodoros N; Ozer, Enver

2011-08-01

To report a single institution's experience with transoral robotic surgery (TORS) and its clinical outcomes. Preliminary clinical data from a prospective TORS study. University tertiary care facility. Patients who underwent TORS at The Ohio State University Medical Center. Demographic, intraoperative, clinicopathological, and follow-up functional data were collected. Sixty-four patients underwent TORS with a median age of 56.9 years. A total of 113 TORS procedures were performed. Fifty-four patients with squamous cell cancer (SCCA) were included in the final analysis. Mean follow-up time was 11.8 months (range, 2-29). There was a trend toward longer TORS setup time, operative time, estimated blood loss, and hospital length of stay with advanced (T(3)) compared with early-stage tumors (T(1-2)). There were no major intraoperative complications, and none of the procedures were aborted because of inability to remove the tumor. Negative resection margins were achieved in 93% of cases of SCCA. No patients experienced immediate postoperative complications, and all of the patients tolerated an oral diet without any airway compromise on the day of surgery. Forty-nine patients (91%) underwent adjuvant radiation therapy (RT), with 11 patients requiring gastrostomy tube placement during RT. Addition of TORS to overall management of head and neck SCCA spared adjuvant RT or combined chemotherapy and RT (CRT) in 50% of stage I/II tumors and spared chemotherapy in 34% of stage III/IV tumors. TORS is a safe procedure with minimal complications and favorable clinical and functional outcomes. It is a promising future alternative surgical treatment for laryngopharyngeal tumors.

Determination of minimal clinically important change in early and advanced Parkinson's disease.

PubMed

Hauser, Robert A; Auinger, Peggy

2011-04-01

Two common primary efficacy outcome measures in Parkinson's disease (PD) are change in Unified Parkinson's Disease Rating Scale (UPDRS) scores in early PD and change in "off" time in patients with motor fluctuations. Defining the minimal clinically important change (MCIC) in these outcome measures is important to interpret the clinical relevance of changes observed in clinical trials and other situations. We analyzed data from 2 multicenter, placebo-controlled, randomized clinical trials of rasagiline; TEMPO studied 404 early PD subjects, and PRESTO studied 472 levodopa-treated subjects with motor fluctuations. An anchor-based approach using clinical global impression of improvement (CGI-I) was used to determine MCIC for UPDRS scores and daily "off" time. MCIC was defined as mean change in actively treated subjects rated minimally improved on CGI-I. Receiver operating characteristic (ROC) curves defined optimal cutoffs discriminating between changed and unchanged subjects. MCIC for improvement in total UPDRS score (parts I-III) in early PD was determined to be -3.5 points based on mean scores and -3.0 points based on ROC curves. In addition, we found an MCIC for reduction in "off" time of 1.0 hours as defined by mean reduction in "off" time in active treated subjects self-rated as minimally improved on CGI-I minus mean reduction in "off" time in placebo-treated subjects self-rated as unchanged (1.9-0.9 hours). We hypothesize that many methodological factors can influence determination of the MCIC, and a range of values is likely to emerge from multiple studies. Copyright © 2011 Movement Disorder Society.

A comparison between the clinical significance and growth mixture modelling early change methods at predicting negative outcomes.

PubMed

Flood, Nicola; Page, Andrew; Hooke, Geoff

2018-05-03

Routine outcome monitoring benefits treatment by identifying potential no change and deterioration. The present study compared two methods of identifying early change and their ability to predict negative outcomes on self-report symptom and wellbeing measures. 1467 voluntary day patients participated in a 10-day group Cognitive Behaviour Therapy (CBT) program and completed the symptom and wellbeing measures daily. Early change, as defined by (a) the clinical significance method and (b) longitudinal modelling, was compared on each measure. Early change, as defined by the simpler clinical significance method, was superior at predicting negative outcomes than longitudinal modelling. The longitudinal modelling method failed to detect a group of deteriorated patients, and agreement between the early change methods and the final unchanged outcome was higher for the clinical significance method. Therapists could use the clinical significance early change method during treatment to alert them of patients at risk for negative outcomes, which in turn could allow therapists to prevent those negative outcomes from occurring.

Exploring a Comprehensive Model for Early Childhood Vocabulary Instruction: A Design Experiment

ERIC Educational Resources Information Center

Wang, X. Christine; Christ, Tanya; Chiu, Ming Ming

2014-01-01

Addressing a critical need for effective vocabulary practices in early childhood classrooms, we conducted a design experiment to achieve three goals: (1) developing a comprehensive model for early childhood vocabulary instruction, (2) examining the effectiveness of this model, and (3) discerning the contextual conditions that hinder or facilitate…

Early Career Teachers' Emotional Experiences and Development--A Norwegian Case Study

ERIC Educational Resources Information Center

Jakhelln, Rachel

2011-01-01

Emotional experiences that are an integral part of the process of becoming teachers have been insufficiently explored in the research literature. The early experiences of three new teachers in a Norwegian upper secondary school are analysed using a collective case-study design and a socio-cultural theoretical framework. Emotions arising in the…

[Initial clinical experience of proton therapy at Shizuoka Cancer Center].

PubMed

Murayama, Shigeyuki; Fuji, Hiroshi; Yamashita, Haruo; Futami, Yasuyuki; Numano, Masumi; Harada, Hideyuki; Kamata, Minoru; Nishimura, Tetsuo

2005-10-01

To present the initial experience and preliminary clinical results of patients treated mainly with proton irradiation at the newly developed proton therapy facility at Shizuoka Cancer Center. We reviewed 125 patients who underwent proton therapy between July 2003 and December 2004. Of these 125 patients, 11 had head and neck malignancies, 15 non-small cell lung cancers, 22 hepatocellular carcinomas, 62 prostate cancers, and 15 other malignant tumors. Most patients experienced Grade 0-1 acute morbidities (NCI-CTC) in skin or mucosa, while a temporary Grade 2-3 reaction was observed in a high dose area. Response rates were 73% for H & N malignancies, 100% for NSCLC, and 77% for HCC. PSA evaluation for patients with prostate cancer revealed a high rate of complete response. The efficacy and safety of proton therapy at Shizuoka Cancer Center was demonstrated for patients with early-stage cancer or locally advanced disease.

Recent early clinical drug development for acute kidney injury.

PubMed

Gallagher, Kevin M; O'neill, Stephen; Harrison, Ewen M; Ross, James A; Wigmore, Stephen J; Hughes, Jeremy

2017-02-01

Despite significant need and historical trials, there are no effective drugs in use for the prevention or treatment of acute kidney injury (AKI). There are several promising agents in early clinical development for AKI and two trials have recently been terminated. There are also exciting new findings in pre-clinical AKI research. There is a need to take stock of current progress in the field to guide future drug development for AKI. Areas covered: The main clinical trial registries, PubMed and pharmaceutical company website searches were used to extract the most recent clinical trials for sterile, transplant and sepsis-associated AKI. We summarise the development of the agents recently in clinical trial, update on their trial progress, consider reasons for failed efficacy of two agents, and discuss new paradigms in pre-clinical targets for AKI. Agents covered include- QPI-1002, THR-184, BB-3, heme arginate, human recombinant alkaline phosphatase (recAP), ciclosporin A, AB103, levosimendan, AC607 and ABT-719. Expert opinion: Due to the heterogenous nature of AKI, agents with the widest pleiotropic effects on multiple pathophysiological pathways are likely to be most effective. Linking preclinical models to clinical indication and improving AKI definition and diagnosis are key areas for improvement in future clinical trials.

Early life experience alters behavior during social defeat: focus on serotonergic systems.

PubMed

Gardner, K L; Thrivikraman, K V; Lightman, S L; Plotsky, P M; Lowry, C A

2005-01-01

Early life experience can have prolonged effects on neuroendocrine, autonomic, and behavioral responses to stress. The objective of this study was to investigate the effects of early life experience on behavior during social defeat, as well as on associated functional cellular responses in serotonergic and non-serotonergic neurons within the dorsal raphe nucleus, a structure which plays an important role in modulation of stress-related physiology and behavior. Male Long Evans rat pups were exposed to either normal animal facility rearing or 15 min or 180 min of maternal separation from postnatal days 2-14. As adults, these rats were exposed to a social defeat protocol. Differences in behavior were seen among the early life treatment groups during social defeat; rats exposed to 180 min of maternal separation from postnatal days 2-14 displayed more passive-submissive behaviors and less proactive coping behaviors. Analysis of the distribution of tryptophan hydroxylase and c-Fos-like immunoreactivity in control rats exposed to a novel cage and rats exposed to social defeat revealed that, independent of the early life experience, rats exposed to social defeat showed an increase in the number of c-Fos-like immunoreactive nuclei in serotonergic neurons in the middle and caudal parts of the dorsal dorsal raphe nucleus and caudal part of the ventral dorsal raphe nucleus, regions known to contain serotonergic neurons projecting to central autonomic and emotional motor control systems. This is the first study to show that the dorsomedial part of the mid-rostrocaudal dorsal raphe nucleus is engaged by a naturalistic stressor and supports the hypothesis that early life experience alters behavioral coping strategies during social conflict; furthermore, this study is consistent with the hypothesis that topographically organized subpopulations of serotonergic neurons principally within the mid-rostrocaudal and caudal part of the dorsal dorsal raphe nucleus modulate stress

78 FR 60291 - Investigational Device Exemptions for Early Feasibility Medical Device Clinical Studies...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-01

...] Investigational Device Exemptions for Early Feasibility Medical Device Clinical Studies, Including Certain First in Human Studies; Guidance for Industry and Food and Drug Administration Staff; Availability AGENCY... Feasibility Medical Device Clinical Studies, Including Certain First in Human (FIH) Studies.'' Through the...

Experience with early postoperative feeding after abdominal aortic surgery.

PubMed

Ko, Po-Jen; Hsieh, Hung-Chang; Liu, Yun-Hen; Liu, Hui-Ping

2004-03-01

Abdominal aortic surgery is a form of major vascular surgery, which traditionally involves long hospital stays and significant postoperative morbidity. Experiences with transit ileus are often encountered after the aortic surgery. Thus traditional postoperative care involves delayed oral feeding until the patients regain their normal bowel activities. This report examines the feasibility of early postoperative feeding after abdominal aortic aneurysm (AAA) open-repair. From May 2002 through May 2003, 10 consecutive patients with infrarenal AAA who underwent elective surgical open-repair by the same surgeon in our department were reviewed. All of them had been operated upon and cared for according to the early feeding postoperative care protocol, which comprised of adjuvant epidural anesthesia, postoperative patient controlled analgesia, early postoperative feeding and early rehabilitation. The postoperative recovery and length of hospital stay were reviewed and analyzed. All patients were able to sip water within 1 day postoperatively without trouble (Average; 12.4 hours postoperatively). All but one patient was put on regular diet within 3 days postoperatively (Average; 2.2 days postoperatively). The average postoperative length of stay in hospital was 5.8 days. No patient died or had major morbidity. Early postoperative feeding after open repair of abdominal aorta is safe and feasible. The postoperative recovery could be improved and the length of stay reduced by simply using adjuvant epidural anesthesia during surgery, postoperative epidural patient-controlled analgesia, early feeding, early ambulation, and early rehabilitation. The initial success of our postoperative recovery program of aortic repair was demonstrated.

The Community Mentorship Program: Providing Community-Engagement Opportunities for Early-Stage Clinical and Translational Scientists to Facilitate Research Translation

PubMed Central

Patino, Cecilia M.; Kubicek, Katrina; Robles, Marisela; Kiger, Holly; Dzekov, Jeanne

2016-01-01

Problem A goal of the Southern California Clinical and Translational Science Institute (SC-CTSI) at the University of Southern California (USC) and Children's Hospital Los Angeles is to train early-stage clinical translational scientists (CTSs) to conduct research that improves the health of diverse communities. This goal aligns well with the Institute of Medicine's recommendations emphasizing community engagement in biomedical research that facilitates research translation. The Community Mentorship Program (CMP), created to complement community-engaged research (CER) didactics, matches CTSs with community mentors who help CTSs identify and complete community-engaged experiences that inform their research. Approach The CMP was piloted in 2013-2015 by the SC-CTSI Workforce Development and Community-Engagement cores. The CMP team matched three CTSs (assistant professors pursuing mentored career development awards, two with CER experience) with mentors at community-based organizations (CBOs) aligned with their research interests. Each mentor–mentee pair signed a memorandum of understanding. The CMP team checked in regularly, monitoring progress and addressing challenges in CTSs’ completion of their community-engaged experience. Outcomes All pairs completed at least one community-engaged activity informing the CTS's research. In exit interviews, the CTSs and CBO mentors expressed satisfaction with the program and stated they would continue to work together. The CTSs reported the program provided opportunities to develop networks outside academia, build trust within the community, and receive feedback and learn from individuals in communities affected by their research. Next Steps The CMP will be expanded to include all eligible early-career CTSs and promoted for use in similar settings outside the SC-CTSI. PMID:27508342

Clinical training in human immunodeficiency virus disease for community physicians. The Los Angeles experience.

PubMed Central

Katsufrakis, P. J.; Radecki, S. E.

1992-01-01

In the past decade, the increased number of persons being treated for infection with the human immunodeficiency virus (HIV) has placed an enormous burden on specialty clinics. This is especially true in Los Angeles, where care of patients with the acquired immunodeficiency syndrome (AIDS) has been termed a "crisis" situation. Especially in its early stages, HIV disease can be appropriately managed by primary care physicians who provide patients with medical and psychological counseling and refer them to specialists when major AIDS-related complications develop. Physicians completing their training as recently as 5 years ago, however, received little systematic preparation in the care of HIV-infected patients and thus may lack important skills such as the ability to recognize opportunistic infections early in their course. By means of a 1-week intensive preceptorship in a high-volume AIDS clinic, we are preparing community physicians to assume a more active role in providing care for this growing patient population. In the preceptorship, participants receive one-on-one training from specialists in infectious diseases, pulmonary diseases, and hematology and oncology, as well as from internists and family physicians. Evaluation of the clinical experience demonstrated a greater level of confidence on the part of program participants in treating HIV-infected patients and showed that participants screen and test high-risk patients in their practices and devote a substantial proportion of their practices to caring for HIV-infected patients. PMID:1615654

Enhancing Research and Practice in Early Childhood through Formative and Design Experiments

ERIC Educational Resources Information Center

Bradley, Barbara A.; Reinking, David

2011-01-01

This article describes formative and design experiments and how they can advance research and instructional practices in early childhood education. We argue that this relatively new approach to education research closes the gap between research and practice, and it addresses limitations that have been identified in early childhood research. We…

Mothers' experience of caring for a child with early onset scoliosis: A qualitative descriptive study.

PubMed

Lauder, Bonnie; Sinclair, Peter M; Maguire, Jane

2018-04-01

This study aimed to identify and describe the experience of parents of children diagnosed with early onset scoliosis living in Australia. Chronic childhood disease has a major impact on health-related quality of life. Caring for a child with a chronic illness is well documented but the specific experiences of parents who care for children with early onset scoliosis, a rare but devastating illness, has not been explored. Numerous studies have described the interrelated psychological, financial, social, physical and logistical factors that impact the experience of the caregiver role with various diseases, but in the case of early onset scoliosis, limited studies have been conducted about the parental experience. A qualitative descriptive design was used. A snowball sampling technique assisted in the recruitment. Parents invited to the study included mothers, fathers and guardians. Data were collected through semistructured interviews and transcribed verbatim. Transcripts were analysed thematically. Data collection complied with the Consolidated criteria for reporting qualitative research guidelines. Twelve mothers of children with early onset scoliosis were interviewed, as only mothers consented to participate. Four major themes emerged: emotional rollercoaster ride, a lack of resources, money talks and pervasive burden. Factors that impacted on the participants' ability to confront, manage and endure caring for a child with early onset scoliosis emerged from the data. The findings suggest there are multiple factors that influence the experience of mothers' caring for a child with early onset scoliosis. The recognition and appropriate management of these factors by healthcare professionals have the potential to improve the quality of life of parents who care for a child with early onset scoliosis. Healthcare professionals have first-line contact with parents of children with early onset scoliosis and are well placed to provide parents with evidence-based education

Videothoracoscopy in the diagnosis of intrathoracic pathology: early experience.

PubMed Central

Waller, D. A.; Hasan, A.; Forty, J.; Morritt, G. N.

1994-01-01

We report our experience using the new technique of videothoracoscopy in the diagnosis of intrathoracic pathology. In the last 12 months, 40 patients (24 male; 16 female) have undergone investigation by this method. Lung biopsy has been performed in 17 patients, pleural biopsy in 20 patients and mediastinal biopsy in three patients. The majority had been referred after other investigations had been inconclusive. All biopsies were diagnostic except one mediastinal biopsy. This early experience suggests that videothoracoscopic biopsy is a well-tolerated technique with high diagnostic yield. PMID:8154806

Engaging GPs in commissioning: realist evaluation of the early experiences of Clinical Commissioning Groups in the English NHS.

PubMed

McDermott, Imelda; Checkland, Kath; Coleman, Anna; Osipovič, Dorota; Petsoulas, Christina; Perkins, Neil

2017-01-01

Objectives To explore the 'added value' that general practitioners (GPs) bring to commissioning in the English NHS. We describe the experience of Clinical Commissioning Groups (CCGs) in the context of previous clinically led commissioning policy initiatives. Methods Realist evaluation. We identified the programme theories underlying the claims made about GP 'added value' in commissioning from interviews with key informants. We tested these theories against observational data from four case study sites to explore whether and how these claims were borne out in practice. Results The complexity of CCG structures means CCGs are quite different from one another with different distributions of responsibilities between the various committees. This makes it difficult to compare CCGs with one another. Greater GP involvement was important but it was not clear where and how GPs could add most value. We identified some of the mechanisms and conditions which enable CCGs to maximize the 'added value' that GPs bring to commissioning. Conclusion To maximize the value of clinical input, CCGs need to invest time and effort in preparing those involved, ensuring that they systematically gather evidence about service gaps and problems from their members, and engaging members in debate about the future shape of services.

Treatment selection of early stage non-small cell lung cancer: the role of the patient in clinical decision making.

PubMed

Mokhles, S; Nuyttens, J J M E; de Mol, M; Aerts, J G J V; Maat, A P W M; Birim, Ö; Bogers, A J J C; Takkenberg, J J M

2018-01-15

The objective of this study is to investigate the role and experience of early stage non-small cell lung cancer (NSCLC) patient in decision making process concerning treatment selection in the current clinical practice. Stage I-II NSCLC patients (surgery 55 patients, SBRT 29 patients, median age 68) were included in this prospective study and completed a questionnaire that explored: (1) perceived patient knowledge of the advantages and disadvantages of the treatment options, (2) experience with current clinical decision making, and (3) the information that the patient reported to have received from their treating physician. This was assessed by multiple-choice, 1-5 Likert Scale, and open questions. The Decisional Conflict Scale was used to assess the decisional conflict. Health related quality of life (HRQoL) was measured with SF-36 questionnaire. In 19% of patients, there was self-reported perceived lack of knowledge about the advantages and disadvantages of the treatment options. Seventy-four percent of patients felt that they were sufficiently involved in decision-making by their physician, and 81% found it important to be involved in decision making. Forty percent experienced decisional conflict, and one-in-five patients to such an extent that it made them feel unsure about the decision. Subscores with regard to feeling uninformed and on uncertainty, contributed the most to decisional conflict, as 36% felt uninformed and 17% of patients were not satisfied with their decision. HRQoL was not influenced by patient experience with decision-making or patient preferences for shared decision making. Dutch early-stage NSCLC patients find it important to be involved in treatment decision making. Yet a substantial proportion experiences decisional conflict and feels uninformed. Better patient information and/or involvement in treatment-decision-making is needed in order to improve patient knowledge and hopefully reduce decisional conflict.

Feasibility of a Clinical Pathway with Early Oral Intake and Discharge for Laparoscopic Gastrectomy.

PubMed

Nakagawa, M; Tomii, C; Inokuchi, M; Otsuki, S; Kojima, K

2017-12-01

Although some studies have reported the safety of early oral intake after gastrectomy, it still remains controversial. This study focused on the feasibility of a clinical pathway with early oral intake and discharge setting for exclusively laparoscopic distal gastrectomy. A clinical pathway was applied to 403 patients until December 2014. In the protocol, patients are allowed to take a sip of water and a soft diet on the first and second days after the operation, respectively, and the discharge day is set as the fifth to seventh day after the operation. Clinicopathological variables were prospectively collected, and risk factors for discharge variances were analyzed. The completion rate of the clinical pathway was 76.9%. There were five re-admissions (1.2%). The overall morbidity rate was 18% ( n = 72), and major complications (Clavien-Dindo IIIa or greater) occurred in 13 patients (3%). Complications were the causes for discharge variances in 68 cases (73%), while the attending surgeons' judgment was the cause in 25 cases (27%). On multivariate analysis, age (odds ratio = 2.23, 95% confidence interval = 1.38-3.60, p = 0.001) and operative time (odds ratio = 2.38, 95% confidence interval = 1.45-3.98, p = 0.001) were independent risk factors for discharge variances. A high completion rate of a clinical pathway with early oral intake and discharge setting for laparoscopic distal gastrectomy was achievable with an acceptably low re-admission rate. Laparoscopic distal gastrectomy is recommended as a first step for a clinical pathway with an early oral intake and discharge protocol.

Early Life Experience and Gut Microbiome: The Brain-Gut-Microbiota Signaling System.

PubMed

Cong, Xiaomei; Henderson, Wendy A; Graf, Joerg; McGrath, Jacqueline M

2015-10-01

Over the past decades, advances in neonatal care have led to substantial increases in survival among preterm infants. With these gains, recent concerns have focused on increases in neurodevelopment morbidity related to the interplay between stressful early life experiences and the immature neuroimmune systems. This interplay between these complex mechanisms is often described as the brain-gut signaling system. The role of the gut microbiome and the brain-gut signaling system have been found to be remarkably related to both short- and long-term stress and health. Recent evidence supports that microbial species, ligands, and/or products within the developing intestine play a key role in early programming of the central nervous system and regulation of the intestinal innate immunity. The purpose of this state-of-the-science review is to explore the supporting evidence demonstrating the importance of the brain-gut-microbiota axis in regulation of early life experience. We also discuss the role of gut microbiome in modulating stress and pain responses in high-risk infants. A conceptual framework has been developed to illustrate the regulation mechanisms involved in early life experience. The science in this area is just beginning to be uncovered; having a fundamental understanding of these relationships will be important as new discoveries continue to change our thinking, leading potentially to changes in practice and targeted interventions.

Clinical features of early onset, familial Alzheimer`s disease linked to chromosome 14

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

Mullan, M.; Bennett, C.; Figueredo, C.

1995-02-27

Early onset familial Alzheimer`s disease (AD) has an autosomal dominant mode of inheritance. Two genes are responsible for the majority of cases of this subtype of AD. Mutations in the {beta}-amyloid precursor protein ({beta}APP) gene on chromosome 21 have been shown to completely cosegregate with the disease. We and others have previously described the clinical features of families with {beta}APP mutations at the codon 717 locus in an attempt to define the phenotype associated with a valine to isoleucine (Val {r_arrow} Ile) or a valine to glycine (Val {r_arrow} Gly) change. More recently, a second locus for very early onsetmore » disease has been localized to chromosome 14. The results of linkage studies in some families suggesting linkage to both chromosomes have been explained by the suggestion of a second (centromeric) locus on chromosome 21. Here we report the clinical features and genetic analysis of a British pedigree (F74) with early onset AD in which neither the {beta}APP locus nor any other chromosome 21 locus segregates with the disease, but in which good evidence is seen for linkage on the long arm of chromosome 14. In particular we report marker data suggesting that the chromosome 14 disease locus is close to D14S43 and D14S77. Given the likelihood that F74 represents a chromosome 14 linked family, we describe the clinical features and make a limited clinical comparison with the {beta}APP717 Val {r_arrow} Ile and {beta}APP717 Val {r_arrow} Gly encoded families that have been previously described. We conclude that although several previously reported clinical features occur to excess in early onset familial AD, no single clinical feature demarcates either the chromosome 14 or {beta}APP codon 717 mutated families except mean age of onset. 52 refs., 2 figs., 5 tabs.« less

Clinical Needs Finding: Developing the Virtual Experience, A Case Study

PubMed Central

Mittal, Vaishali; Thompson, Megan; Altman, Stuart M; Taylor, Peter; Summers, Alexander; Goodwin, Kelsey; Louie, Angelique Y

2013-01-01

We describe an innovative program at the University of California, Davis for students to engage in clinical needs finding. Using a team-based approach, students participated in clinical rotations to observe firsthand the needs of clinicians at the university affiliated medical center. The teams were asked to develop documentary-style videos to capture key experiences that would allow future viewers to use the videos as “virtual” clinical rotations. This was conceived as a strategy to allow students in prohibitively large classes, or students in programs at institutions without associated medical or veterinary school programs, to experience clinical rotations and perform needs assessments. The students' perspectives on the experience as well as instructor analysis of best practices for this type of activity are presented and discussed. We found that the internship experience was valuable to the students participating, by not only introducing the practice of needs finding but for increasing the students' confidence in the practice of engineering design and their ability to work independently. The videos produced were of such high quality that instructors from other institutions have requested copies for instructional use. Virtual clinical rotations through video experiences may provide a reasonable substitute for students who do not have the ability to participate in rotations in person. PMID:23483373

Inside information: Financial conflicts of interest for research subjects in early phase clinical trials.

PubMed

Helft, Paul R; Ratain, Mark J; Epstein, Richard A; Siegler, Mark

2004-05-05

In recent years, several research subjects have told us that they had bought or intended to buy stock in the companies sponsoring the clinical trials in which they were enrolled. This situation has led us to ask what, if any, are physician-investigators' scientific, ethical, and legal responsibilities concerning research subjects who choose to buy stock in the companies sponsoring the clinical trials in which they are participating. Although the scope of this problem is unknown and is likely to be small, this commentary examines the scientific, ethical, and legal concerns raised by such activities on the part of research subjects enrolled in early phase clinical trials. In addition, this commentary also outlines the basis for our opinion that research subjects involved in an early phase clinical trial should avoid the financial conflicts of interest created by trading stock in the company sponsoring the clinical trial.

Early results from the ultra heavy cosmic ray experiment

NASA Technical Reports Server (NTRS)

Osullivan, D.; Thompson, A.; Bosch, J.; Keegan, R.; Wenzel, K.-P.; Jansen, F.; Domingo, C.

1995-01-01

Data extraction and analysis of the LDEF Ultra Heavy Cosmic Ray Experiment is continuing. Almost twice the pre LDEF world sample has been investigated and some details of the charge spectrum in the region from Z approximately 70 up to and including the actinides are presented. The early results indicate r process enhancement over solar system source abundances.

Early Academic Experiences of Recently Incarcerated African American Males

ERIC Educational Resources Information Center

Jeffers, Adam R.

2010-01-01

This project examines the early educational experiences of 6 young African American males (ages 18-25) who attended urban schools in San Diego, California. All 6 men were incarcerated for at least 1-year before participating in a pre-release program. The participants were part of a pre-release program in San Diego, California, which was selected…

Development of the Play Experience Model to Enhance Desirable Qualifications of Early Childhood

ERIC Educational Resources Information Center

Panpum, Watchara; Soonthornrojana, Wimonrat; Nakunsong, Thatsanee

2015-01-01

The objectives of this research were to develop the play experience model and to study the effect of usage in play experience model for enhancing the early childhood's desirable qualification. There were 3 phases of research: 1) the document and context in experience management were studied, 2) the play experience model was developed, and 3) the…

Early Care, Education, and Family Life in Rural Fiji: Experiences and Reflections

ERIC Educational Resources Information Center

Bullock, Janis

2005-01-01

As a member of a delegation of educators, physicians, and lay people to rural Fiji the author shares her experiences and reflections of early care, education, and family life on a small, remote island. She discusses her visits to the village and boarding school, and her interactions with teachers, children, and parents in the early childhood…

Early thinning experiments established by the Fort Valley Experimental Forest (P-53)

Treesearch

Benjamin P. De Blois; Alex. J. Finkral; Andrew J. Sánchez Meador; Margaret M. Moore

2008-01-01

Between 1925 and 1936, the Fort Valley Experimental Forest (FVEF) scientists initiated a study to examine a series of forest thinning experiments in second growth ponderosa pine stands in Arizona and New Mexico. These early thinning plots furnished much of the early background for the development of methods used in forest management in the Southwest. The plots ranged...

A Comparison of Premenarcheal Expectations and Postmenarcheal Experiences in Chinese Early Adolescents

ERIC Educational Resources Information Center

Tang, Catherine So-Kum; Yeung, Dannii Y. L.; Lee, Antoinette Marie

2004-01-01

The present study examined Chinese early adolescents' expectations and experiences of their first menstruation. It included 952 participants, 476 premenarcheal and 476 postmenarcheal girls matched by age and by grade level. Results showed that compared to experiences of postmenarcheal girls, premenarcheal girls anticipated more negative emotional…

78 FR 39736 - Draft Guidance for Industry: Considerations for the Design of Early-Phase Clinical Trials of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-02

..., choosing a study population, using a control group and blinding, dose selection, treatment plans...] Draft Guidance for Industry: Considerations for the Design of Early-Phase Clinical Trials of Cellular... document entitled ``Guidance for Industry: Considerations for the Design of Early-Phase Clinical Trials of...

Early Life Experiences and Exercise Associate with Canine Anxieties.

PubMed

Tiira, Katriina; Lohi, Hannes

2015-01-01

Personality and anxiety disorders across species are affected by genetic and environmental factors. Shyness-boldness personality continuum exists across species, including the domestic dog, with a large within- and across-breed variation. Domestic dogs are also diagnosed for several anxiety-related behavioral conditions, such as generalized anxiety disorders, phobias, and separation anxiety. Genetic and environmental factors contributing to personality and anxiety are largely unknown. We collected questionnaire data from a Finnish family dog population (N = 3264) in order to study the associating environmental factors for canine fearfulness, noise sensitivity, and separation anxiety. Early life experiences and exercise were found to associate with anxiety prevalence. We found that fearful dogs had less socialization experiences (p = 0.002) and lower quality of maternal care (p < 0.0001) during puppyhood. Surprisingly, the largest environmental factor associating with noise sensitivity (p < 0.0001) and separation anxiety (p = 0.007) was the amount of daily exercise; dogs with noise sensitivity and separation anxiety had less daily exercise. Our findings suggest that dogs share many of the same environmental factors that contribute to anxiety in other species as well, such as humans and rodents. Our study highlights the importance of early life experiences, especially the quality of maternal care and daily exercise for the welfare and management of the dogs, and reveals important confounding factors to be considered in the genetic characterization of canine anxiety.

Assessing the Clinical Role of Genetic Markers of Early-Onset Prostate Cancer Among High-Risk Men Enrolled in Prostate Cancer Early Detection

PubMed Central

Hughes, Lucinda; Zhu, Fang; Ross, Eric; Gross, Laura; Uzzo, Robert G.; Chen, David Y. T.; Viterbo, Rosalia; Rebbeck, Timothy R.; Giri, Veda N.

2011-01-01

Background Men with familial prostate cancer (PCA) and African American men are at risk for developing PCA at younger ages. Genetic markers predicting early-onset PCA may provide clinically useful information to guide screening strategies for high-risk men. We evaluated clinical information from six polymorphisms associated with early-onset PCA in a longitudinal cohort of high-risk men enrolled in PCA early detection with significant African American participation. Methods Eligibility criteria include ages 35–69 with a family history of PCA or African American race. Participants undergo screening and biopsy per study criteria. Six markers associated with early-onset PCA (rs2171492 (7q32), rs6983561 (8q24), rs10993994 (10q11), rs4430796 (17q12), rs1799950 (17q21), and rs266849 (19q13)) were genotyped. Cox models were used to evaluate time to PCA diagnosis and PSA prediction for PCA by genotype. Harrell’s concordance index was used to evaluate predictive accuracy for PCA by PSA and genetic markers. Results 460 participants with complete data and ≥1 follow-up visit were included. 56% were African American. Among African American men, rs6983561 genotype was significantly associated with earlier time to PCA diagnosis (p=0.005) and influenced prediction for PCA by the PSA (p<0.001). When combined with PSA, rs6983561 improved predictive accuracy for PCA compared to PSA alone among African American men (PSA= 0.57 vs. PSA+rs6983561=0.75, p=0.03). Conclusions Early-onset marker rs6983561 adds potentially useful clinical information for African American men undergoing PCA risk assessment. Further study is warranted to validate these findings. Impact Genetic markers of early-onset PCA have potential to refine and personalize PCA early detection for high-risk men. PMID:22144497

Clinical Environment as a Learning Environment: Student Nurses' Perceptions Concerning Clinical Learning Experiences.

ERIC Educational Resources Information Center

Papp, Inkeri; Markkanen, Marjatta; von Bonsdorff, Mikaela

2003-01-01

Finnish student nurses (n=16) described their clinical learning experiences. Several themes were identified: feeling appreciated and supported, the quality of mentoring and patient care, and self-directedness. School and clinical staff cooperation helped create a good learning environment in which theory and practice complemented each other.…

Clinical Implications of a Dimensional Approach: The Normal:Abnormal Spectrum of Early Irritability.

PubMed

Wakschlag, Lauren S; Estabrook, Ryne; Petitclerc, Amelie; Henry, David; Burns, James L; Perlman, Susan B; Voss, Joel L; Pine, Daniel S; Leibenluft, Ellen; Briggs-Gowan, Margaret L

2015-08-01

The importance of dimensional approaches is widely recognized, but an empirical base for clinical application is lacking. This is particularly true for irritability, a dimensional phenotype that cuts across many areas of psychopathology and manifests early in life. We examine longitudinal, dimensional patterns of irritability and their clinical import in early childhood. Irritability was assessed longitudinally over an average of 16 months in a clinically enriched, diverse community sample of preschoolers (N = 497; mean = 4.2 years; SD = 0.8). Using the Temper Loss scale of the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) as a developmentally sensitive indicator of early childhood irritability, we examined its convergent/divergent, clinical, and incremental predictive validity, and modeled its linear and nonlinear associations with clinical risk. The Temper Loss scale demonstrated convergent and divergent validity to child and maternal factors. In multivariate analyses, Temper Loss predicted mood (separation anxiety disorder [SAD], generalized anxiety disorder [GAD], and depression/dysthymia), disruptive (oppositional defiant disorder [ODD], attention-deficit/hyperactivity disorder [ADHD], and conduct disorder [CD]) symptoms. Preschoolers with even mildly elevated Temper Loss scale scores showed substantially increased risk of symptoms and disorders. For ODD, GAD, SAD, and depression, increases in Temper Loss scale scores at the higher end of the dimension had a greater impact on symptoms relative to increases at the lower end. Temper Loss scale scores also showed incremental validity over DSM-IV disorders in predicting subsequent impairment. Finally, accounting for the substantial heterogeneity in longitudinal patterns of Temper Loss significantly improved prediction of mood and disruptive symptoms. Dimensional, longitudinal characterization of irritability informs clinical prediction. A vital next step will be empirically generating

An evaluation of learning clinical decision-making for early rehabilitation in the ICU via interactive education with audience response system.

PubMed

Toonstra, Amy L; Nelliot, Archana; Aronson Friedman, Lisa; Zanni, Jennifer M; Hodgson, Carol; Needham, Dale M

2017-06-01

Knowledge-related barriers to safely implement early rehabilitation programs in intensive care units (ICUs) may be overcome via targeted education. The purpose of this study was to evaluate the effectiveness of an interactive educational session on short-term knowledge of clinical decision-making for safe rehabilitation of patients in ICUs. A case-based teaching approach, drawing from published safety recommendations for initiation of rehabilitation in ICUs, was used with a multidisciplinary audience. An audience response system was incorporated to promote interaction and evaluate knowledge before vs. after the educational session. Up to 175 audience members, of 271 in attendance (129 (48%) physical therapists, 51 (19%) occupational therapists, 31 (11%) nursing, 14 (5%) physician, 46 (17%) other), completed both the pre- and post-test questions for each of the six unique patient cases. In four of six patient cases, there was a significant (p< 0.001) increase in identifying the correct answer regarding initiation of rehabilitation activities. This learning effect was similar irrespective of participants' years of experience and clinical discipline. An interactive, case-based, educational session may be effective for increasing short-term knowledge, and identifying knowledge gaps, regarding clinical decision-making for safe rehabilitation of patients in ICUs. Implications for Rehabilitation Lack of knowledge regarding the safety considerations for early rehabilitation of ICU patients is a barrier to implementing early rehabilitation. Interactive educational formats, such as the use of audience response systems, offer a new method of teaching and instantly assessing learning of clinically important information. In a small study, we have shown that an interactive, case-based educational format may be used to effectively teach clinical decision-making for the safe rehabilitation of ICU patients to a diverse audience of clinicians.

The Clinical/Practicum Experience in Professional Preparation: Preliminary Findings

ERIC Educational Resources Information Center

Ralph, Edwin George; Walker, Keith; Wimmer, Randy

2008-01-01

The authors synthesize preliminary findings from an interdisciplinary study of the practicum/clinical phase of undergraduate pre-service education in the professions. Early data analysis identified similarities and differences across disciplines in terms of: (a) the terminology describing each practicum program, (b) the programs' key…

Clinical outcome of critically ill patients with thrombocytopenia and hypophosphatemia in the early stage of sepsis.

PubMed

Brotfain, Evgeni; Schwartz, Andrei; Boniel, Avi; Koyfman, Leonid; Boyko, Matthew; Kutz, Ruslan; Klein, Moti

2016-01-01

Hypophosphatemia and thrombocytopenia may both be independent risk factors for the development of multiple organ failure and correlate well with the severity of sepsis. In the present study we wanted to analyze the potential clinical role and prognostic significance of both early hypophosphatemia and thrombocytopenia on clinical outcomes of critically ill ICU patients with severe sepsis. We analyzed the clinical data, including the outcome of critically ill ICU patients with severe sepsis who presented during a 5 year period with early hypophosphatemia and thrombocytopenia.This study was retrospective and single centre. All clinical and laboratory data was collected from the patients' ICU and hospital electronic records. All laboratory measurements were done on admission and during the ICU stay. The included patients were distributed into one of three study groups based on the presence of hypophosphatemia and/or thrombocytopenia during the first 24 hours of admission to the ICU: group 1 - early hypophosphatemia; group 2 - early hypophosphatemia and thrombocytopenia and group 3 - early thrombocytopenia. The ICU mortality rate was significantly higher in groups 2 and 3 (25.9% and 22% vs. 9.3%, respectively, P = 0.034). An APACHE II > 27, a TISS > 25 following the first 24 hours of ICU stay , an age higher than 70, male gender and total parenteral nutrition were independent predictors of ICU and hospital mortality in this study population. It may be considered that hypophosphatemia and thrombocytopenia in the early stage of sepsis, even when severe and coexisting, reflect the degree of initial illness severity of sepsis. However, further investigations need to be done for a better understanding of the potential clinical role of these features in the septic critically ill population.

Bias to pollen odors is affected by early exposure and foraging experience.

PubMed

Arenas, A; Farina, W M

2014-07-01

In many pollinating insects, foraging preferences are adjusted on the basis of floral cues learned at the foraging site. In addition, olfactory experiences gained at early adult stages might also help them to initially choose food sources. To understand pollen search behavior of honeybees, we studied how responses elicited by pollen-based odors are biased in foraging-age workers according to (i) their genetic predisposition to collect pollen, (ii) pollen related information gained during foraging and (iii) different experiences with pollen gained at early adult ages. Bees returning to the hive carrying pollen loads, were strongly biased to unfamiliar pollen bouquets when tested in a food choice device against pure odors. Moreover, pollen foragers' orientation response was specific to the odors emitted by the pollen type they were carrying on their baskets, which suggests that foragers retrieve pollen odor information to recognize rewarding flowers outside the hive. We observed that attraction to pollen odor was mediated by the exposure to a pollen diet during the first week of life. We did not observe the same attraction in foraging-age bees early exposed to an artificial diet that did not contain pollen. Contrary to the specific response observed to cues acquired during foraging, early exposure to single-pollen diets did not bias orientation response towards a specific pollen odor in foraging-age bees (i.e. bees chose equally between the exposed and the novel monofloral pollen odors). Our results show that pollen exposure at early ages together with olfactory experiences gained in a foraging context are both relevant to bias honeybees' pollen search behavior. Copyright © 2014 Elsevier Ltd. All rights reserved.

Designing Informal Learning Experiences for Early Career Academics Using a Knowledge Ecosystem Model

ERIC Educational Resources Information Center

Miller, Faye; Partridge, Helen; Bruce, Christine; Hemmings, Brian

2017-01-01

This article presents a "knowledge ecosystem" model of how early career academics experience using information to learn while building their social networks for developmental purposes. Developed using grounded theory methodology, the model offers a way of conceptualising how to empower early career academics through (1) agency…

Preparedness to Teach: Experiences of the University of Ibadan Early Career Academics

ERIC Educational Resources Information Center

Udegbe, I. Bola

2016-01-01

This research examined the experiences of early career academics (ECAs) in terms of their preparedness to teach. Using a survey design involving 104 ECAs in a large Nigeria university, quantitative and qualitative data were obtained to address the research questions raised. Findings showed that (1) prior experience and training impacted on…

Engaging GPs in commissioning: realist evaluation of the early experiences of Clinical Commissioning Groups in the English NHS

PubMed Central

Checkland, Kath; Coleman, Anna; Osipovič, Dorota; Petsoulas, Christina; Perkins, Neil

2016-01-01

Objectives To explore the ‘added value’ that general practitioners (GPs) bring to commissioning in the English NHS. We describe the experience of Clinical Commissioning Groups (CCGs) in the context of previous clinically led commissioning policy initiatives. Methods Realist evaluation. We identified the programme theories underlying the claims made about GP ‘added value’ in commissioning from interviews with key informants. We tested these theories against observational data from four case study sites to explore whether and how these claims were borne out in practice. Results The complexity of CCG structures means CCGs are quite different from one another with different distributions of responsibilities between the various committees. This makes it difficult to compare CCGs with one another. Greater GP involvement was important but it was not clear where and how GPs could add most value. We identified some of the mechanisms and conditions which enable CCGs to maximize the ‘added value’ that GPs bring to commissioning. Conclusion To maximize the value of clinical input, CCGs need to invest time and effort in preparing those involved, ensuring that they systematically gather evidence about service gaps and problems from their members, and engaging members in debate about the future shape of services. PMID:27151153

Clinical and molecular characterization of KCNT1-related severe early-onset epilepsy

PubMed Central

Nair, Umesh; Malhotra, Sony; Meyer, Esther; Trump, Natalie; Gazina, Elena V.; Papandreou, Apostolos; Ngoh, Adeline; Ackermann, Sally; Ambegaonkar, Gautam; Appleton, Richard; Desurkar, Archana; Eltze, Christin; Kneen, Rachel; Kumar, Ajith V.; Lascelles, Karine; Montgomery, Tara; Ramesh, Venkateswaran; Samanta, Rajib; Scott, Richard H.; Tan, Jeen; Whitehouse, William; Poduri, Annapurna; Scheffer, Ingrid E.; Chong, W.K. “Kling”; Cross, J. Helen; Topf, Maya; Petrou, Steven

2018-01-01

Objective To characterize the phenotypic spectrum, molecular genetic findings, and functional consequences of pathogenic variants in early-onset KCNT1 epilepsy. Methods We identified a cohort of 31 patients with epilepsy of infancy with migrating focal seizures (EIMFS) and screened for variants in KCNT1 using direct Sanger sequencing, a multiple-gene next-generation sequencing panel, and whole-exome sequencing. Additional patients with non-EIMFS early-onset epilepsy in whom we identified KCNT1 variants on local diagnostic multiple gene panel testing were also included. When possible, we performed homology modeling to predict the putative effects of variants on protein structure and function. We undertook electrophysiologic assessment of mutant KCNT1 channels in a xenopus oocyte model system. Results We identified pathogenic variants in KCNT1 in 12 patients, 4 of which are novel. Most variants occurred de novo. Ten patients had a clinical diagnosis of EIMFS, and the other 2 presented with early-onset severe nocturnal frontal lobe seizures. Three patients had a trial of quinidine with good clinical response in 1 patient. Computational modeling analysis implicates abnormal pore function (F346L) and impaired tetramer formation (F502V) as putative disease mechanisms. All evaluated KCNT1 variants resulted in marked gain of function with significantly increased channel amplitude and variable blockade by quinidine. Conclusions Gain-of-function KCNT1 pathogenic variants cause a spectrum of severe focal epilepsies with onset in early infancy. Currently, genotype-phenotype correlations are unclear, although clinical outcome is poor for the majority of cases. Further elucidation of disease mechanisms may facilitate the development of targeted treatments, much needed for this pharmacoresistant genetic epilepsy. PMID:29196579

Client Accounts of Corrective Experiences in Psychotherapy: Implications for Clinical Practice.

PubMed

Angus, Lynne; Constantino, Michael J

2017-02-01

The Patient Perceptions of Corrective Experiences in Individual Therapy (PPCEIT; Constantino, Angus, Friedlander, Messer, & Moertl, 2011) posttreatment interview guide was developed to provide clinical researchers with an effective mode of inquiry to identify and further explore clients' firsthand accounts of corrective and transformative therapy experiences and their determinants. Not only do findings from the analysis of client corrective experience (CE) accounts help identify what and how CEs happen in or as a result of psychotherapy, but the measure itself may also provide therapists with an effective tool to further enhance clients' awareness, understanding, and integration of transformative change experiences. Accordingly, we discuss in this afterword to the series the implications for clinical practice arising from (a) the thematic analysis of client CE accounts, drawn from a range of clinical samples and international research programs and (b) the clinical effect of completing the PPCEIT posttreatment interview inquiry. We also identify directions for future clinical training and research. © 2016 Wiley Periodicals, Inc.

Systems-Oriented Workplace Learning Experiences for Early Learners: Three Models.

PubMed

O'Brien, Bridget C; Bachhuber, Melissa R; Teherani, Arianne; Iker, Theresa M; Batt, Joanne; O'Sullivan, Patricia S

2017-05-01

Early workplace learning experiences may be effective for learning systems-based practice. This study explores systems-oriented workplace learning experiences (SOWLEs) for early learners to suggest a framework for their development. The authors used a two-phase qualitative case study design. In Phase 1 (spring 2014), they prepared case write-ups based on transcribed interviews from 10 SOWLE leaders at the authors' institution and, through comparative analysis of cases, identified three SOWLE models. In Phase 2 (summer 2014), studying seven 8-week SOWLE pilots, the authors used interview and observational data collected from the seven participating medical students, two pharmacy students, and site leaders to construct case write-ups of each pilot and to verify and elaborate the models. In Model 1, students performed specific patient care activities that addressed a system gap. Some site leaders helped students connect the activities to larger systems problems and potential improvements. In Model 2, students participated in predetermined systems improvement (SI) projects, gaining experience in the improvement process. Site leaders had experience in SI and often had significant roles in the projects. In Model 3, students worked with key stakeholders to develop a project and conduct a small test of change. They experienced most elements of an improvement cycle. Site leaders often had experience with SI and knew how to guide and support students' learning. Each model could offer systems-oriented learning opportunities provided that key elements are in place including site leaders facile in SI concepts and able to guide students in SOWLE activities.

[Early clinical diagnosis of acanthamoeba keratitis. A study of 70 eyes].

PubMed

Bernauer, W; Duguid, G I; Dart, J K

1996-05-01

Acanthamoeba keratitis is an uncommon condition which is usually associated with contact lens wear. The use of home made saline and poor hygiene are important risk factors. Early diagnosis is crucial since these cases respond well to medical therapy. The purpose of this paper is to describe and demonstrate early clinical signs. Between September 1992 and October 1994, 70 cases of acanthamoeba keratitis, one of them bilateral, were prospectively monitored at Moorfields Eye Hospital in London. A database of all patients was set up and the clinical findings, diagnostic methods, therapeutic interventions and the outcome were recorded. 66 patients (96%) were contact lens wearers, 64 of them (97%) wore soft lenses. The mean interval between first symptoms and correct diagnosis was 42%. The most frequent initial diagnoses were "unclear keratoconjunctivitis" and "herpetic keratitis". Early corneal findings included punctate keratopathy (n = 14; 20%), pseudodendrites (n = 4; 6%), epithelial infiltrates (n = 17; 24%), diffuse or focal sub-epithelial infiltrates (n = 36; 51%) and radial keratoneuritis (n = 5; 7%). Ring infiltrates (n = 13; 18%) and corneal ulceration (n = 13) were late signs. When the above corneal findings are observed, particularly in contact lens wearers, the diagnosis of acanthamoeba keratitis should be considered. The diagnosis of "herpetic keratitis" in association with contact lens wear should be encountered with scepticism.

Physiotherapy clinical educators' perceptions and experiences of clinical prediction rules.

PubMed

Knox, Grahame M; Snodgrass, Suzanne J; Rivett, Darren A

2015-12-01

Clinical prediction rules (CPRs) are widely used in medicine, but their application to physiotherapy practice is more recent and less widespread, and their implementation in physiotherapy clinical education has not been investigated. This study aimed to determine the experiences and perceptions of physiotherapy clinical educators regarding CPRs, and whether they are teaching CPRs to students on clinical placement. Cross-sectional observational survey using a modified Dillman method. Clinical educators (n=211, response rate 81%) supervising physiotherapy students from 10 universities across 5 states and territories in Australia. Half (48%) of respondents had never heard of CPRs, and a further 25% had never used CPRs. Only 27% reported using CPRs, and of these half (51%) were rarely if ever teaching CPRs to students in the clinical setting. However most respondents (81%) believed CPRs assisted in the development of clinical reasoning skills and few (9%) were opposed to teaching CPRs to students. Users of CPRs were more likely to be male (p<0.001), have post-professional qualifications (p=0.020), work in private practice (p<0.001), and work in the area of musculoskeletal physiotherapy (p<0.001) compared with non-users. The CPRs most commonly known, used and taught were the Ottawa Ankle Rule, the Ottawa Knee Rule, and Wells' Rule for Deep Vein Thrombosis. Students are unlikely to be learning about CPRs on clinical placement, as few clinical educators use them. Clinical educators will require training in CPRs and assistance in teaching them if students are to better learn about implementing CPRs in physiotherapy clinical practice. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Migration characteristics and early clinical results of the NANOS® short-stem hip arthroplasty.

PubMed

Kaipel, Martin; Grabowiecki, Phillip; Sinz, Katrina; Farr, Sebastian; Sinz, Günter

2015-05-01

Femoral short stems promise essential advantages in total hip arthroplasty. Up to now, only short- and midterm clinical studies exist. Data on early stem migration that could predict later aseptic loosening at an early stage are rare. The purpose of this study was to assess migration patterns and clinical outcome 2 years after hip replacement by a metaphyseal anchored cementless short stem. Migration data and clinical results were prospectively assessed in 49 patients. Clinical outcome was measured using the Harris Hip Score (HHS). Migration analyses were performed using the computer-assisted Einzel-Bild-Roentgen-Analyse (EBRA) system. At 2 years after surgery, none of the implants needed revision, and HHS increased from 47.9 up to 98.1. Of 49 patients, 5 (10%) showed increased vertical stem migration (1.5 mm/2a) that might predict late aseptic loosening. Of 49 stems, 44 (90%) showed stable migration patterns indicating a beneficial long-term outcome. Results of this study confirm the excellent clinical data of previous works. Migration patterns strongly suggest that short-stem arthroplasty is not only an innovative but also a reliable strategy in total hip replacement.

Preparing Beginning Reading Teachers: An Experimental Comparison of Initial Early Literacy Field Experiences

ERIC Educational Resources Information Center

Al Otaiba, Stephanie; Lake, Vickie E.; Greulich, Luana; Folsom, Jessica S.; Guidry, Lisa

2012-01-01

This randomized-control trial examined the learning of preservice teachers taking an initial Early Literacy course in an early childhood education program and of the kindergarten or first grade students they tutored in their field experience. Preservice teachers were randomly assigned to one of two tutoring programs: Book Buddies and Tutor…

Medical education in difficult circumstances: analysis of the experience of clinical medical students following the new innovative medical curriculum in Aksum, rural Ethiopia.

PubMed

Morgan, C; Teshome, M; Crocker-Buque, T; Bhudia, R; Singh, K

2018-05-31

In 2012, 12 medical schools were opened in Ethiopia to tackle the significant shortage of doctors. This included Aksum School of Medicine situated in Aksum, a rural town in Northern Ethiopia. The new Innovative Medical Curriculum (NIMC) is a four-year programme designed by the Ethiopian Federal Ministries of Health and Education. The curriculum is designed to train biomedical science graduates to become doctors in 4 years, with a focus on the healthcare needs of rural people living in poverty. This research was conducted at Aksum School of Medicine and included two hospitals (Aksum Referral Hospital and St Mary's District Hospital). This study focused on medical students during their clinical years across multiple specialities (61 Clerkship 1 students and 13 Clerkship 2 students). We used primarily qualitative research methods supplemented with quantitative measures. There were 3 stages of data collection over a 1 month period, this included qualitative group interviews, direct observation of students in a clinical setting and direct observation of skills sessions followed by a questionnaire on the sessions. We analysed the data by reconstructing the student experience and comparing it with the NIMC. The proposed typical week set out in the NIMC tended to differ from the real clinical experience of these students. Through qualitative group interview and direct observation of teaching, the main theme that was consistent throughout was the lack of doctors with specialist postgraduate training. Clinical need often took priority over education. However, students enjoyed taking early responsibility and gaining practical experience. Through direct observation of skills sessions and short questionnaires, these sessions were highly valuable to the students and they felt confident in carrying out the taught procedures in the future. The combination of poorly resourced hospitals and lack of specialist doctors provides a challenging environment for medical students to learn

Outcomes of laparoscopic fertility-sparing surgery in clinically early-stage epithelial ovarian cancer.

PubMed

Park, Jin-Young; Heo, Eun Jin; Lee, Jeong-Won; Lee, Yoo-Young; Kim, Tae-Joong; Kim, Byoung-Gie; Bae, Duk-Soo

2016-03-01

Fertility-sparing surgery (FSS) is becoming an important technique in the surgical management of young women with early-stage epithelial ovarian cancer (EOC). We retrospectively evaluated the outcome of laparoscopic FSS in presumed clinically early-stage EOC. We retrospectively searched databases of patients who received laparoscopic FSS for EOC between January 1999 and December 2012 at Samsung Medical Center. Women aged ≤40 years were included. The perioperative, oncological, and obstetric outcomes of these patients were evaluated. A total of 18 patients was evaluated. The median age of the patients was 33.5 years (range, 14 to 40 years). The number of patients with clinically stage IA and IC was 6 (33.3%) and 12 (66.7%), respectively. There were 7 (38.9%), 5 (27.8%), 3 (16.7%), and 3 patients (16.7%) with mucinous, endometrioid, clear cell, and serous tumor types, respectively. Complete surgical staging to preserve the uterus and one ovary with adnexa was performed in 4 patients (22.2%). Two out of them were upstaged to The International Federation of Gynecology and Obstetrics stage IIIA1. During the median follow-up of 47.3 months (range, 11.5 to 195.3 months), there were no perioperative or long term surgical complications. Four women (22.2%) conceived after their respective ovarian cancer treatments. Three (16.7%) of them completed full-term delivery and one is expecting a baby. One patient had disease recurrence. No patient died of the disease. FSS in young patients with presumed clinically early-stage EOC is a challenging and cautious procedure. Further studies are urgent to determine the safety and feasibility of laparoscopic FSS in young patients with presumed clinically early-stage EOC.

Outcomes of laparoscopic fertility-sparing surgery in clinically early-stage epithelial ovarian cancer

PubMed Central

Park, Jin-Young; Lee, Yoo-Young; Kim, Tae-Joong; Kim, Byoung-Gie; Bae, Duk-Soo

2016-01-01

Objective Fertility-sparing surgery (FSS) is becoming an important technique in the surgical management of young women with early-stage epithelial ovarian cancer (EOC). We retrospectively evaluated the outcome of laparoscopic FSS in presumed clinically early-stage EOC. Methods We retrospectively searched databases of patients who received laparoscopic FSS for EOC between January 1999 and December 2012 at Samsung Medical Center. Women aged ≤40 years were included. The perioperative, oncological, and obstetric outcomes of these patients were evaluated. Results A total of 18 patients was evaluated. The median age of the patients was 33.5 years (range, 14 to 40 years). The number of patients with clinically stage IA and IC was 6 (33.3%) and 12 (66.7%), respectively. There were 7 (38.9%), 5 (27.8%), 3 (16.7%), and 3 patients (16.7%) with mucinous, endometrioid, clear cell, and serous tumor types, respectively. Complete surgical staging to preserve the uterus and one ovary with adnexa was performed in 4 patients (22.2%). Two out of them were upstaged to The International Federation of Gynecology and Obstetrics stage IIIA1. During the median follow-up of 47.3 months (range, 11.5 to 195.3 months), there were no perioperative or long term surgical complications. Four women (22.2%) conceived after their respective ovarian cancer treatments. Three (16.7%) of them completed full-term delivery and one is expecting a baby. One patient had disease recurrence. No patient died of the disease. Conclusion FSS in young patients with presumed clinically early-stage EOC is a challenging and cautious procedure. Further studies are urgent to determine the safety and feasibility of laparoscopic FSS in young patients with presumed clinically early-stage EOC. PMID:26768783

Preparing for practice: Nursing intern and faculty perceptions on clinical experiences.

PubMed

AlThiga, Hanan; Mohidin, Sharifah; Park, Yoon Soo; Tekian, Ara

2017-04-01

Clinical experience and exposure to real patients are required elements of nursing education. Trainees in nursing are expected to be prepared adequately for the hard-working environment, increasing patient complexity, and higher-level competencies. This study investigates differences between nursing interns and clinical faculty on actual and perceived importance of educational preparation and development of clinical competencies, focusing on the nursing curriculum and transition to practice. A convenient sampling technique with a mixed-methods design was used to collect quantitative and qualitative data, by surveying and interviewing nursing interns and faculty members from King Abdul-Aziz University in Saudi Arabia; data collection occurred in December 2015. The survey (23 items) and focused interviews measured perceptions of clinical instruction and experience. Descriptive statistics and t-tests were used to analyze differences in mean ratings between actual and perceived importance. Themes collected from narrative interview data were summarized. Significant differences were found between nursing interns (n = 46) and faculty (n = 29) perceptions of actual clinical teaching and experiences and its importance including the clinical teaching and the development of clinical competence, p < .01. Moreover, nursing interns rated actual experiences of knowledge base and skills significantly lower than faculty perceptions, p = .001. Narrative data provided in-depth information on factors contributing and hindering the learning and teaching environment. Findings from this study call for clinical instruction and experiences to take a step further to meet current practice standards and to improve patient safety in the health professions education of nurses.

Starting Smart: How Early Experiences Affect Brain Development. Second Edition.

ERIC Educational Resources Information Center

Hawley, Theresa

Based on recent research, it is now believed that brain growth is highly dependent upon children's early experiences. Neurons allow communication and coordinated functioning among various brain areas. Brain development after birth consists of an ongoing process of wiring and rewiring the connections among neurons. The forming and breaking of…

Psychological Distress of Fathers Attending an Australian Early Parenting Service for Early Parenting Difficulties

ERIC Educational Resources Information Center

Giallo, Rebecca; Cooklin, Amanda; Zerman, Nikki; Vittorino, Renzo

2013-01-01

Background: Early parenting centres are in a unique position to identify and provide support to fathers experiencing mental health difficulties. However, the extent to which fathers attending these services experience mental health difficulties is not known. This study aimed to assess fathers' mental health, identify specific clinical profiles…

Early-life experience affects honey bee aggression and resilience to immune challenge

PubMed Central

Rittschof, Clare C.; Coombs, Chelsey B.; Frazier, Maryann; Grozinger, Christina M.; Robinson, Gene E.

2015-01-01

Early-life social experiences cause lasting changes in behavior and health for a variety of animals including humans, but it is not well understood how social information ‘‘gets under the skin’’ resulting in these effects. Adult honey bees (Apis mellifera) exhibit socially coordinated collective nest defense, providing a model for social modulation of aggressive behavior. Here we report for the first time that a honey bee’s early-life social environment has lasting effects on individual aggression: bees that experienced high-aggression environments during pre-adult stages showed increased aggression when they reached adulthood relative to siblings that experienced low-aggression environments, even though all bees were kept in a common environment during adulthood. Unlike other animals including humans however, high-aggression honey bees were more, rather than less, resilient to immune challenge, assessed as neonicotinoid pesticide susceptibility. Moreover, aggression was negatively correlated with ectoparasitic mite presence. In honey bees, early-life social experience has broad effects, but increased aggression is decoupled from negative health outcomes. Because honey bees and humans share aspects of their physiological response to aggressive social encounters, our findings represent a step towards identifying ways to improve individual resiliency. Pre-adult social experience may be crucial to the health of the ecologically threatened honey bee. PMID:26493190

Developing a discrete choice experiment in Malawi: eliciting preferences for breast cancer early detection services.

PubMed

Kohler, Racquel E; Lee, Clara N; Gopal, Satish; Reeve, Bryce B; Weiner, Bryan J; Wheeler, Stephanie B

2015-01-01

In Malawi, routine breast cancer screening is not available and little is known about women's preferences regarding early detection services. Discrete choice experiments are increasingly used to reveal preferences about new health services; however, selecting appropriate attributes that describe a new health service is imperative to ensure validity of the choice experiment. To identify important factors that are relevant to Malawian women's preferences for breast cancer detection services and to select attributes and levels for a discrete choice experiment in a setting where both breast cancer early detection and choice experiments are rare. We reviewed the literature to establish an initial list of potential attributes and levels for a discrete choice experiment and conducted qualitative interviews with health workers and community women to explore relevant local factors affecting decisions to use cancer detection services. We tested the design through cognitive interviews and refined the levels, descriptions, and designs. Themes that emerged from interviews provided critical information about breast cancer detection services, specifically, that breast cancer interventions should be integrated into other health services because asymptomatic screening may not be practical as an individual service. Based on participants' responses, the final attributes of the choice experiment included travel time, health encounter, health worker type and sex, and breast cancer early detection strategy. Cognitive testing confirmed the acceptability of the final attributes, comprehension of choice tasks, and women's abilities to make trade-offs. Applying a discrete choice experiment for breast cancer early detection was feasible with appropriate tailoring for a low-income, low-literacy African setting.

Dental Students' Clinical Expectations and Experiences Treating Persons with Disabilities.

PubMed

Perusini, Darsi J; Llacuachaqui, Marcia; Sigal, Michael J; Dempster, Laura J

2016-03-01

Persons with disabilities (PWDs) have a disproportionate level of dental disease relative to the general population. Access to care is a cause along with dentists' willingness to treat PWDs. The aim of this study was to investigate the expectations and experiences of dental students in providing treatment to these patients in a hospital-based dental clinic for PWDs. Senior dental students at the Faculty of Dentistry, University of Toronto (n=92) were surveyed prior to (Phase I) and at the end of (Phase II) mandatory clinical rotations at the Mount Sinai Hospital's Dentistry Clinic for Persons with Special Needs. Response rates were 88% for Phase I and 58% for Phase II. Before the rotations, 70% of the respondents reported little or no experience with PWDs, and 46% said they did not feel comfortable providing basic dental treatment to PWDs. However, in Phase II, significantly more students reported being comfortable than in Phase I (p=0.001). Overall, the majority of respondents (Phase I 95%; Phase II 98%) indicated they would at least attempt to provide basic dental care to PWDs after graduation. The majority also identified the opportunity to provide care and interact with PWDs as the most enjoyable aspect of their experience at the clinic. They reported that the experience helped reduce their concerns about treating PWDs including being more realistic about the time required and ideal quality of the treatment they could provide. These results suggest that their experience in the clinic significantly increased students' comfort in treating PWDs. The respondents expressed a willingness to treat PWDs once graduated and generally identified their experience as being more positive than their expectations.

Preceptor-guided clinical practica and the learning experiences of nursing students.

PubMed

Jiang, Ru-Shang; Chou, Chuan-Chiang; Tsai, Pi-Lan

2012-06-01

In Taiwan, nearly one third of newly graduated nurses quit their first nursing job within 3 months and many never return to nursing. Because traditional clinical practice designs do not offer adequate opportunities for students to work independently, many senior nursing students lack self-confidence in their nursing skills and are not familiar with the day-to-day realities of nursing even after completing all their required clinical practica. A model for a preceptor-guided clinical practicum was designed to address this concern. The aim of this study was to explore the learning experiences of senior nursing students who worked with preceptors during their clinical practica. Thirteen female nursing students were interviewed to discover their perceptions of their preceptor-guided clinical practicum. All interviews were tape recorded and transcribed. Descriptions were analyzed using Colaizzi's phenomenological methodology. Four themes emerged from the data that described the preceptorship experience in the clinical practicum: (1) information and new experience overload, (2) feelings of loneliness and stress, (3) questioning whether strict preceptors achieve the best results, and (4) beginning to feel like a nurse. Findings suggest that it is important for nurse educators to be clear and precise about the expectations of the preceptorship experience. Orientation for both preceptors and students is essential. Support and encouragement throughout the entire practicum experience for preceptors and students is necessary to ensure program success.

Influence of Clinical Experience and Productivity on Emergency Medicine Faculty Teaching Scores

PubMed Central

Clyne, Brian; Smith, Jessica L.; Napoli, Anthony M.

2012-01-01

Background Commonly cited barriers to effective teaching in emergency medicine include lack of time, competing demands for patient care, and a lack of formal teaching experience. Teaching may be negatively affected by demands for increased clinical productivity, or positively influenced by clinical experience. Objective To examine the association between faculty teaching scores and clinical productivity, years of clinical experience, and amount of clinical contact with resident physicians. Methods We conducted a retrospective, observational study with existing data on full-time faculty at a high-volume, urban emergency medicine residency training program for academic year 2008–2009. Residents rated faculty on 9 domains of teaching, including willingness to teach, enthusiasm for teaching, medical knowledge, preparation, and communication. Clinical productivity data for relative value units per hour and number of patients per hour, years of clinical experience, and annual clinical hours were obtained from existing databases. Results For the 25 core faculty members included in the study, there was no relationship between faculty teaching scores and clinical productivity measures (relative value units per hour: r2  =  0.01, P  =  .96, patients per hour: r2  =  0.00, P  =  .76), or between teaching scores and total clinical hours with residents (r2  =  0.07, P  =  .19). There was a significant negative relationship between years of experience and teaching scores (r2  =  0.27, P < .01). Conclusions Our study demonstrated that teaching scores for core emergency medicine faculty did not correlate with clinical productivity or amount of clinical contact with residents. Teaching scores were inversely related to number of years of clinical experience, with more experienced faculty earning the lowest teaching scores. Further study is necessary to determine if there are clinical measures that identify good educators

The treatment of posterior urethral disruption associated with pelvic fractures: comparative experience of early realignment versus delayed urethroplasty.

PubMed

Mouraviev, Vladimir B; Coburn, Michael; Santucci, Richard A

2005-03-01

Urological treatment of the patient with severe mechanical trauma and urethral disruption remains controversial. Debate continues regarding the advisability of early realignment vs delayed open urethroplasty. We analyzed our experience with 96 patients to determine the long-term results of the 2 approaches. We retrospectively reviewed the records of 191 men with posterior urethral disruption after severe blunt pelvic injury between 1984 and 2001, of whom 96 survived. Data on 57 patients who underwent early realignment were compared to those on 39 treated with delayed urethroplasty with an average 8.8-year followup (range 1 to 22). All patients were evaluated postoperatively for incontinence, impotence and urethral strictures. The majority of patients had severe concomitant organ injuries (78%) and severe pelvic fractures (76%). The overall mortality rate was 51%. Diagnosis of urethral rupture was based on clinical findings and retrograde urethrography. Strictures developed in 49% of the early realignment group and in 100% of the suprapubic tube group. Impotence (33.6%) and incontinence (17.7%) were less frequent in the early realignment group than in the delayed reconstruction group (42.1% and 24.9%, respectively). Patients with delayed reconstruction underwent an average of 3.1 procedures compared with an average of 1.6 in the early realignment group. Early realignment may provide better outcomes than delayed open urethroplasty after posterior urethral disruption. Increased complications are not seen and, although it can be inconvenient in the massively injured patient, it appears to be a worthwhile maneuver.

Planning a study abroad clinical experience.

PubMed

Wright, Dolores J

2010-05-01

Not only is globalization expanding areas of human activity, it is also influencing the variety of educational offerings in universities. Therefore, globalization must be considered by nurse educators as they reevaluate ways of preparing nursing students to meet the health care needs of populations they currently serve and will care for in the future. Study abroad programs have been encouraged to be part of the college experience in the United States for more than 30 years; however, these programs have been relatively lacking in nursing education. Most of the study abroad programs described in the nursing literature are research-based or first-person accounts of an experience and provide little information about planning a study abroad program. This article describes a study abroad learning experience for senior nursing students and discusses the issues such as student selection, student safety, and available clinical experiences that need to be considered before undertaking such an endeavor.

Early and intermediate age-related macular degeneration: update and clinical review.

PubMed

García-Layana, Alfredo; Cabrera-López, Francisco; García-Arumí, José; Arias-Barquet, Lluís; Ruiz-Moreno, José M

2017-01-01

Age-related macular degeneration (AMD) is the leading cause of irreversible central vision loss in developed countries. With the aging of population, AMD will become globally an increasingly important and prevalent disease worldwide. It is a complex disease whose etiology is associated with both genetic and environmental risk factors. An extensive decline in the quality of life and progressive need of daily living assistance resulting from AMD among those most severely affected highlights the essential role of preventive strategies, particularly advising patients to quit smoking. In addition, maintaining a healthy diet, controlling other risk factors (such as hypertension, obesity, and atherosclerosis), and the use of nutritional supplements (antioxidants) are recommendable. Genetic testing may be especially important in patients with a family history of AMD. Recently, unifying criteria for the clinical classification of AMD, defining no apparent aging changes; normal aging changes; and early, intermediate, and late AMD stages, are of value in predicting AMD risk of progression and in establishing recommendations for the diagnosis, therapeutic approach, and follow-up of patients. The present review is focused on early and intermediate AMD and presents a description of the clinical characteristics and ophthalmological findings for these stages, together with algorithms for the diagnosis and management of patients, which are easily applicable in daily clinical practice.

Early and intermediate age-related macular degeneration: update and clinical review

PubMed Central

García-Layana, Alfredo; Cabrera-López, Francisco; García-Arumí, José; Arias-Barquet, Lluís; Ruiz-Moreno, José M

2017-01-01

Age-related macular degeneration (AMD) is the leading cause of irreversible central vision loss in developed countries. With the aging of population, AMD will become globally an increasingly important and prevalent disease worldwide. It is a complex disease whose etiology is associated with both genetic and environmental risk factors. An extensive decline in the quality of life and progressive need of daily living assistance resulting from AMD among those most severely affected highlights the essential role of preventive strategies, particularly advising patients to quit smoking. In addition, maintaining a healthy diet, controlling other risk factors (such as hypertension, obesity, and atherosclerosis), and the use of nutritional supplements (antioxidants) are recommendable. Genetic testing may be especially important in patients with a family history of AMD. Recently, unifying criteria for the clinical classification of AMD, defining no apparent aging changes; normal aging changes; and early, intermediate, and late AMD stages, are of value in predicting AMD risk of progression and in establishing recommendations for the diagnosis, therapeutic approach, and follow-up of patients. The present review is focused on early and intermediate AMD and presents a description of the clinical characteristics and ophthalmological findings for these stages, together with algorithms for the diagnosis and management of patients, which are easily applicable in daily clinical practice. PMID:29042759

Separation, failure and temporary relinquishment: women's experiences of early mothering in the context of emergency hysterectomy.

PubMed

Elmir, Rakime; Schmied, Virginia; Wilkes, Lesley; Jackson, Debra

2012-04-01

To describe the experiences of women who have had an emergency hysterectomy following a severe postpartum haemorrhage and the impact on their early mothering experiences. Postpartum haemorrhage and subsequent hysterectomy is a traumatic birth event. Traumatic birth experiences have the potential to impact on a woman's experience of motherhood and her initial relationship with her baby. The relative rarity of this event makes it easy to dismiss the experiences of women having a hysterectomy following childbirth. Little is known about a woman's early mothering experience in the context of having an emergency hysterectomy. Qualitative naturalistic inquiry approach. Data were collected through semi-structured qualitative interviews from 21 Australian women who had an emergency hysterectomy following a severe postpartum haemorrhage. Findings revealed three themes in relation to early mothering experiences in the context of having a hysterectomy following a severe postpartum haemorrhage. They were 'initial separation: lost bonding time', 'feelings of failure' and 'relinquishing care of the infant'. This paper highlights the ways undergoing emergency hysterectomy following childbirth can impact on the experience of early mothering in the postnatal period. Greater recognition and attention to the specific needs of women who have an emergency hysterectomy following childbirth is required. Providing women with an opportunity to talk, debrief and ask questions related to their birthing experiences, will help women to reconcile their feelings. Giving women the opportunity to have their infants with them in intensive care unit, together with ongoing emotional support and anticipatory guidance, may also be useful approaches in assisting women during this difficult and traumatic time. © 2011 Blackwell Publishing Ltd.

The early postpartum experience of previously infertile mothers.

PubMed

Ladores, Sigrid; Aroian, Karen

2015-01-01

To explore the lived experience of becoming a new mother from the unique perspectives of previously infertile women. A descriptive phenomenological design was used to extract the fundamental structure of the postpartum experience of previously infertile mothers. Central Florida. Twelve first-time, previously infertile mothers age 27 to 43 years. Face-to-face interviews were conducted twice with each participant. Recorded interviews were transcribed verbatim and analyzed using Colaizzi's approach. Two main themes emerged that described the early postpartum experience of first-time, previously infertile mothers: (a) lingering identity as infertile and (b) gratitude for the gift of motherhood. Participants reported that their lingering identities as infertile and immense gratitude for the gift of motherhood propelled them to establish unrealistic expectations to be perfect mothers. When they were unable to live up this expectation, they censored their feelings of inadequacy, guilt, and shame. Findings from this study may help to sensitize health care providers to the difficulties faced by previously infertile women during their transition to motherhood. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Low clinical diagnostic accuracy of early vs advanced Parkinson disease: clinicopathologic study.

PubMed

Adler, Charles H; Beach, Thomas G; Hentz, Joseph G; Shill, Holly A; Caviness, John N; Driver-Dunckley, Erika; Sabbagh, Marwan N; Sue, Lucia I; Jacobson, Sandra A; Belden, Christine M; Dugger, Brittany N

2014-07-29

Determine diagnostic accuracy of a clinical diagnosis of Parkinson disease (PD) using neuropathologic diagnosis as the gold standard. Data from the Arizona Study of Aging and Neurodegenerative Disorders were used to determine the predictive value of a clinical PD diagnosis, using 2 clinical diagnostic confidence levels, PossPD (never treated or not clearly responsive) and ProbPD (responsive to medications). Neuropathologic diagnosis was the gold standard. Based on first visit, 9 of 34 (26%) PossPD cases had neuropathologically confirmed PD while 80 of 97 (82%) ProbPD cases had confirmed PD. PD was confirmed in 8 of 15 (53%) ProbPD cases with <5 years of disease duration and 72 of 82 (88%) with ≥5 years of disease duration. Using final diagnosis at time of death, 91 of 107 (85%) ProbPD cases had confirmed PD. Clinical variables that improved diagnostic accuracy were medication response, motor fluctuations, dyskinesias, and hyposmia. Using neuropathologic findings of PD as the gold standard, this study establishes the novel findings of only 26% accuracy for a clinical diagnosis of PD in untreated or not clearly responsive subjects, 53% accuracy in early PD responsive to medication (<5 years' duration), and >85% diagnostic accuracy of longer duration, medication-responsive PD. Caution is needed when interpreting clinical studies of PD, especially studies of early disease that do not have autopsy confirmation. The need for a tissue or other diagnostic biomarker is reinforced. This study provides Class II evidence that a clinical diagnosis of PD identifies patients who will have pathologically confirmed PD with a sensitivity of 88% and specificity of 68%. © 2014 American Academy of Neurology.

Interprofessional student experiences on the HAVEN free clinic leadership board.

PubMed

Scott, Elizabeth Anne; Swartz, Martha K

2015-01-01

In this study, we examined the experiences of students serving on the leadership board of HAVEN - the student-run free clinic of the Yale University health professional schools. Open-ended responses were collected from 18 of the 28 members of the 2011-2012 leadership board through an online survey. Students reported an overall positive experience participating on the board and valued the opportunity to be part of a committed community creating change. The majority of students reported that their time as a board member had improved their attitude towards interprofessional collaboration (78%) and had also fostered their leadership skills (67%). Around two thirds (67%) reported that their experience had positively impacted their future career plans, either reinforcing their desire to work with underserved populations or encouraging them to pursue leadership roles. Based on these data, it is suggested that the HAVEN Free Clinic offers a useful opportunity for students to experience the demands of clinical care leadership while working together in an interprofessional context.

Early childhood experiences, cultural beliefs, and oral health of Mexican American women.

PubMed

Miltiades, Helen B

2013-01-01

This qualitative article examines how financial resources, cultural beliefs, and early childhood experiences affect perceptions of oral health and dental utilization of middle-aged and older Mexican American women. Fourteen in-depth qualitative interviews were conducted. The women's ages range from 49 to 87 years. Most had not visited the dentist in more than 2 years. Most women's early childhood experiences did not include dental visits or dental instruction. Some believed tooth loss was a normal aging process. Misconceptions regarding preventive care, the belief that dental visits were only necessary when experiencing pain, and finances were the primary reasons for not visiting the dentist. The results lend insight into the oral health, self-care practices, and dental utilization of middle-aged and older immigrant Mexican American women.

Effects of Cyberbullying Experience and Cyberbullying Tendency on School Violence in Early Adolescence

PubMed Central

Cho, Mi-Kyoung; Kim, Miyoung

2017-01-01

Background: School violence in early adolescence, whose frequency and status have recently changed significantly. Objective: This study attempts to detect the cyber bullying inclination of youth in early adolescence when aggressiveness reaches its peak, to identify school violence, and to develop a school violence prevention program. Method: This study was a survey research, investigating participants who were 470 middle school students in South Korea. For the analysis, independent t-test, one-way ANOVA and hierarchical regression analysis. Results: It is suggested that the school violence victimization experience and cyber bullying infliction experience has an influence in the school violence infliction. And the cyber bullying victimization experience and school violence victimization experience variables exert effects. Conclusion: The results of this study suggest that school nurses who are connecting to the community-school-home should take an active part in the development of school violence mediation education program, considering the cultural characteristics of the country. PMID:29081871

Dental Students' Clinical Experience Across Three Successive Curricula at One U.S. Dental School.

PubMed

White, Joel M; Jenson, Larry E; Gansky, Stuart A; Walsh, Cameron J; Accurso, Brent T; Vaderhobli, Ram M; Kalenderian, Elsbeth; Walji, Muhammad F; Cheng, Jing

2017-04-01

As dental schools continue to seek the most effective ways to provide clinical education for students, it is important to track the effects innovations have on students' clinical experience to allow for quantitative comparisons of various curricula. The aim of this study was to compare the impact of three successive clinical curricula on students' experience at one U.S. dental school. The three were a discipline-based curriculum (DBC), a comprehensive care curriculum (CCC), and a procedural requirement curriculum plus externships (PRCE). Students' clinic experience data from 1992 to 2013 were analyzed for total experience and in five discipline areas. Clinic experience metrics analyzed were patient visits (PVs), relative value units (RVUs), and equivalent amounts (EQAs). A minimum experience threshold (MET) and a high experience threshold (HET) were set at one standard deviation above and below the mean for the DBC years. Students below the MET were designated as low achievers; students above the HET were designated as high achievers. The results showed significant differences among the three curricula in almost all areas of comparison: total PVs, total EQAs, total RVUs, RVUs by discipline, and number of high and low achievers in total clinical experience and by discipline. The comprehensive care approach to clinical education did not negatively impact students' clinical experience and in many cases enhanced it. The addition of externships also enhanced student total clinical experience although more study is needed to determine their effectiveness. The insights provided by this study suggest that the methodology used including the metrics of PVs, EQAs, and RVUs may be helpful for other dental schools in assessing students' clinical experience.

[Clinical characteristics and renal uric acid excretion in early-onset gout patients].

PubMed

Li, Q H; Liang, J J; Chen, L X; Mo, Y Q; Wei, X N; Zheng, D H; Dai, L

2018-03-01

Objective: To investigate clinical characteristics and renal uric acid excretion in early-onset gout patients. Methods: Consecutive inpatients with primary gout were recruited between 2013 and 2017. The patients with gout onset younger than 30 were defined as early-onset group while the others were enrolled as control group. Clinical characteristics and uric acid (UA) indicators were compared between two groups. Results: Among 202 recruited patients, the early-onset group included 36 patients (17.8%). Compared with control group, the early-onset group presented more patients with obesity [13 patients (36.1%) vs. 22 patients (13.3%), P< 0.05], significantly higher serum UA level [(634±124)μmol/L vs.(527±169)μmol/L] and glomerular load of UA[(7.2±2.8)mg·min(-1)·1.73m(-2) vs. (4.4±2.2)mg·min(-1)·1.73m(-2)] and estimated glomerular filtration rate (GFR) [(83±21)ml·min(-1)·1.73m(-2) vs. (67±21)ml·min(-1)·1.73m(-2)] (all P< 0.05), lower fractional excretion of UA [4.4% (3.4%,6.1%) vs. 7.2% (5.2%,9.6%), P< 0.05], whereas 24h urinary UA excretion was comparable [(2 788±882)μmol/1.73m(2) vs. (2 645±1 140)μmol/1.73m(2), P= 0.274]. Subgroup analysis of patients without chronic kidney disease showed significantly lower fractional excretion of UA in the early-onset group [4.5%(3.3%,6.1%) vs. 6.7% (5.1%,8.7%), P< 0.05]. Logistic regression analysis showed that obesity ( OR= 3.25) and fractional excretion of UA less than 7% ( OR= 9.01, all P< 0.05) were risk factors of gout early onset. Conclusion: The gout patients with early-onset younger than 30 present high serum and glomerular load of uric acid which might be due to obesity and relative under-excretion of renal uric acid.

The Meta-Analysis of Clinical Judgment Project: Effects of Experience on Judgment Accuracy

ERIC Educational Resources Information Center

Spengler, Paul M.; White, Michael J.; Aegisdottir, Stefania; Maugherman, Alan S.; Anderson, Linda A.; Cook, Robert S.; Nichols, Cassandra N.; Lampropoulos, Georgios K.; Walker, Blain S.; Cohen, Genna R.; Rush, Jeffrey D.

2009-01-01

Clinical and educational experience is one of the most commonly studied variables in clinical judgment research. Contrary to clinicians' perceptions, clinical judgment researchers have generally concluded that accuracy does not improve with increased education, training, or clinical experience. In this meta-analysis, the authors synthesized…

Clinicopathological characteristics of clinical early gastric cancer in the upper-third stomach.

PubMed

Ichikawa, Daisuke; Komatsu, Shuhei; Kosuga, Toshiyuki; Konishi, Hirotaka; Okamoto, Kazuma; Shiozaki, Atsushi; Fujiwara, Hitoshi; Otsuji, Eigo

2015-12-07

To elucidate the clinicopathological characteristics of clinically early gastric cancer in the upper-third stomach and to clarify treatment precautions. A total of 683 patients with clinical early gastric cancer were enrolled in this retrospective study, 128 of whom had gastric cancer in the upper-third stomach (U group). All patients underwent a double contrast barium examination, endoscopy, and computed tomography (CT), and were diagnosed preoperatively based on the findings obtained. The clinicopathological features of these patients were compared with those of patients with gastric cancer in the middle- and lower-third stomach (ML group). We also compared clinicopathological factors between accurate-diagnosis and under-diagnosis groups in order to identify factors affecting the accuracy of a preoperative diagnosis of tumor depth. Patients in the U group were older (P = 0.029), had a higher ratio of males to females (P = 0.015), and had more histologically differentiated tumors (P = 0.007) than patients in the ML group. A clinical under-diagnosis occurred in 57 out of 683 patients (8.3%), and was more frequent in the U group than in the ML group (16.4% vs 6.3%, P < 0.0001). Therefore, the rates of lymph node metastasis and lymphatic invasion were slightly higher in the U group than in the ML group (P = 0.071 and 0.082, respectively). An under-diagnosis was more frequent in histologically undifferentiated tumors (P = 0.094) and in those larger than 4 cm (P = 0.024). The median follow-up period after surgery was 56 mo (range, 1-186 mo). Overall, survival and disease-specific survival rates were significantly lower in the U group than in the ML group (P = 0.016 and 0.020, respectively). However, limited operation-related cancer recurrence was not detected in the U group in the present study. Clinical early gastric cancer in the upper-third stomach has distinguishable characteristics that increase the risk of a clinical under-diagnosis, especially in patients with

A Medical Student-Run Child and Adolescent Psychiatry Clinic: One Institution's Experience.

PubMed

Murzl, Cassandra A; Durns, Tyler A; Mowrey, Lorin T; Tubbs, Andrew S; Boeve, Sally A

2017-10-01

This report examines the experience of one institution's development of the first student-run psychiatry clinic that serves both adult and pediatric populations. The clinic is held weekly with pre-clinical and clinical medical student volunteers under the supervision of board-certified adult and child psychiatrists. The development and evolution of the clinic over time are evaluated with particular attention to obstacles overcome. Medical student volunteers were surveyed retrospectively to evaluate their experience with patients with psychiatric illness, skill development, and interest in psychiatry. Since January 2016, the clinic has scheduled 90 patients, 32% of which were pediatric patients. Ninety-six medical students have volunteered, with roughly equal parts from all four medical school classes. Respondents to the experience survey showed marked improvement in their comfort working with patients with mental illness. Additionally, 40% "strongly agreed" or "agreed" that their experience influenced their interest in pursuing psychiatry as a career. This report describes a student-run psychiatry clinic with a dual mission of education and service, and the challenges associated with these sometimes competing goals. This clinic serves a vital need within our community and may be an example of the role that student-run clinics can have in fostering interdisciplinary care, psychiatric recruitment, and training for medical students.

Internet-based virtual classroom and educational management software enhance students' didactic and clinical experiences in perfusion education programs.

PubMed

Riley, Jeffrey B; Austin, Jon W; Holt, David W; Searles, Bruce E; Darling, Edward M

2004-09-01

A challenge faced by many university-based perfusion education (PE) programs is the need for student clinical rotations at hospital locations that are geographically disparate from the main educational campus. The problem has been addressed through the employment of distance-learning environments. The purpose of this educational study is to evaluate the effectiveness of this teaching model as it is applied to PE. Web-based virtual classroom (VC) environments and educational management system (EMS) software were implemented independently and as adjuncts to live, interactive Internet-based audio/video transmission from classroom to classroom in multiple university-based PE programs. These Internet environments have been used in a variety of ways including: 1) forum for communication between the university faculty, students, and preceptors at clinical sites, 2) didactic lectures from expert clinicians to students assigned to distant clinical sites, 3) small group problem-based-learning modules designed to enhance students analytical skills, and 4) conversion of traditional face-to-face lectures to asynchronous learning modules. Hypotheses and measures of student and faculty satisfaction, clinical experience, and learning outcomes are proposed, and some early student feedback was collected. For curricula that emphasize both didactic and clinical education, the use of Internet-based VC and EMS software provides significant advancements over traditional models. Recognized advantages include: 1) improved communications between the college faculty and the students and clinical preceptors, 2) enhanced access to a national network of clinical experts in specialized techniques, 3) expanded opportunity for student distant clinical rotations with continued didactic course work, and 4) improved continuity and consistency of clinical experiences between students through implementation of asynchronous learning modules. Students recognize the learning efficiency of on

Clinical assessment of early language development: a simplified short form of the Mandarin communicative development inventory.

PubMed

Soli, Sigfrid D; Zheng, Yun; Meng, Zhaoli; Li, Gang

2012-09-01

The purpose of this study was to develop a practical mean for clinical evaluation of early pediatric language development by establishing developmental trajectories for receptive and expressive vocabulary growth in children between 6 and 32 months of age using a simple, time-efficient assessment tool. Simplified short form versions of the Words and Gestures and Words and Sentences vocabulary inventories in the Mandarin Communicative Development Inventory [1] were developed and used to assess early language development in developmentally normal children from 6 to 32 months of age during routine health checks. Developmental trajectories characterizing the rate of receptive and expressive vocabulary growth between 6 and 32 months of age are reported. These trajectories allow the equivalent age corresponding to a score to be determined after a brief structured interview with the child's parents that can be conducted in a busy clinical setting. The simplified short forms of the Mandarin Communicative Development Inventories can serve as a clinically useful tool to assess early child language development, providing a practical mean of objectively assessing early language development following early interventions to treat young children with hearing impairment as well as speech and language delays. Objective evidence of language development is essential for achievement of effective (re)habilitation outcomes. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Spray cryotherapy (SCT): institutional evolution of techniques and clinical practice from early experience in the treatment of malignant airway disease

PubMed Central

Turner, J. Francis; Parrish, Scott

2015-01-01

Background Spray cryotherapy (SCT) was initially developed for gastroenterology (GI) endoscopic use in the esophagus. In some institutions where a device has been utilized by GI, transition to use in the airways by pulmonologists and thoracic surgeons occurred. Significant differences exist, however, in the techniques for safely using SCT in the airways. Methods We describe the early experience at Walter Reed National Military Medical Center from 2011 to 2013 using SCT in patients with malignant airway disease and the evolution of our current techniques and clinical practice patterns for SCT use in patients. In November 2013 enrollment began in a multi-institutional prospective SCT registry in which we are still enrolling and will be reported on separately. Results Twenty-seven patients that underwent 80 procedures (2.96 procedures/patient). The average age was 63 years with a range of 20 to 87 years old. The average Eastern Cooperative Oncology Group (ECOG) status was 1.26. All malignancies were advanced stage disease. All procedures were performed in the central airways. Other modalities were used in combination with SCT in 31 (39%) of procedures. Additionally 45 of the 80 (56%) procedures were performed in proximity to a silicone, hybrid, or metal stent. Three complications occurred out of the 80 procedures. All three were transient hypoxia that limited continued SCT treatments. These patients were all discharged from the bronchoscopy recovery room to their pre-surgical state. Conclusions SCT can be safely used for treatment of malignant airway tumor (MAT) in the airways. Understanding passive venting of the nitrogen gas produced as the liquid nitrogen changes to gas is important for safe use of the device. Complications can be minimized by adopting strict protocols to maximize passive venting and to allow for adequate oxygenation in between sprays. PMID:26807288

Clinically relevant characteristics associated with early treatment drug use versus abstinence.

PubMed

Cochran, Gerald; Stitzer, Maxine; Nunes, Edward V; Hu, Mei-Chen; Campbell, Aimee

2014-04-04

This study describes early treatment drug use status and associated clinical characteristics in a diverse sample of patients entering outpatient substance abuse psychosocial counseling treatment. The goal is to more fully characterize those entering treatment with and without active use of their primary drug in order to better understand associated treatment needs and resilience factors. We examined baseline data from a NIDA Clinical Trials Network (CTN) study (Web-delivery of Treatment for Substance Use) with an all-comers sample of patients (N = 494) entering 10 outpatient treatment centers. Patients were categorized according to self-identified primary drug of abuse (alcohol, cocaine/stimulants, opioids, marijuana) and by baseline drug use status (positive/negative) based on urine testing or self-reports of recent use (alcohol). Characteristics were examined by primary drug and early use status. Classified as drug-negative were 84%, 76%, 62%, and 33% of primary opioid, stimulant, alcohol, and marijuana users; respectively. Drug-positive versus -negative patients did not differ on demographics or rates of substance abuse/dependence diagnoses. However, those negative for active use had better physical and mental health profiles, were less likely to be using a secondary drug, and were more likely to be attending 12-step self-help meetings. Early treatment drug abstinence is common among substance users entering outpatient psychosocial counseling programs, regardless of primary abused drug. Abstinence (by negative UA) is associated with better health and mental health profiles, less secondary drug use, and more days of 12-step attendance. These data highlight differential treatment needs and resiliencies associated with early treatment drug use status. NCT01104805.

The Community Mentorship Program: Providing Community-Engagement Opportunities for Early-Stage Clinical and Translational Scientists to Facilitate Research Translation.

PubMed

Patino, Cecilia M; Kubicek, Katrina; Robles, Marisela; Kiger, Holly; Dzekov, Jeanne

2017-02-01

A goal of the Southern California Clinical and Translational Science Institute (SC-CTSI) at the University of Southern California and Children's Hospital Los Angeles is to train early-stage clinical and translational scientists (CTSs) to conduct research that improves the health of diverse communities. This goal aligns well with the Institute of Medicine's recommendations emphasizing community engagement in biomedical research that facilitates research translation. The Community Mentorship Program (CMP), created to complement community-engaged research didactics, matches CTSs with community mentors who help them identify and complete community-engaged experiences that inform their research. The CMP was piloted in 2013-2015 by the SC-CTSI Workforce Development and Community Engagement cores. The CMP team matched three CTSs (assistant professors pursuing mentored career development awards) with mentors at community-based organizations (CBOs) aligned with their research interests. Each mentor-mentee pair signed a memorandum of understanding. The CMP team checked in regularly, monitoring progress and addressing challenges in CTSs' completion of their community-engaged experience. Each pair completed at least one community-engaged activity informing the CTS's research. In exit interviews, the CTSs and CBO mentors expressed satisfaction with the program and stated that they would continue to work together. The CTSs reported that the program provided opportunities to develop networks outside academia, build trust within the community, and receive feedback and learn from individuals in communities affected by their research. The CMP will be expanded to include all eligible early-career CTSs and promoted for use in similar settings outside the SC-CTSI.

Early Results from the RAIDS Experiment on the ISS

NASA Astrophysics Data System (ADS)

Budzien, S. A.; Bishop, R. L.; Stephan, A. W.; Christensen, A. B.; Hecht, J. H.; Straus, P. R.

2009-12-01

The Remote Atmospheric and Ionospheric Detection System (RAIDS) is a suite of three photometers, three spectrometers, and two spectrographs which span the wavelength range 55-874 nm and remotely sense the thermosphere and ionosphere by scanning and imaging the limb. RAIDS was scheduled to fly to the Japanese Experiment Module—Exposed Facility (JEM-EF) aboard the International Space Station (ISS) in September 2009. RAIDS along with a companion hyperspectral imaging experiment will serve as the first US payload on the JEM-EF. The scientific objectives of the new RAIDS experiment are to study the temperature of the lower thermosphere (100-200 km), to measure composition and chemistry of the lower thermosphere and ionosphere, and to measure the initial source of OII 83.4 nm emission. RAIDS will provide valuable data useful for exploring tidal effects in the thermosphere and ionosphere system, validating dayside ionospheric remote sensing methods, and studying local time variations in important chemical and thermal processes. Early observational results from the RAIDS experiment will be presented. The RAIDS sensor suite performs multispectral limb scanning from the open end of the HICO-RAIDS Experiment Payload aboard the ISS.

Interventional Treatment of Severe Tricuspid Regurgitation: Early Clinical Experience in a Multicenter, Observational, First-in-Man Study.

PubMed

Lauten, Alexander; Figulla, Hans R; Unbehaun, Axel; Fam, Neil; Schofer, Joachim; Doenst, Torsten; Hausleiter, Joerg; Franz, Marcus; Jung, Christian; Dreger, Henryk; Leistner, David; Alushi, Brunilda; Stundl, Anja; Landmesser, Ulf; Falk, Volkmar; Stangl, Karl; Laule, Michael

2018-02-01

Transcatheter caval valve implantation is under evaluation as a treatment option for inoperable patients with severe tricuspid regurgitation (TR). The procedure involves the catheter-based implantation of bioprosthetic valves in the inferior vena cava and superior vena cava to treat symptoms associated with TR. This study is the first to evaluate the feasibility, safety, and efficacy of this interventional concept. Twenty-five patients (mean age, 73.9±7.6 years; women, 52.0%) with severe symptomatic TR despite optimal medical treatment deemed unsuitable for surgery were treated with caval valve implantation under a compassionate clinical use program. Technical feasibility defined as procedural success, hemodynamic effect defined as venous pressure reduction, and safety defined as periprocedural adverse events were evaluated, with clinical follow-up at discharge and up to 12 months. The functional impact was evaluated by assessment of New York Heart Association class at the time of hospital discharge. The total number of valves implanted in the caval position was 31. Patients were treated with single (inferior vena cava-only; n=19; 76.0%) or bicaval valve implantation (inferior vena cava+superior vena cava; n=6; 24.0%). Either balloon-expandable valves (Sapien XT/3: n=18; 72.0%) or self-expandable valves (TricValve: n=6; 24.0%; Directflow: n=1; 4.0%) were used. Procedural success was achieved in 96% (n=24). Early and late valve migration requiring surgical intervention occurred in 1 patient each. Thirty-day and in-hospital mortality were 8% (2 of 25) and 16% (4 of 25). Causes of in-hospital mortality included respiratory (n=1) or multiple organ failure (n=3) and were not linked to the procedure. Mean overall survival in the study cohort was 316±453 days (14-1540 days). Caval valve implantation for the treatment of severe TR and advanced right ventricular failure is associated with a high procedural success rate and seems safe and feasible in an excessive

Exposure to a mildly aversive early life experience leads to prefrontal cortex deficits in the rat.

PubMed

Stamatakis, Antonios; Manatos, Vasileios; Kalpachidou, Theodora; Stylianopoulou, Fotini

2016-11-01

Aversive early life experiences in humans have been shown to result in deficits in the function of the prefrontal cortex (PFC). In an effort to elucidate possible neurobiological mechanisms involved, we investigated in rats, the effects of a mildly aversive early experience on PFC structure and function. The early experience involved exposure of rat pups during postnatal days (PND) 10-13 to a T-maze in which they search for their mother, but upon finding her are prohibited contact with her, thus being denied the expected reward (DER). We found that the DER experience resulted in adulthood in impaired PFC function, as assessed by two PFC-dependent behavioral tests [attention set-shifting task (ASST) and fear extinction]. In the ASST, DER animals showed deficits specifically in the intra-dimensional reversal shifts and a lower activation-as determined by c-Fos immunohistochemistry-of the medial orbital cortex (MO), a PFC subregion involved in this aspect of the task. Furthermore, the DER experience resulted in decreased glutamatergic neuron and dendritic spine density in the MO and infralimbic cortex (IL) in the adult brain. The decreased neuronal density was detected as early as PND12 and was accompanied by increased micro- and astroglia-density in the MO/IL.

CARs and other T cell therapies for MM: The clinical experience.

PubMed

Danhof, Sophia; Hudecek, Michael; Smith, Eric L

2018-06-01

Harnessing the endogenous immune system to eliminate malignant cells has long been an intriguing approach. After considerable success in the treatment of B-cell acute lymphoblastic leukemia, chimeric antigen receptor (CAR)-modified T cells have entered early clinical evaluation in the field of multiple myeloma (MM). The choice of suitable non-CD19 target antigens is challenging and a variety of myeloma-associated surface molecules have been under preclinical investigation. Most recent clinical protocols have focused on targeting B-cell maturation antigen (BCMA), and early results are promising. The trials differ in receptor constructs, patient selection, dosing strategies and conditioning chemotherapy and will thus pave the way to eventually define the optimal parameters. Other sources for autologous T-cell therapy of MM include affinity-enhanced T-cell receptor-modified cells and marrow infiltrating lymphocytes. In summary, adoptive T-cell transfer for the treatment of MM is still in its infancy, but if early response rates indicate durability, will be a paradigm changing therapeutic modality for the treatment of MM. Copyright © 2018. Published by Elsevier Ltd.

The Lived-Experience of Novice Nurse's Actualizing Clinical Reasoning in Academic Simulation

ERIC Educational Resources Information Center

Brinker, Mary Catherine

2016-01-01

The purpose of this existential-phenomenological study was to address the first-person perspective of what it is like to experience clinical reasoning during a simulation. It was not known how a novice nurse would describe the experience of actualizing clinical reasoning during the academic simulation experience. In order to maintain the…

The Use of Concrete Experiences in Early Childhood Mathematics Instruction.

PubMed

Baroody, Arthur J

2017-01-01

Addressed are four key issues regarding concrete instruction: What is concrete? What is a worthwhile concrete experience? How can concrete experiences be used effectively in early childhood mathematics instruction? Is there evidence such experiences work? I argue that concrete experiences are those that build on what is familiar to a child and can involve objects, verbal analogies, or virtual images. The use of manipulatives or computer games, for instance, does not in itself guarantee an educational experience. Such experiences are worthwhile if they target and further learning (e.g., help children extend their informal knowledge or use their informal knowledge to understand and learn formal knowledge). A crucial guideline for the effective use of concrete experience is Dewey's principle of interaction-external factors (e.g., instructional activities) need to mesh with internal factors (readiness, interest). Cognitive views of concrete materials, such as the cognitive alignment perspective and dual-representation hypothesis, provide useful guidance about external factors but do not adequately take into account internal factors and their interaction with external factors. Research on the effectiveness of concrete experience is inconclusive because it frequently overlooks internal factors. © 2017 Elsevier Inc. All rights reserved.

Risk factors associated with early implant failure: A 5-year retrospective clinical study.

PubMed

Olmedo-Gaya, Maris Victoria; Manzano-Moreno, Francisco J; Cañaveral-Cavero, Esther; de Dios Luna-del Castillo, Juan; Vallecillo-Capilla, Manuel

2016-02-01

The replacement of lost teeth with dental implants is a widespread treatment whose associated problems are also frequently encountered. Nevertheless, the factors associated with early implant failure have not been well documented. Further analyses of the factors influencing osseointegration establishment are required to maximize the predictability of the procedure and minimize implant failures. The purpose of this retrospective clinical study was to explore the association between possible risk factors and early implant failure. This retrospective clinical study evaluated 142 participants who received 276 external connection BTI implants between 2007 and 2011. Participant variables (age, sex, systemic disease, tobacco use, alcohol consumption, bruxism, and degree of periodontal disease), implant variables (type of edentulism, localization, area, diameter, length, and bone quality), intervention variables (expansion mechanisms, sinus augmentation techniques, bone regeneration, and implant insertion), and postoperative variables (presence of pain/inflammation at 1 week postsurgery) were studied. A multilevel logistic regression model (mixed effects-type model) was used to determine the influence of variables on early implant failure. Early implant failure was significantly associated with the male sex (P=.001), severe periodontal disease (P=.005), short implants (P=.001), expansion technique (P=.002), and postoperative pain/inflammation at 1 week postsurgery (P<.001). Early dental implant failure is more frequent in men and in individuals with severe periodontal disease, short implants, pain/inflammation at 1 week postsurgery, or bone expansion treatment. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Early clinical outcomes of primary percutaneous coronary intervention in bharatpur, Nepal.

PubMed

Dubey, Laxman; Bhattacharya, Rabindra; Guruprasad, Sogunuu; Subramanyam, Gangapatnam

2013-06-01

Primary percutaneous coronary intervention represents one of the cornerstone management modalities for patients with acute ST-elevation myocardial infarction and has undergone tremendous growth over the past two decades. This study was aimed to determine the early clinical outcomes of primary percutaneous coronary interventions in a tertiary-level teaching hospital without onsite cardiac surgery backup. This was a prospective descriptive study which included all consecutive patients who were admitted for primary percutaneous coronary interventions between March 2011 and January 2013 at the College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal. Total 68 patients underwent primary percutaneous coronary interventions as a mode of revascularization. The primary end point of the study was to identify in-hospital as well as 30-day clinical outcomes of primary percutaneous coronary interventions. The mean age was 56.31 ± 11.47 years, with age range of 32 years to 91 years. Of the 68 primary percutaneous coronary interventions performed, 15 (22.05%) were carried out in women and 10 (14.70%) in patients over 75 years of age. Primary percutaneous coronary intervention for anterior wall myocardial infarction was more common than for non-anterior wall myocardial infarction (55.88% vs. 44.12%). Proximal artery stenting was performed in 38.50% and the non proximal artery stenting in 61.50%. The outcomes were mortality (5.88%), cardiogenic shock (5.88%), contrast-induced nephropathy requiring dialysis (2.94%), arrhythmias requiring treatment (4.41%), early stent thrombosis (2.94%) and minor complications (14.70%). Primary percutaneous coronary intervention improves the early clinical outcomes in patient with acute ST-elevation myocardial infarction. Despite having no onsite cardiac surgery backup, primary percutaneous coronary intervention was feasible with acceptable complications in a tertiary-care teaching hospital.

Development of an International Clinical Education Extracurricular Experience Through a Collaborative Partnership.

PubMed

Mandich, MaryBeth; Erickson, Mia; Nardella, Beth

2017-01-01

Participating in global health care through international clinical education may enhance the development of cultural competence and professionalism. Many logistical issues need to be resolved in the development of international clinical education experiences that meet program requirements. The purpose of this case report is to describe how a university developed such an experience for students by partnering with Amizade Global Service-Learning (Amizade), an organization that facilitates global learning experiences. Medical, nursing, and pharmacy students were already participating in a 4-week international health-related service learning rotation through Amizade. The preexisting relationship and contractual agreement with the university provided the necessary legal framework. Amizade staff assisted in finding a physical therapist qualified and willing to host a student. The academic coordinator for clinical education at the university and Amizade liaisons determined living arrangements, schedule, clinical settings, and patient population. The selected student had expressed interest and had met all clinical education placement requirements. The academic coordinator for clinical education had ongoing electronic communications with all parties. The student demonstrated predicted attributes of cultural competence and professionalism; through the partnership with Amizade, the student was exposed to several unique interprofessional experiences. The steps used by the university faculty in developing this interprofessional, international clinical education experience through a collaborative partnership may provide guidance for other institutions. © 2017 American Physical Therapy Association

"It's Just So Lovely to Hear Him Talking": Exploring the Early-Intervention Expectations and Experiences of Parents

ERIC Educational Resources Information Center

Lyons, Rena; O'Malley, Mary Pat; O'Connor, Patricia; Monaghan, Una

2010-01-01

Little research to date explores parental experiences of early intervention. This study uses action research over a six-month period to explore the expectations and experiences of parents whose children attended an early-intervention group for speech/language impairments. This intervention programme was facilitated by a speech and language…

Early experience with gamete intrafallopian transfer (GIFT) and direct intraperitoneal insemination (DIPI).

PubMed Central

Dooley, M; Lim-Howe, D; Savvas, M; Studd, J W

1988-01-01

We present our early experience with gamete intrafallopian transfer (GIFT) and direct intraperitoneal insemination (DIPI) combined with intrauterine insemination (IUI), two recently described methods of assisting conception in patients with patent fallopian tubes. Sixty-nine patients (93 cycles) were entered into the study. Thirty-three patients (51 cycles) entered the DIPI/IUI programme and 36 patients (42 cycles) entered the GIFT programme. The mean age, duration and aetiology of infertility were similar in both groups. In the GIFT programme 12 pregnancies occurred, which is a 29% pregnancy rate per cycle and a 33% pregnancy rate per patient. In the DIPI/IUI programme only 3 pregnancies occurred, being a 6% pregnancy rate per cycle and a 9% pregnancy rate per patient. With the live birth rate of in vitro fertilization (IVF) being 12% per embryo transfer, we conclude that GIFT is more successful than either DIPI/IUI or IVF in patients with patent fallopian tubes. Further controlled studies are required to assess the future role of DIPI/IUI in clinical practice. PMID:3210194

Early experiences with E-prescribing.

PubMed

Halamka, John

2006-01-01

Most physicians understand that e-prescribing will reduce medical errors and will be perceived by patients as making the prescription process easier. However, they are skeptical about a number of things. They worry whether their office processes will be improved or streamlined; e-prescribing will interface seamlessly with their existing practice management software; training and support will be available; e-prescribing data will be seamlessly transferable to an electronic health record when they implement a more advanced clinical record system for their practice; and if they will achieve a return on investment. Early adopting clinicians in Massachusetts can convince the majority of clinicians to adopt e-prescribing by sharing their motivations for adopting e-prescribing, the challenges that they needed to overcome, the hardware and software requirements, and integration into their office workflow. Finally, interaction with the physicians and practice managers in the audience makes the adoption of e-prescribing seem both reasonable and exciting. Resources such as vendor lists, questions to ask, and hardware and software requirements also need to be readily available and in a form that non-technical staff can read and understand. Physicians who know the "why" would also like to know

Audit of the autoantibody test, EarlyCDT®-lung, in 1600 patients: an evaluation of its performance in routine clinical practice.

PubMed

Jett, James R; Peek, Laura J; Fredericks, Lynn; Jewell, William; Pingleton, William W; Robertson, John F R

2014-01-01

EarlyCDT(®)-Lung may enhance detection of early stage lung cancer by aiding physicians in assessing high-risk patients through measurement of biological markers (i.e., autoantibodies). The test's performance characteristics in routine clinical practice were evaluated by auditing clinical outcomes of 1613 US patients deemed at high risk for lung cancer by their physician, who ordered the EarlyCDT-Lung test for their patient. Clinical outcomes for all 1613 patients who provided HIPAA authorization are reported. Clinical data were collected from each patient's treating physician. Pathology reports when available were reviewed for diagnostic classification. Staging was assessed on histology, otherwise on imaging. Six month follow-up for the positives/negatives was 99%/93%. Sixty-one patients (4%) were identified with lung cancer, 25 of whom tested positive by EarlyCDT-Lung (sensitivity=41%). A positive EarlyCDT-Lung test on the current panel was associated with a 5.4-fold increase in lung cancer incidence versus a negative. Importantly, 57% (8/14) of non-small cell lung cancers detected as positive (where stage was known) were stage I or II. EarlyCDT-Lung has been extensively tested and validated in case-control settings and has now been shown in this audit to perform in routine clinical practice as predicted. EarlyCDT-Lung may be a complementary tool to CT for detection of early lung cancer. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Deep Brain Stimulation in Early Parkinson’s Disease: Enrollment Experience from a Pilot Trial

PubMed Central

Charles, PD; Dolhun, RM; Gill, CE; Davis, TL; Bliton, MJ; Tramontana, MG; Salomon, RM; Wang; Hedera, P; Phibbs, FT; Neimat, JS; Konrad, PE

2011-01-01

Background Deep brain stimulation (DBS) of the subthalamic nucleus is an accepted therapy for advanced Parkinson’s disease (PD). In animal models, pharmacologic ablation and stimulation of the subthalamic nucleus have resulted in clinical improvement and, in some cases, improved survival of dopaminergic neurons. DBS has not been studied in the early stages of PD, but early application should be explored to evaluate safety, efficacy, and the potential to alter disease progression. Methods We are conducting a prospective, randomized, single-blind clinical trial of optimal drug therapy (ODT) compared to medication plus DBS (ODT + DBS) in subjects with Hoehn & Yahr Stage II idiopathic PD who are without motor fluctuations or dementia. We report here subject screening, enrollment, baseline characteristics, and adverse events. Results 30 subjects (average age 60 ± 6.9 years, average duration of medicine 2.1 ± 1.3 years, average UPDRS-III scores 14.9 on medication and 27.0 off medication) are enrolled in the ongoing study. Twelve of 15 subjects randomized to DBS experienced perioperative adverse events, the majority of which were related to the procedure or device and resolved without sequelae. Frequently reported adverse events included wound healing problems, headache, edema, and confusion. Conclusion This report demonstrates that subjects with early stage PD can be successfully recruited, consented and retained in a long term clinical trial of DBS. Our ongoing pilot investigation will provide important preliminary safety and tolerability data concerning the application of DBS in early stage PD. PMID:22104012

Perinatal Experiences: The Association of Stress, Childbearing, Breastfeeding, and Early Mothering

PubMed Central

Humenick, Sharron S.; Howell, Olivia S.

2003-01-01

The support of women and their families through childbirth, breastfeeding, and early parenting experiences are often treated as separate areas of maternity care. In fact, growing evidence, as cited in this article, links their intertwined impact on the health of mothers, infants, and their families. PMID:17273350

Family Attachment Narrative Therapy: Healing the Experience of Early Childhood Maltreatment

ERIC Educational Resources Information Center

May, Joanne C.

2005-01-01

Based on attachment theory and research, Family Attachment Narrative Therapy is introduced as a new family therapy modality developed to heal the experience of early childhood maltreatment. Unresolved childhood trauma has been correlated with impaired and delayed cognitive, behavioral and emotional functioning. Gentle, soothing, nonprovocative and…

Survey Examines Experiences of Families Entering Early Intervention. FPG Snapshot #14

ERIC Educational Resources Information Center

FPG Child Development Institute, University of North Carolina, 2004

2004-01-01

A recent FPG study looked at families' initial experiences in determining their child's eligibility for early intervention (EI) services as mandated by Part C (IDEA), interactions with medical professionals, effort required to get services, participation in planning for services, satisfaction with services, and interactions with professionals. A…

Undergraduate nursing students' experience related to their clinical learning environment and factors affecting to their clinical learning process.

PubMed

Arkan, Burcu; Ordin, Yaprak; Yılmaz, Dilek

2018-03-01

Clinical education is an essential part of nursing education. The purpose of this study was to explore nurse students' experiences related to cinical learning environments, factors effecting to clinical learning process. Descriptive qualitative design was used in this study, and data were collected from 2nd class nursing student (n = 14). The study took the form of in-depth interviews between August-October 2015. The qualitative interviews were analyzed by using simple content analysis. Data were analyzed manually. Experiences nurse students are described five themes. The themes of the study are (1) effecting persons to clinical learning, (2) educational atmosphere, (3) students' personal charactering, (4) the impact of education in school, and (5) students' perceptions related to clinical learning. Participants stated that they experienced many difficulties during clinical learning process. All students importantly stated that nurse teacher is very effecting to clinical learning. This study contributes to the literature by providing data on beginner nursing student' experiences about clinical learning process. The data of this present study show to Turkish nursing student is affecting mostly from persons in clinical learning. The data of this present study will guide nurse teacher when they plan to interventions to be performed to support student during clinical learning process. Copyright © 2017 Elsevier Ltd. All rights reserved.

Age at adoption from institutional care as a window into the lasting effects of early experiences

PubMed Central

Julian, Megan M.

2013-01-01

One of the major questions of human development is how early experience impacts the course of development years later. Children adopted from institutional care experience varying levels of deprivation in their early life followed by qualitatively better care in an adoptive home, providing a unique opportunity to study the lasting effects of early deprivation and its timing. The effects of age at adoption from institutional care are discussed for multiple domains of social and behavioral development within the context of several prominent developmental hypotheses about the effects of early deprivation (cumulative effects, experience-expectant developmental programming, and experience-adaptive developmental programming). Age at adoption effects are detected in a majority of studies, particularly when children experienced global deprivation and were assessed in adolescence. For most outcomes, institutionalization beyond a certain age is associated with a step-like increase in risk for lasting social and behavioral problems, with the step occurring at an earlier age for children who experienced more severe levels of deprivation. Findings are discussed in terms of their concordance and discordance with our current hypotheses, and speculative explanations for the findings are offered. PMID:23576122

Early adverse experience and substance addiction: dopamine, oxytocin, and glucocorticoid pathways

PubMed Central

Kim, Sohye; Kwok, Stephanie; Mayes, Linda C.; Potenza, Marc N.; Rutherford, Helena J. V.; Strathearn, Lane

2016-01-01

Substance addiction may follow a chronic, relapsing course and critically undermine the physical and psychological well-being of the affected individual and the social units of which the individual is a member. Despite the public health burden associated with substance addiction, treatment options remain suboptimal, with relapses often seen. The present review synthesizes growing insights from animal and human research to shed light upon developmental and neurobiological pathways that may increase susceptibility to addiction. We examine the dopamine system, the oxytocin system, and the glucocorticoid system, as they are particularly relevant to substance addiction. Our aim is to delineate how early adverse experience may induce long-lasting alterations in each of these systems at molecular, neuroendocrine, and behavioral levels and ultimately lead to heightened vulnerability to substance addiction. We further discuss how substance addiction in adulthood may increase the risk of suboptimal caregiving for the next generation, perpetuating the intergenerational cycle of early adverse experiences and addiction. PMID:27508337

Early clinical applications for imaging at microscopic detail: microfocus computed tomography (micro-CT).

PubMed

Hutchinson, J Ciaran; Shelmerdine, Susan C; Simcock, Ian C; Sebire, Neil J; Arthurs, Owen J

2017-07-01

Microfocus CT (micro-CT) has traditionally been used in industry and preclinical studies, although it may find new applicability in the routine clinical setting. It can provide high-resolution three-dimensional digital imaging data sets to the same level of detail as microscopic examination without the need for tissue dissection. Micro-CT is already enabling non-invasive detailed internal assessment of various tissue specimens, particularly in breast imaging and early gestational fetal autopsy, not previously possible from more conventional modalities such as MRI or CT. In this review, we discuss the technical aspects behind micro-CT image acquisition, how early work with small animal studies have informed our knowledge of human disease and the imaging performed so far on human tissue specimens. We conclude with potential future clinical applications of this novel and emerging technique.

Nurses’ experiences of humour in clinical settings

PubMed Central

Ghaffari, Fatemeh; Dehghan-Nayeri, Nahid; Shali, Mahboubeh

2015-01-01

Background: Providing holistic nursing care when there is a shortage of personnel and equipment exposes nurses to stress and a higher risk of occupational burnout. Humour can promote nurses’ health and influence nursing care. The aim of this study was to describe nurses’ experiences of humour in clinical settings and factors affecting it. Methods: This qualitative study investigated nurses’ experiences of humour. Five hospitals affiliated to Tehran University of Medical Sciences provided the setting for this study. The participants comprised of 17 nurses with master’s and Baccalaureate degrees (BSN) in nursing. These nurses worked at educational hospitals affiliated to Tehran University of Medical Sciences and had minimum work experience of 12 months in various clinical wards. Nurses from all wards were invited to participate in this study. The data were collected through semi structure interviews using guides comprising probing questions. Telephonic interviews were used to further supplement the data. The data were analysed using conventional content analysis. Results: The data were classified into five themes including the dynamics of humour, condition enforcement, Risk making probability, Instrumental use and Change: opportunities and threats. Conclusion: Understanding nurses’ perceptions and experiences of humour helps identify its contributing factors and provides valuable guidelines for enhancing nurses and patients’ mental, emotional and physical health. Spreading a culture of humour through teaching methods can improve workplace cheerfulness and highlights the importance of humour in patient care in nurses and nursing students. PMID:26034735

Clinical outcomes of immediate/early loading of dental implants. A literature review of recent controlled prospective clinical studies.

PubMed

Sennerby, L; Gottlow, J

2008-06-01

Two previous reviews have evaluated the clinical outcomes of immediate/early loading of dental implants based on studies published until 2005.(1,2) The aim of the present paper was to review controlled clinical studies on the subject published since 2005 including at least 10 patients in each group followed for at least one year in function. Six comparative studies were found and none of these showed any differences in survival rates or marginal bone loss after one to five years. Most authors used specified inclusion criteria to avoid known risk factors such as soft bone, short implants and bruxism. Data from one randomized study in the edentulous maxilla showed no differences between early and delayed loading in consecutive clinical routine cases including short implants and soft bone. Three additional studies comparing different surfaces or implant designs under immediate loading were reviewed. No differences between implants with a moderately rough or smooth surface topography were observed. The data add to the previous bulk of evidence that various designs of implants can be loaded shortly after their placement in both the mandible and the maxilla. However, one study reported on marginal bone loss around a novel one-piece implant design leading to implant failure which was not seen for control two-piece implants.(3).

Breast Cancer Knowledge, Behaviors, and Preferences in Malawi: Implications for Early Detection Interventions From a Discrete Choice Experiment.

PubMed

Kohler, Racquel E; Gopal, Satish; Lee, Clara N; Weiner, Bryan J; Reeve, Bryce B; Wheeler, Stephanie B

2017-10-01

Breast cancer is the most common female cancer in Africa and leading cause of death resulting from cancer; however, many countries lack early detection services. In Malawi, women are frequently diagnosed with large tumors after long symptomatic periods. Little is known about local cancer knowledge. We administered a cross-sectional survey with a discrete choice experiment to a random sample in urban and rural areas of Lilongwe district. Bivariable and multivariable analyses determined factors associated with knowledge. Preference utilities for early detection interventions were estimated using a hierarchical Bayesian model in Sawtooth software. Of 213 women recruited, fewer than half were aware of breast cancer. In multivariable analysis, electricity at home and knowing someone with cancer increased the odds of awareness. Women were more knowledgeable about symptoms than treatment or risk factors; more than 60% erroneously believed local misconceptions. Seventeen percent were aware of breast self-examination, and 20% were aware of clinical breast examination (CBE); few reported either behavior. Common barriers included not knowing where to access CBE and transportation difficulties. Discrete choice experiment results indicated the detection strategy (breast health awareness, CBE, or both) was the most important attribute of an intervention, followed by the encounter setting and travel time. Addressing misconceptions in health messages and engaging survivors to promote early detection may help improve breast cancer knowledge in Malawi. Program designs accounting for women's preferences should provide breast health education and CBEs in convenient settings to address transportation barriers, particularly for women with low socioeconomic position.

Breast Cancer Knowledge, Behaviors, and Preferences in Malawi: Implications for Early Detection Interventions From a Discrete Choice Experiment

PubMed Central

Gopal, Satish; Lee, Clara N.; Weiner, Bryan J.; Reeve, Bryce B.; Wheeler, Stephanie B.

2017-01-01

Purpose Breast cancer is the most common female cancer in Africa and leading cause of death resulting from cancer; however, many countries lack early detection services. In Malawi, women are frequently diagnosed with large tumors after long symptomatic periods. Little is known about local cancer knowledge. Methods We administered a cross-sectional survey with a discrete choice experiment to a random sample in urban and rural areas of Lilongwe district. Bivariable and multivariable analyses determined factors associated with knowledge. Preference utilities for early detection interventions were estimated using a hierarchical Bayesian model in Sawtooth software. Results Of 213 women recruited, fewer than half were aware of breast cancer. In multivariable analysis, electricity at home and knowing someone with cancer increased the odds of awareness. Women were more knowledgeable about symptoms than treatment or risk factors; more than 60% erroneously believed local misconceptions. Seventeen percent were aware of breast self-examination, and 20% were aware of clinical breast examination (CBE); few reported either behavior. Common barriers included not knowing where to access CBE and transportation difficulties. Discrete choice experiment results indicated the detection strategy (breast health awareness, CBE, or both) was the most important attribute of an intervention, followed by the encounter setting and travel time. Conclusion Addressing misconceptions in health messages and engaging survivors to promote early detection may help improve breast cancer knowledge in Malawi. Program designs accounting for women’s preferences should provide breast health education and CBEs in convenient settings to address transportation barriers, particularly for women with low socioeconomic position. PMID:29094086

Management Control Systems and Clinical Experience of Managers in Public Hospitals

PubMed Central

Naranjo-Gil, David

2018-01-01

Healthcare authorities are encouraging managers in hospitals to acquire clinical experience and knowledge in order to better carry out and coordinate healthcare service delivery. The main objective of this paper is to analyse how the clinical experience of hospital managers is related to public health institutions’ performance. It is proposed that the effect of the clinical experience on operative and financial organizational performance is indirect through the mediating variables of perceived utility of management information and horizontal management control system. This paper analyses how these variables impact hospital performance through the data from a survey sent to 364 hospital managers in Brazil. The results show that managers’ clinical experience is related to higher perceived utility of historical, financial, short-term, and internal information, but not with horizontal control adoption in hospitals. Furthermore, our results show that, in hospitals, perceived utility of forecasted, non-financial, long-term, and external managerial information positively affects hospitals’ financial performance, while adoption of horizontal control management positively affects operational performance. Through showing evidence that clinical background could explain the differences not only in hospital service management but also in information capabilities and management control processes, this study offer meaningful implications for healthcare authorities and hospital managers involved in the development and implementation of strategies in the health sector. PMID:29673192

Application of lean methods improves surgical clinic experience.

PubMed

Waldhausen, John H T; Avansino, Jeffrey R; Libby, Arlene; Sawin, Robert S

2010-07-01

A quality visit in high volume surgery clinics is challenging. There is variability in numbers of patients seen and care provider behavior. Documentation, regulatory and compliance issues and computerization of patient care systems may decrease clinic efficiency and throughput. We tried to reduce variability and improve patient experience. Baseline data included: patients seen, time in exam rooms, and spent with providers, and patient satisfaction surveys. Two Rapid Process Improvement Workshops (RPIWs) were conducted to apply lean methods. 5S techniques helped standardize exam rooms. Similar data were collected at 30 days, 60 days, and 1 year. Satisfaction surveys were followed at 6 months and 1 year. Median pre-RPIW room time was 49 minutes. Post-RPIW times were 33 minutes at 30 days, 41 minutes at 60 days, and 42 minutes at 1 year. Face to face provider-patient time increased 30% to 61% at 30 days, 58% at 60 days, and 59% at 1 year. The median number of patients in a 4-hour clinic increased from 10 to 12. Satisfaction survey Problem Scores improved and were sustained. Lean methodology may be used to improve clinic efficiency as well as patient and staff's experience. Copyright 2010. Published by Elsevier Inc.

Providing Quality Early Care and Education to Young Children Who Experience Maltreatment: A Review of the Literature

ERIC Educational Resources Information Center

Dinehart, Laura H.; Katz, Lynne F.; Manfra, Louis; Ullery, Mary Anne

2013-01-01

The current paper highlights the few studies that examine the role of early care and education on the developmental and early academic outcomes of children who experience maltreatment. First, we argue that children who experience maltreatment are at significant risk for poor developmental outcomes as a result of the chronic exposure to stress that…

How the Timing and Quality of Early Experiences Influence the Development of Brain Architecture

ERIC Educational Resources Information Center

Fox, Sharon E.; Levitt, Pat; Nelson, Charles A., III.

2010-01-01

Early life events can exert a powerful influence on both the pattern of brain architecture and behavioral development. In this study a conceptual framework is provided for considering how the structure of early experience gets "under the skin." The study begins with a description of the genetic framework that lays the foundation for brain…

Faculty Development for Fostering Clinical Reasoning Skills in Early Medical Students Using a Modified Bayesian Approach.

PubMed

Addy, Tracie Marcella; Hafler, Janet; Galerneau, France

2016-01-01

Clinical reasoning is a necessary skill for medical students to acquire in the course of their education, and there is evidence that they can start this process at the undergraduate level. However, physician educators who are experts in their given fields may have difficulty conveying their complex thought processes to students. Providing faculty development that equips educators with tools to teach clinical reasoning may support skill development in early medical students. We provided faculty development on a modified Bayesian method of teaching clinical reasoning to clinician educators who facilitated small-group, case-based workshops with 2nd-year medical students. We interviewed them before and after the module regarding their perceptions on teaching clinical reasoning. We solicited feedback from the students about the effectiveness of the method in developing their clinical reasoning skills. We carried out this project during an institutional curriculum rebuild where clinical reasoning was a defined goal. At the time of the intervention, there was also increased involvement of the Teaching and Learning Center in elevating the status of teaching and learning. There was high overall satisfaction with the faculty development program. Both the faculty and the students described the modified Bayesian approach as effective in fostering the development of clinical reasoning skills. Through this work, we learned how to form a beneficial partnership between a clinician educator and Teaching and Learning Center to promote faculty development on a clinical reasoning teaching method for early medical students. We uncovered challenges faced by both faculty and early learners in this study. We observed that our faculty chose to utilize the method of teaching clinical reasoning in a variety of manners in the classroom. Despite obstacles and differing approaches utilized, we believe that this model can be emulated at other institutions to foster the development of clinical

Milgram's Obedience to Authority experiments: origins and early evolution.

PubMed

Russell, Nestar John Charles

2011-03-01

Stanley Milgram's Obedience to Authority experiments remain one of the most inspired contributions in the field of social psychology. Although Milgram undertook more than 20 experimental variations, his most (in)famous result was the first official trial run - the remote condition and its 65% completion rate. Drawing on many unpublished documents from Milgram's personal archive at Yale University, this article traces the historical origins and early evolution of the obedience experiments. Part 1 presents the previous experiences that led to Milgram's conception of his rudimentary research idea and then details the role of his intuition in its refinement. Part 2 traces the conversion of Milgram's evolving idea into a reality, paying particular attention to his application of the exploratory method of discovery during several pilot studies. Both parts illuminate Milgram's ad hoc introduction of various manipulative techniques and subtle tension-resolving refinements. The procedural adjustments continued until Milgram was confident that the first official experiment would produce a high completion rate, a result contrary to expectations of people's behaviour. Showing how Milgram conceived of, then arrived at, this first official result is important because the insights gained may help others to determine theoretically why so many participants completed this experiment. ©2010 The British Psychological Society.

INDIVIDUAL DIFFERENCES IN THE EFFECTS OF EARLY EXPERIENCE ON AFTER BEHAVIOR.

ERIC Educational Resources Information Center

FORGAYS, DONALD G.

TWO SERIES OF STUDIES WHOSE SUBJECTS WERE EITHER HOODED AND ALBINO RATS OR YOUNG CHILDREN INVESTIGATED THE INFLUENCE OF EARLY EXPERIENCES ON LATER BEHAVIOR. IN THE FIRST, BOTH SUBSPECIES OF RATS WERE EXPOSED TO EITHER ENRICHED OR RESTRICTED ENVIRONMENTS TO ASSESS THEIR PROBLEM-SOLVING ABILITIES UNDER VARIOUS LEARNING CONDITIONS. THE RESULTS…

Early detection of psychosis: finding those at clinical high risk.

PubMed

Addington, Jean; Epstein, Irvin; Reynolds, Andrea; Furimsky, Ivana; Rudy, Laura; Mancini, Barbara; McMillan, Simone; Kirsopp, Diane; Zipursky, Robert B

2008-08-01

In early detection work, recruiting individuals who meet the prodromal criteria is difficult. The aim of this paper was to describe the development of a research clinic for individuals who appear to be at risk of developing a psychosis and the process for educating the community and obtaining referrals. The outcome of all referrals to the clinic over a 4-year period was examined. Following an ongoing education campaign that was over inclusive in order to aid recruitment, approximately 27% of all referrals met the criteria for being at clinical high risk of psychosis. We are seeing only a small proportion of those in the community who eventually go on to develop a psychotic illness. This raises two important issues, namely how to remedy the situation, and second, the impact of this on current research in terms of sampling bias and generalizability of research findings. © 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Asia Pty Ltd.

Enhancing an introductory Pharmacy Practice Experience at free medical clinics.

PubMed

Morello, Candis M; Singh, Renu F; Chen, Karen J; Best, Brookie M

2010-02-01

The aim of the study was to assess and improve first-year student pharmacists' satisfaction and learning experience in a Student-Run Free Medical Clinic Project (SFMCP) providing medical care to an underserved population. Two consecutive classes of first-year student pharmacists at the University of California San Diego (UCSD) Skaggs School of Pharmacy and Pharmaceutical Sciences participated in an Introductory Pharmacy Practice Experience (IPPE) at the UCSD SFMCP. This IPPE involved two inter-professional evening free clinics which provide medical care to an underserved population and opportunities for healthcare professional training and service. Year 1 students completed a self-assessment survey instrument and year 2 students completed the survey instrument plus a new competency checklist tool. Average scores from the self-assessment survey instrument were compared between years 1 and 2. Initial survey results showed that students felt the SFMCP was worthwhile; however, they did not experience enough involvement in the patient assistance programme or non-pharmacy-related clinic activities. After the competency checklist tool implementation, overall student pharmacist satisfaction of the SFMCP IPPE remained high (88%), participation in identified weak areas improved and students agreed that the tool helped focus their clinic experience. Areas of improvement were identified with the survey instrument and the competency checklist tool increased achievement of learning objectives. Overall, student pharmacists felt the SFMCP IPPE was a good learning experience. Practising pharmacists can employ these or similar tools in specific practice settings, to evaluate and help ensure that student pharmacists or interns are achieving applicable learning objectives.

An Exploration of Dental Students' Assumptions About Community-Based Clinical Experiences.

PubMed

Major, Nicole; McQuistan, Michelle R

2016-03-01

The aim of this study was to ascertain which assumptions dental students recalled feeling prior to beginning community-based clinical experiences and whether those assumptions were fulfilled or challenged. All fourth-year students at the University of Iowa College of Dentistry & Dental Clinics participate in community-based clinical experiences. At the completion of their rotations, they write a guided reflection paper detailing the assumptions they had prior to beginning their rotations and assessing the accuracy of their assumptions. For this qualitative descriptive study, the 218 papers from three classes (2011-13) were analyzed for common themes. The results showed that the students had a variety of assumptions about their rotations. They were apprehensive about working with challenging patients, performing procedures for which they had minimal experience, and working too slowly. In contrast, they looked forward to improving their clinical and patient management skills and knowledge. Other assumptions involved the site (e.g., the equipment/facility would be outdated; protocols/procedures would be similar to the dental school's). Upon reflection, students reported experiences that both fulfilled and challenged their assumptions. Some continued to feel apprehensive about treating certain patient populations, while others found it easier than anticipated. Students were able to treat multiple patients per day, which led to increased speed and patient management skills. However, some reported challenges with time management. Similarly, students were surprised to discover some clinics were new/updated although some had limited instruments and materials. Based on this study's findings about students' recalled assumptions and reflective experiences, educators should consider assessing and addressing their students' assumptions prior to beginning community-based dental education experiences.

Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS): Demographic and Clinical Characteristics

ERIC Educational Resources Information Center

Frazier, Jean A.; McClellan, Jon; Findling, Robert L.; Vitiello, Benedetto; Anderson, Robert; Zablotsky, Benjamin; Williams, Emily; McNamara, Nora K.; Jackson, Joseph A.; Ritz, Louise; Hlastala, Stefanie A.; Pierson, Leslie; Varley, Jennifer A.; Puglia, Madeline; Maloney, Ann E.; Ambler, Denisse; Hunt-Harrison, Tyehimba; Hamer, Robert M.; Noyes, Nancy; Lieberman, Jeffrey A.; Sikich, Linmarie

2007-01-01

Objective: We examined baseline demographic and clinical profiles of youths enrolled from 2001 to 2006 in the publicly funded multicenter, randomized controlled trial Treatment of Early-Onset Schizophrenia Spectrum Disorders. Method: Youths (8-19 years) with schizophrenia (SZ) and schizoaffective disorder were recruited at four academic sites.…

Early Clinical Features of Dengue Virus Infection in Nicaraguan Children: A Longitudinal Analysis

PubMed Central

Biswas, Hope H.; Ortega, Oscar; Gordon, Aubree; Standish, Katherine; Balmaseda, Angel; Kuan, Guillermina; Harris, Eva

2012-01-01

Background Tens of millions of dengue cases and approximately 500,000 life-threatening complications occur annually. New tools are needed to distinguish dengue from other febrile illnesses. In addition, the natural history of pediatric dengue early in illness in a community-based setting has not been well-defined. Methods Data from the multi-year, ongoing Pediatric Dengue Cohort Study of approximately 3,800 children aged 2–14 years in Managua, Nicaragua, were used to examine the frequency of clinical signs and symptoms by day of illness and to generate models for the association of signs and symptoms during the early phase of illness and over the entire course of illness with testing dengue-positive. Odds ratios (ORs) and 95% confidence intervals were calculated using generalized estimating equations (GEE) for repeated measures, adjusting for age and gender. Results One-fourth of children who tested dengue-positive did not meet the WHO case definition for suspected dengue. The frequency of signs and symptoms varied by day of illness, dengue status, and disease severity. Multivariable GEE models showed increased odds of testing dengue-positive associated with fever, headache, retro-orbital pain, myalgia, arthralgia, rash, petechiae, positive tourniquet test, vomiting, leukopenia, platelets ≤150,000 cells/mL, poor capillary refill, cold extremities and hypotension. Estimated ORs tended to be higher for signs and symptoms over the course of illness compared to the early phase of illness. Conclusions Day-by-day analysis of clinical signs and symptoms together with longitudinal statistical analysis showed significant associations with testing dengue-positive and important differences during the early phase of illness compared to the entire course of illness. These findings stress the importance of considering day of illness when developing prediction algorithms for real-time clinical management. PMID:22413033

Physiotherapy students' perceptions and experiences of clinical prediction rules.

PubMed

Knox, Grahame M; Snodgrass, Suzanne J; Stanton, Tasha R; Kelly, David H; Vicenzino, Bill; Wand, Benedict M; Rivett, Darren A

2017-09-01

Clinical reasoning can be difficult to teach to pre-professional physiotherapy students due to their lack of clinical experience. It may be that tools such as clinical prediction rules (CPRs) could aid the process, but there has been little investigation into their use in physiotherapy clinical education. This study aimed to determine the perceptions and experiences of physiotherapy students regarding CPRs, and whether they are learning about CPRs on clinical placement. Cross-sectional survey using a paper-based questionnaire. Final year pre-professional physiotherapy students (n=371, response rate 77%) from five universities across five states of Australia. Sixty percent of respondents had not heard of CPRs, and a further 19% had not clinically used CPRs. Only 21% reported using CPRs, and of these nearly three-quarters were rarely, if ever, learning about CPRs in the clinical setting. However most of those who used CPRs (78%) believed CPRs assisted in the development of clinical reasoning skills and none (0%) was opposed to the teaching of CPRs to students. The CPRs most commonly recognised and used by students were those for determining the need for an X-ray following injuries to the ankle and foot (67%), and for identifying deep venous thrombosis (63%). The large majority of students in this sample knew little, if anything, about CPRs and few had learned about, experienced or practiced them on clinical placement. However, students who were aware of CPRs found them helpful for their clinical reasoning and were in favour of learning more about them. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Does early-life family income influence later dental pain experience? A prospective 14-year study.

PubMed

Ghorbani, Z; Peres, M A; Liu, P; Mejia, G C; Armfield, J M; Peres, K G

2017-12-01

The aim of this study was to investigate the association between early-life family income and dental pain experience from childhood to early adulthood. Data came from a 14-year prospective study (1991/1992-2005/2006) carried out in South Australia, which included children and adolescents aged 4-17 years (N = 9875) at baseline. The outcome was dental pain experience obtained at baseline, 14 years later in adulthood and at a middle point of time. The main explanatory variable was early-life family income collected at baseline. The prevalence of dental pain was 22.8% at baseline, 19.3% at 'middle time' and 39.3% at follow up. The proportion of people classified as 'poor' at baseline was 27.7%. Being poor early in life was significantly associated with dental pain at 14-year follow up (odds ratio = 1.45; 95% confidence interval = 1.27-1.66). Early-life relative poverty is associated with more frequent dental pain across the 14-year follow up and may be a key exposure variable for later dental conditions. © 2017 Australian Dental Association.

The Relationship Between Levels of Fidelity in Simulation, Traditional Clinical Experiences and Objectives.

PubMed

Gore, Teresa

2017-06-15

The purpose of this study was to explore the relationship of baccalaureate nursing students' (BSN) perceived learning effectiveness using the Clinical Learning Environments Comparison Survey of different levels of fidelity simulation and traditional clinical experiences. A convenience sample of 103 first semester BSN enrolled in a fundamental/assessment clinical course and 155 fifth semester BSN enrolled in a leadership clinical course participated in this study. A descriptive correlational design was used for this cross-sectional study to evaluate students' perceptions after a simulation experience and the completion of the traditional clinical experiences. The subscales measured were communication, nursing leadership, and teaching-learning dyad. No statistical differences were noted based on the learning objectives. The communication subscale showed a tendency toward preference for traditional clinical experiences in meeting students perceived learning for communication. For student perceived learning effectiveness, faculty should determine the appropriate level of fidelity in simulation based on the learning objectives.

Death in the clinic: women's perceptions and experiences of discarding supernumerary IVF embryos.

PubMed

de Lacey, Sheryl

2017-03-01

Perspectives on the status of human embryos and whether they should be discarded differ globally. Some countries protect embryos in law while in other countries embryos 'die' or 'succumb' in assisted reproductive technology clinics on a daily basis. This study analyses interview data drawn from a larger qualitative study conducted in South Australia from 2004-2007. 21 women and 12 of 21 partners were interviewed about the decision they made to discard their embryos. The analysis reported here sought to examine the ways in which women constructed and experienced the decision to discard embryos. The article highlights the ways in which embryo discard is a contested discursive space. Embryo death is sequestered through their confinement in the laboratory and their invisibility to the naked eye. The clinic treated embryo discard as disposal of biological waste and failed to acknowledge the meaning of the event. By contrast women experienced emotional bereavement described as similar to early pregnancy loss, and described experiences of attachment and grief. For sensitive and compassionate care these differences in perceptions of embryo discard need to be addressed. © 2016 Foundation for the Sociology of Health & Illness.

Transient ischaemic attacks clinics provide equivalent and more efficient care than early in-hospital assessment.

PubMed

Martínez-Martínez, M M; Martínez-Sánchez, P; Fuentes, B; Cazorla-García, R; Ruiz-Ares, G; Correas-Callero, E; Lara-Lara, M; Díez-Tejedor, E

2013-02-01

Clinics for early management of transient ischaemic attacks (TIAs) have been developed in some stroke centres, resulting in reduced recurrence rates compared to appointment-based outpatient management, thus saving on hospitalization. We analysed the care process, recurrence rates and economic impact of the first year of work in our early-management TIA clinic and compared these with our previous in-hospital study protocols for low- and moderate-risk TIA patients. This was a prospective evaluation of the management of low- to moderate-risk TIA patients, comparing a new TIA clinic model (2010) with a previous hospitalization model (2009). Demographic data, vascular risk factor profiles, diagnostic test performance, secondary prevention measures, final aetiological diagnoses and cerebrovascular recurrences at 7 and 90 days were compared between in-hospital and TIA clinic assessed patients. We also carried out an economic comparison of the costs of each model's process. Two hundred and eleven low- to moderate-risk TIA patients were included, of whom 40.8% were hospitalized. There were no differences between the TIA clinic assessed and in-hospital assessed patients in terms of risk factor diagnosis and secondary prevention measures. The stroke recurrence rate (2.4% vs. 1.2%; P = 0.65) was low and similar for both groups (CI 95%, 0.214-20.436; P = 0.52). Cost per patient was €393.28 for clinic versus €1931.18 for in-hospital management. Outpatient management resulted in a 77.8% reduction in hospitalizations. Transient ischaemic attacks clinics are efficient for the early management of low- to moderate-risk TIA patients compared to in-hospital assessment, with no higher recurrence rates and at almost one-fifth the cost. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

Practice-based learning experience to develop residents as clinical faculty members.

PubMed

Slazak, Erin M; Zurick, Gina M

2009-07-01

A practice-based learning experience designed to expose postgraduate year 1 (PGY1) and 2 (PGY2) residents to and prepare them for a career as clinical faculty is described. A practice-based learning experience was designed to give PGY1 and PGY2 residents exposure to the responsibilities of a clinical faculty member, integrating clinical practice, preceptor duties, and other academia-related responsibilities. The learning experience is a four-week, elective rotation for PGY1 and PGY2 residents. The rotation is designed to correspond to a four-week advanced pharmacy practice experience (APPE) rotation, allowing the resident to work continuously with the same one or two APPE students for the entire rotation. The resident is required to design and implement a rotation for the students and provide clinical services while integrating students into daily tasks, facilitating topic and patient discussions, evaluating assignments, providing constructive feedback, and assigning a final rotation grade. The resident also attends all academic and committee meetings and teaching obligations with his or her residency director, if applicable. The resident is mentored by the residency director throughout all phases of the rotation and is evaluated using goals and objectives tailored to this experience. The development of a formal, structured rotation to give postgraduate residents experience as a preceptor provided an opportunity for residents to further explore their interests in academia and allowed them to serve as a primary preceptor while being guided and evaluated by a mentor.

The Experiences of Early Career Teachers: New Initiatives and Old Problems

ERIC Educational Resources Information Center

Schuck, Sandy; Aubusson, Peter; Buchanan, John; Varadharajan, Meera; Burke, Paul F.

2018-01-01

The task of supporting beginning teachers has received considerable attention in recent years, and numerous initiatives have been implemented. In this article we investigate the experiences of early career teachers (ECTs) in New South Wales, Australia, at a time when their employing authority mandated the provision of mentors and a reduction in…

Assessment of early combination effects of colistin and meropenem against Pseudomonas aeruginosa and Acinetobacter baumannii in dynamic time-kill experiments.

PubMed

Tängdén, Thomas; Karvanen, Matti; Friberg, Lena E; Odenholt, Inga; Cars, Otto

2017-07-01

In view of the paucity of clinical evidence, in vitro studies are needed to find antibiotic combinations effective against multidrug-resistant Gram-negative bacteria. Interpretation of in vitro effects is usually based on bacterial growth after 24 h in time-kill and checkerboard experiments. However, the clinical relevance of the effects observed in vitro is not established. In this study we explored alternative output parameters to assess the activities of colistin and meropenem against Pseudomonas aeruginosa and Acinetobacter baumannii. Four strains each of P. aeruginosa and A. baumannii were exposed to colistin and meropenem, alone and in combination, in 8 h dynamic time-kill experiments. Initial (1 h), maximum and 8 h bacterial reductions and the area under the bacterial time-kill curve were evaluated. Checkerboards, interpreted based on fractional inhibitory concentration indices after 24 h, were performed for comparison. In the time-kill experiments, the combination resulted in enhanced 1 h, maximum and 8 h bacterial reductions against 2, 3 and 5 of 8 strains, respectively, as compared to the single drugs. A statistically significant reduction in the area under the time-kill curve was observed for three strains. In contrast, the checkerboards did not identify synergy for any of the strains. Combination effects were frequently found with colistin and meropenem against P. aeruginosa and A. baumannii in time-kill experiments but were not detected with the checkerboard method. We propose that the early dynamics of bacterial killing and growth, which may be of great clinical importance, should be considered in future in vitro combination studies.

The Effects of Abortion Training on Family Medicine Residents' Clinical Experience.

PubMed

Summit, Aleza K; Gold, Marji

2017-01-01

RHEDI, Reproductive Health Education in Family Medicine, offers technical assistance and funding to family medicine residency programs to support integrated opt-out abortion and reproductive health training for residents. This study assessed the impact of this enhanced training on residents' reproductive health experience. Investigator-developed pre- and post-surveys were administered online to 214 residents at 12 family medicine residency programs before and after their RHEDI training experience. Surveys addressed experience in contraception and abortion, attitudes around abortion provision, and post-residency intentions. Descriptive statistics were generated, and statistical tests were performed to assess changes after training. Surveys had a 90% response rate. After the RHEDI enhanced reproductive health rotation, residents reported increased experience in contraception provision, early pregnancy ultrasound, aspiration and medication abortion, and miscarriage management. After training, residents with experience in IUD insertion increased from 85% to 99%, and contraceptive implant insertion experience rose from 60% to 85%. Residents who had performed any abortions increased from 15% to 79%, and self-rated competency in abortion increased. Finally, almost all residents agreed that early abortion was within the scope of family medicine, and training confirmed residents' intentions to provide reproductive health services after residency. Integrated training in reproductive health, with an emphasis on abortion, increases residents' experience and underscores their understanding of the role of these services in family medicine. Increasing the number of family medicine residency programs that offer this training could help prepare family physicians to meet their patients' needs for reproductive health services.

Management Control Systems and Clinical Experience of Managers in Public Hospitals.

PubMed

Lunkes, Rogério Joao; Naranjo-Gil, David; Lopez-Valeiras, Ernesto

2018-04-17

Healthcare authorities are encouraging managers in hospitals to acquire clinical experience and knowledge in order to better carry out and coordinate healthcare service delivery. The main objective of this paper is to analyse how the clinical experience of hospital managers is related to public health institutions’ performance. It is proposed that the effect of the clinical experience on operative and financial organizational performance is indirect through the mediating variables of perceived utility of management information and horizontal management control system. This paper analyses how these variables impact hospital performance through the data from a survey sent to 364 hospital managers in Brazil. The results show that managers’ clinical experience is related to higher perceived utility of historical, financial, short-term, and internal information, but not with horizontal control adoption in hospitals. Furthermore, our results show that, in hospitals, perceived utility of forecasted, non-financial, long-term, and external managerial information positively affects hospitals’ financial performance, while adoption of horizontal control management positively affects operational performance. Through showing evidence that clinical background could explain the differences not only in hospital service management but also in information capabilities and management control processes, this study offer meaningful implications for healthcare authorities and hospital managers involved in the development and implementation of strategies in the health sector.

Changes in neural circuitry associated with depression at pre-clinical, pre-motor and early motor phases of Parkinson's disease.

PubMed

Borgonovo, Janina; Allende-Castro, Camilo; Laliena, Almudena; Guerrero, Néstor; Silva, Hernán; Concha, Miguel L

2017-02-01

Although Parkinson's Disease (PD) is mostly considered a motor disorder, it can present at early stages as a non-motor pathology. Among the non-motor clinical manifestations, depression shows a high prevalence and can be one of the first clinical signs to appear, even a decade before the onset of motor symptoms. Here, we review the evidence of early dysfunction in neural circuitry associated with depression in the context of PD, focusing on pre-clinical, pre-motor and early motor phases of the disease. In the pre-clinical phase, structural and functional changes in the substantia nigra, basal ganglia and limbic structures are already observed. Some of these changes are linked to motor compensation mechanisms while others correspond to pathological processes common to PD and depression and thus could underlie the appearance of depressive symptoms during the pre-motor phase. Studies of the early motor phase (less than five years post diagnosis) reveal an association between the extent of damage in different monoaminergic systems and the appearance of emotional disorders. We propose that the limbic loop of the basal ganglia and the lateral habenula play key roles in the early genesis of depression in PD. Alterations in the neural circuitry linked with emotional control might be sensitive markers of the ongoing neurodegenerative process and thus may serve to facilitate an early diagnosis of this disease. To take advantage of this, we need to improve the clinical criteria and develop biomarkers to identify depression, which could be used to determine individuals at risk to develop PD. Copyright © 2016 Elsevier Ltd. All rights reserved.

Predicting distant failure in early stage NSCLC treated with SBRT using clinical parameters.

PubMed

Zhou, Zhiguo; Folkert, Michael; Cannon, Nathan; Iyengar, Puneeth; Westover, Kenneth; Zhang, Yuanyuan; Choy, Hak; Timmerman, Robert; Yan, Jingsheng; Xie, Xian-J; Jiang, Steve; Wang, Jing

2016-06-01

The aim of this study is to predict early distant failure in early stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT) using clinical parameters by machine learning algorithms. The dataset used in this work includes 81 early stage NSCLC patients with at least 6months of follow-up who underwent SBRT between 2006 and 2012 at a single institution. The clinical parameters (n=18) for each patient include demographic parameters, tumor characteristics, treatment fraction schemes, and pretreatment medications. Three predictive models were constructed based on different machine learning algorithms: (1) artificial neural network (ANN), (2) logistic regression (LR) and (3) support vector machine (SVM). Furthermore, to select an optimal clinical parameter set for the model construction, three strategies were adopted: (1) clonal selection algorithm (CSA) based selection strategy; (2) sequential forward selection (SFS) method; and (3) statistical analysis (SA) based strategy. 5-cross-validation is used to validate the performance of each predictive model. The accuracy was assessed by area under the receiver operating characteristic (ROC) curve (AUC), sensitivity and specificity of the system was also evaluated. The AUCs for ANN, LR and SVM were 0.75, 0.73, and 0.80, respectively. The sensitivity values for ANN, LR and SVM were 71.2%, 72.9% and 83.1%, while the specificity values for ANN, LR and SVM were 59.1%, 63.6% and 63.6%, respectively. Meanwhile, the CSA based strategy outperformed SFS and SA in terms of AUC, sensitivity and specificity. Based on clinical parameters, the SVM with the CSA optimal parameter set selection strategy achieves better performance than other strategies for predicting distant failure in lung SBRT patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Early Adversity and Developmental Outcomes: Interaction Between Genetics, Epigenetics, and Social Experiences Across the Life Span.

PubMed

Champagne, Frances A

2010-09-01

Longitudinal studies in humans demonstrate the association between prenatal and postnatal experiences of adversity and long-term changes in neurodevelopment. These studies raise the question of how experiences become incorporated at a biological level to induce persistent changes in functioning. Laboratory studies using animal models and recent analyses in human cohorts implicate epigenetic mechanisms as a possible route through which these environmental effects are achieved. In particular, there is evidence that changes in DNA methylation are associated with early life experiences with consequences for gene expression and behavior. Despite the potential stability of DNA methylation, it is apparent that this epigenetic mark can be dynamically modified through pharmacological targeting and behavioral experiences. Developmental plasticity may also be achieved through modification of the juvenile environment. Although these juvenile experiences may lead to common endpoints, there is evidence suggesting that the effects of early and later life experiences may be achieved by different molecular pathways. This review discusses evidence for the role of epigenetic mechanisms in shaping developmental trajectories in response to early life experience as well as the potential plasticity that can occur beyond the perinatal period. These studies have implications for approaches to intervention and suggest the importance of considering individual differences in genetic and epigenetic vulnerability in developing treatment strategies. © The Author(s) 2010.

Teachers' Experiences of Georgia's Early Math Intervention Program: A Phenomenological Study

ERIC Educational Resources Information Center

Scott, Rachel Amanda Garner

2016-01-01

The purpose of this phenomenological study was to investigate the perceptions that K-5 teachers have toward Georgia's mandated Early Intervention Math Program (EIP) on at risk learners in an elementary school in a rural, North Georgia community. The following questions guided the study: 1. How do K-5 teachers describe their experience with…

Onboarding Experiences: An Examination of Early Institutional Advancement Professionals' Decisions

ERIC Educational Resources Information Center

Radosh, Meghan E.

2013-01-01

Onboarding is a new employee orientation process that is designed to formalize and socialize new hires to an organization, or in this case higher education institutions. The onboarding experience that many new employees have can shape employee views and first impressions of their new employer, and shape their early career path to stay or leave…

[Application of portfolio in teaching dermatology clinic: an experience in teaching of medicine].

PubMed

de Cabalier, M E; Chalub, D M

2009-01-01

We present a learning experience conducted in the Chair of Dermatology Clinic of the Faculty of Medical Sciences, National University of Cordoba in the context of curriculum change. For comprehension,present a theoretical framework and practical from the conceptualization of the "portfolio" teaching and its role teaching and learning paradigms sustained constructivist medical education. The portfolio Teach-ing is not a collection of papers, but a coherent set of experiences led thoughtful learning between teachers and students. This resource allows to account for the "qualitative achievements" of students from their work produced, sorted and evaluated in a carefully planned sequence of experiences and case Dermatology Clinic. To introduce the teaching portfolio, the planned new student grouping shapes and a sequence of learning experiences for the construction of this resource, namely: "The development of theoretical material iconographic resources and working guidelines for students. "The clinical reasoning on a case or laboratory experience-Clinical case Discussion and bibliography. -The development of records to from observation of patients. "The study of clinical cases: diagnosis and evolution of clinical cases. Interconsultations-Registration and referrals. "The magazine room and sharing experiences. In each of these, production, tutorial feedback Team teaching and assessment tasks allowed assessment approach to learning and improving he achievements of the students to the approval of the subject.

South Asian patients' views and experiences of clinical trial participation.

PubMed

Hussain-Gambles, Mah

2004-12-01

This paper explores South Asian patients' views and experiences of clinical trial participation, as part of a larger study which sought to assess British South Asian under-representation in clinical trials. The study was based on semi-structured interviews with South Asian trial participants in primary care and specialist treatment centres in the north of England. Fifteen South Asian patients who had participated in one of six different clinical trials to test pharmaceutical products comprised the study cohort. South Asian motivations to participate in clinical trials are similar to those of the majority 'White' population. Clear and concise trial information (provided by caring and understanding trial staff) was considered an important aspect of the respondents' experiences. Appealing to South Asian peoples' altruistic nature by making them aware of South Asian under-representation (especially in clinical trials that investigate illnesses prevalent in their community) was also identified as a strong motivational factor. Potential barriers to their participation included: trial burden (which bears heavily on the poor), language, and discriminatory practices in the NHS, which can lead to mistrust of health professionals. In addition, female modesty and preference for female trial staff was recognized as a 'cultural' barrier to participation. There are more similarities than differences between the experiences of British South Asians and 'White' trial participants. Present findings suggest that ethnicity operates at different levels. In addition to South Asian trial participants' culture, social class and gender are also as likely to affect their participation in clinical trials. To improve South Asian accrual rates, strategies should be designed to take into consideration linguistic differences and improving overall trust in the clinical trial team.

Maturity and medical students' ease of transition into the clinical environment.

PubMed

Shacklady, Jaine; Holmes, Eileen; Mason, Graham; Davies, Ioan; Dornan, Tim

2009-07-01

Medical education has been characterized in terms of points of transition, which are accentuated by lack of relevant prior experience and can lead to extreme positive and negative emotions. Quantify the effect of maturity on medical students' transitions into the clinical environment and identify how experiences of transition might be improved. Eleven weeks after entering the clinical environment, 29 mature students (age over 21 at entry, median age 22) in a horizontally-integrated, predominantly undergraduate entry, problem-based curriculum offering little early clinical exposure and 58 matched non-mature students (median age 18 years) rated their experiences of transition and wrote free text comments about them. 62% of mature students compared with 24% of controls described 'good transitions' (odds ratio [OR] for a good transition 6.1; p = 0.002) and mature students were more likely than controls to describe how they drew on their previous years in medical school (OR 2.7, p = 0.04) and their wider life experiences in making the transition (OR 3.9, p = 0.01). They were less likely to feel confused or daunted. Whether mature or not, prior workplace experience, having learned the theory of medicine by PBL, and being confident in their knowledge and skills helped students' transitions. Both mature and non-mature students valued the support of teachers and peers and would have valued clinical experience earlier. The fact that just a few extra years of life experience made such a large difference to students' experiences of transition illustrates how important social factors are in the personal development of medical students. In respondents' views, early clinical experience and early skills training could ease students' passage into the clerkship phase of their education.

Laparoscopic single port surgery in children using Triport: our early experience.

PubMed

de Armas, Ismael A Salas; Garcia, Isabella; Pimpalwar, Ashwin

2011-09-01

Laparoscopy has become the gold standard technique for appendectomy and cholecystectomy. With the emergence of newer laparoscopic instruments which are roticulating and provide 7 degrees of freedom it is now possible to perform these operations through a single umbilical incision rather than the standard 3-4 incisions and thus lead to more desirable cosmetic results and less postoperative pain. The newer reticulating telescopes provide excellent exposure of the operating field and allow the operations to proceed routinely. Recently, ports [Triports (Olympus surgery)/SILS ports] especially designed for single incision laparoscopic surgery (SILS) have been developed. We herein describe our experience with laparoscopic single port appendectomies and cholecystectomies in children using the Triport. This is a retrospective cohort study of children who underwent single incision laparoscopic surgery between May 2009 and August 2010 at Texas Children's Hospital and Ben Taub General Hospital in Houston Texas by a single surgeon. Charts were reviewed for demographics, type of procedure, operative time, early or late complications, outcome and cosmetic results. Fifty-four patients underwent SILS. A total of 50 appendectomies (early or perforated) and 4 cholecystectomies were performed using this new minimally invasive approach. The average operative time for SILS/LESS appendectomy was 54 min with a range between 25 and 205 min, while operative time for SILS cholecystectomy was 156 min with a range of 75-196 min. Only small percentage (4%) of appendectomies (mostly complicated) were converted to standard laparoscopy, but none were converted to open procedure. All patients were followed up in the clinic after 3-4 weeks. No complications were noted and all patients had excellent cosmetic results. Parents were extremely satisfied with the cosmetic results. SILS/LESS is a safe, minimally invasive approach for appendectomy and cholecystectomy in children. This new approach is

Early breastfeeding experiences of adolescent mothers: a qualitative prospective study

PubMed Central

2012-01-01

Background Teen mothers face many challenges to successful breastfeeding and are less likely to breastfeed than any other population group in the U.S. Few studies have investigated this population; all prior studies are cross-sectional and collect breastfeeding data retrospectively. The purpose of our qualitative prospective study was to understand the factors that contribute to the breastfeeding decisions and practices of teen mothers. Methods This prospective study took place from January through December 2009 in Greensboro, North Carolina in the U.S. We followed the cohort from pregnancy until two weeks after they ceased all breastfeeding and milk expression. We conducted semi-structured interviews at baseline and follow-up, and tracked infant feeding weekly by phone. We analyzed the data to create individual life and breastfeeding journeys and then identified themes that cut across the individual journeys. Results Four of the five teenagers breastfed at the breast for nine days: in contrast, one teen breastfed exclusively for five months. Milk expression by pumping was associated with significantly longer provision of human milk. Breastfeeding practices and cessation were closely connected with their experiences as new mothers in the context of ongoing multiple roles, complex living situations, youth and dependency, and poor knowledge of the fundamentals of breastfeeding and infant development. Breastfeeding cessation was influenced by inadequate breastfeeding skill, physically unpleasant and painful early experiences they were unprepared to manage, and inadequate health care response to real problems. Conclusions Continued breastfeeding depends on a complex interplay of multiple factors, including having made an informed choice and having the skills, support and experiences needed to sustain the belief that breastfeeding is the best choice for them and their baby given their life situation. Teenagers in the US context need to have a positive early

The Eole experiment - Early results and current objectives.

NASA Technical Reports Server (NTRS)

Morel, P.; Bandeen, W.

1973-01-01

The Eole experiment with 480 constant level balloons released in the Southern Hemisphere is described. Each balloon, floating freely at approximately the 200-mb level, is a precise tracer of the horizontal motion of air masses, the accuracy of which is limited only by the laminated structure of the stratospheric flow, within an rms uncertainty of 1.5 m/sec. The balloons were found after 2 months to distribute at random over the whole hemisphere outside the tropics, irrespective of their original launching site. Early results of Eulerian and Lagrangian averages of the Eole wind data are given for describing the mean 200-mb zonal and meridional circulations.

Reflecting on the Challenges of Informal Contexts: Early Field Experiences with Technology in Teacher Education

ERIC Educational Resources Information Center

Lux, Nick; Obery, Amanda; Cornish, Jamie; Grimberg, Bruna Irene; Hartshorn, Anthony

2017-01-01

Early field experiences, or those that come early in a teacher's preparation before more formalized opportunities like practicum and student teaching, can provide a venue for pre service teachers to practice technology-specific instructional decision-making and reflective practice. Although research exists on the potential roles of field…

Testing Drugs and Trying Cures: Experiment and Medicine in Medieval and Early Modern Europe.

PubMed

Leong, Elaine; Rankin, Alisha

2017-01-01

This article examines traditions of testing drugs (as substances) and trying cures (on patients) in medieval and early modern Europe. It argues that the history of drug testing needs to be a more central story to overall histories of scientific experiment. The practice of conducting thoughtful-and sometimes contrived-tests on drugs has a rich and varied tradition dating back to antiquity, which expanded in the Middle Ages and early modern period. Learned physicians paired text-based knowledge (reason) with hands-on testing (experience or experiment) in order to make claims about drugs' properties or effects on humans. Lay practitioners similarly used hands-on testing to gain knowledge of pharmaceutical effects. Although drug testing practices expanded in scale, actors, and sites, therpublished a work extolling the virtues of drugs froe was significant continuity from the Middle Ages to the eighteenth century.

Sociodemographic differences in women's experience of early labour care: a mixed methods study.

PubMed

Henderson, Jane; Redshaw, Maggie

2017-07-13

To explore women's experiences of early labour care focusing on sociodemographic differences, and to examine the effect of antenatal education, using mixed methods. England, 2014. Women who completed postal questionnaires about their experience of maternity care, including questions about antenatal education, early labour and sociodemographic factors, included space for free-text comments. Worries about labour, contact with midwives in early labour and subsequent care. This study was based on secondary analysis of a national maternity survey carried out in England in 2014. Quantitative data were analysed using descriptive statistics and binary logistic regression; qualitative data were analysed using a thematic content analytic approach. Completed questionnaires were received from 4578 women (47% response rate). There were significant differences by sociodemographic factors, particularly ethnicity, in women's worries about early labour. Compared with white women, women from black or minority ethnic groups had an adjusted OR of 1.93 (95% CI 1.56 to 2.39) of feeling worried about not knowing when labour would start. Among women who contacted a midwife at the start of labour, 84% perceived their advice as appropriate, more in older and multiparous women. Overall, 64% of women were asked to come to the hospital at this time, more in multiparous women (adjusted OR 1.63, 95% CI 1.35 to 1.96). Those who did not have access to antenatal education experienced greater worry about early labour. Five themes emerged from the qualitative analysis: 'Differentiating between early and active labour', 'Staff attitudes', 'Not being allowed…', 'Previous labours' and 'Perceived consequences for women'. These findings reinforce the importance of providing reassurance to women in early labour, taking care that women do not feel neglected or dismissed. In particular, primiparous and ethnic minority women reported greater worry about early labour and require additional reassurance. �

Language experience enhances early cortical pitch-dependent responses

PubMed Central

Krishnan, Ananthanarayan; Gandour, Jackson T.; Ananthakrishnan, Saradha; Vijayaraghavan, Venkatakrishnan

2014-01-01

Pitch processing at cortical and subcortical stages of processing is shaped by language experience. We recently demonstrated that specific components of the cortical pitch response (CPR) index the more rapidly-changing portions of the high rising Tone 2 of Mandarin Chinese, in addition to marking pitch onset and sound offset. In this study, we examine how language experience (Mandarin vs. English) shapes the processing of different temporal attributes of pitch reflected in the CPR components using stimuli representative of within-category variants of Tone 2. Results showed that the magnitude of CPR components (Na-Pb and Pb-Nb) and the correlation between these two components and pitch acceleration were stronger for the Chinese listeners compared to English listeners for stimuli that fell within the range of Tone 2 citation forms. Discriminant function analysis revealed that the Na-Pb component was more than twice as important as Pb-Nb in grouping listeners by language affiliation. In addition, a stronger stimulus-dependent, rightward asymmetry was observed for the Chinese group at the temporal, but not frontal, electrode sites. This finding may reflect selective recruitment of experience-dependent, pitch-specific mechanisms in right auditory cortex to extract more complex, time-varying pitch patterns. Taken together, these findings suggest that long-term language experience shapes early sensory level processing of pitch in the auditory cortex, and that the sensitivity of the CPR may vary depending on the relative linguistic importance of specific temporal attributes of dynamic pitch. PMID:25506127

Physiotherapy students' experiences of bullying on clinical internships: a qualitative study.

PubMed

Whiteside, Diana; Stubbs, Brendon; Soundy, Andy

2014-03-01

To consider the experiences of final-year physiotherapy students who have experienced workplace bullying on a clinical internship. Qualitative methodology using individual semi-structured interviews. A university in the Midlands region of the UK. Eight undergraduate physiotherapy students who had experienced one incident of bullying on a clinical internship. Thematic analysis of semi-structured interviews. Four main themes were identified: (1) external and situational influences of bullying; (2) students' reactions to the experience of bullying; (3) inability to reveal the experience; and (4) overcoming problems. Bullying had a range of adverse effects on the students, with many expressing self-doubt in their competence and viewing their supervisor as unapproachable and unsupportive. Five students were not initially able to recognise the experience as bullying. In addition, students did not feel able to report the experience and use the support mechanisms in place. This may have been a result of having concerns that the problem would escalate if they reported the experience and, as a consequence, have a negative effect on their grade. Students were keen to offer a range of strategies for clinical practice in order to prevent bullying for future generations of students. Students' health, security and confidence in their ability as a physiotherapist can be at great risk from bullying. Steps are needed to ensure that students are better protected from bullying, and feel more able to address bullying behaviour during clinical internships. Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Early Experiences with Family Conflict: Implications for Arguments with a Close Friend.

ERIC Educational Resources Information Center

Herrera, Carla; Dunn, Judy

1997-01-01

Examined associations between children's early experiences in family disputes and later conflict management with close friends. Found that argument used by mothers and siblings that considered children's needs was positively associated with children's later constructive argument and resolution techniques. Mothers' use of argument predicted…

Early MIMD experience on the CRAY X-MP

NASA Astrophysics Data System (ADS)

Rhoades, Clifford E.; Stevens, K. G.

1985-07-01

This paper describes some early experience with converting four physics simulation programs to the CRAY X-MP, a current Multiple Instruction, Multiple Data (MIMD) computer consisting of two processors each with an architecture similar to that of the CRAY-1. As a multi-processor, the CRAY X-MP together with the high speed Solid-state Storage Device (SSD) in an ideal machine upon which to study MIMD algorithms for solving the equations of mathematical physics because it is fast enough to run real problems. The computer programs used in this study are all FORTRAN versions of original production codes. They range in sophistication from a one-dimensional numerical simulation of collisionless plasma to a two-dimensional hydrodynamics code with heat flow to a couple of three-dimensional fluid dynamics codes with varying degrees of viscous modeling. Early research with a dual processor configuration has shown speed-ups ranging from 1.55 to 1.98. It has been observed that a few simple extensions to FORTRAN allow a typical programmer to achieve a remarkable level of efficiency. These extensions involve the concept of memory local to a concurrent subprogram and memory common to all concurrent subprograms.

Our clinical experience in low-energy laser medical treatments

NASA Astrophysics Data System (ADS)

Antipa, Ciprian; Bruckner, Ion I.; Crangulescu, Nicolae; Moldovan, Corneliu I.; Podoleanu, Adrian G.; Stanciulescu, Viorica; Ionescu, Elena

1996-05-01

In clinical research the efficiency of low-energy laser (LEL) therapy remains controversial. We present here some of the most important results of our clinical experience in this field. We summarize our opinions about the LEL effects in rheumatic diseases, in chronic pelvic inflammatory disorders, in the treatment of some dermatological disorders, and in the recovery of the distal forearm nerve from traumatic lesion after surgical suture. We conclude that these results may be important evidence for the real clinical efficiency of the LEL.

Detection and Evaluation of Early Breast Cancer via Magnetic Resonance Imaging: Studies of Mouse Models and Clinical Implementation

DTIC Science & Technology

2008-03-01

CONTRACT NUMBER Detection and Evaluation of Early Breast Cancer via Magnetic Resonance Imaging: Studies of Mouse Models and Clinical Implementation...research proposed here can directly lead to clinical improvements in both early breast cancer detection, as well as effective breast cancer therapy. To date... cancer is a major prognostic factor in the management of the disease. In particular, detecting breast cancer in its pre-invasive form as ductal carcinoma

A Systems Perspective on Practicum Experiences in Early Childhood Teacher Education: Focus on Interprofessional Relationships

ERIC Educational Resources Information Center

La Paro, Karen M.; Van Schagen, Amy; King, Elizabeth; Lippard, Christine

2018-01-01

High quality early childhood teachers have a wealth of knowledge and use a range of skills in their daily classroom practices, and research has consistently demonstrated the positive influence effective early childhood teachers have on children's development and long-term outcomes. Given the importance of practicum experiences in the development…

Experiences of clinical teaching for dental core trainees working in hospital.

PubMed

Mannion, C J; Brotherton, P

2014-07-11

There is recognition that the provision of excellence in education and training results in a skilled and competent workforce. However, the educational experiences of dental core trainees (DCT's) working in the hospital oral and maxillofacial surgery (OMFS) setting have not been previously investigated. In this paper, we examine DCT's learning experiences both 'formal' and 'non-formal' within the hospital setting of ward and clinic-based teaching. Are hospital dental core trainees receiving a meaningful educational experience? To conclude this paper, the authors recommend methods, based upon sound educational principles, to maximise the value of clinical sessions for teaching.

Early Identification of Autism

PubMed Central

Webb, Sara Jane; Jones, Emily J.H.

2016-01-01

In the first year of life, infants who later go on to develop autistic spectrum disorders (ASD) may exhibit subtle disruptions in social interest and attention, communication, temperament, and head circumference growth that occur prior to the onset of clinical symptoms. These disruptions may reflect the early course of ASD development and may also contribute to the later development of clinical symptoms through alterations in the child’s experience of his or her environment. By age 2, developmental precursors of autism symptoms can be used to diagnose children reliably, and by age 3, the diagnosis is thought to be relatively stable. The downward extension of the autism diagnosis poses important questions for therapists in designing interventions that are applicable for infants who demonstrate early risk factors. We review current knowledge of the early signs of ASD in the infancy period (0–12 months) and the manifestation of symptoms in toddlerhood (12– 36 months), noting the importance of considering the variability in onset and trajectory of ASD. Finally, we consider the implications of this emerging research for those who work or interact with young children, including the importance of early monitoring and the development and evaluation of age-appropriate interventions. PMID:28090148

Insights from Australian parents into educational experiences in the early postnatal period.

PubMed

McKellar, Lois V; Pincombe, Jan I; Henderson, Ann M

2006-12-01

to investigate the provision of parent education during the early postnatal period in order to gain insight that, through stakeholder collaboration, will contribute to the development of innovative strategies to enhance the provision of postnatal education in a contemporary health-care environment. the study comprises the first stage of an action-research project. The first stage of research sought to explore the experiences of mothers and fathers in the early postnatal period by conducting a questionnaire within 4 weeks of the birth of their baby. The data obtained from the questionnaire is to inform an action-research group for stage two of the project. The Children, Youth and Women's Health Service, a large city maternity hospital in South Australia, covering a range of socio-economic strata. 85 parents completed and returned the questionnaire, comprising 52 mothers and 33 fathers. an anonymous self-report questionnaire was purpose designed to provide each parent with an opportunity to reflect on their own experience, with particular emphasis given to the provision of education and support during the early postnatal period. a number of themes emerged, including a window of opportunity during the postnatal hospital stay to provide education and support, despite the reduction in the length of stay; the need for a family-centred approach to maternity services; and the significance of self and social network in the early transition to parenthood. The findings from this stage of the research, combined with a review of the literature, provide insight that will contribute to stage two of the study. At this stage, an action-research group will continue planning to develop specific actions to enhance the provision of education to parents in the early postnatal period. These actions will subsequently be implemented and assessed.

Implicit Association to Infant Faces: How Genetics, Early Care Experiences, and Cultural Factors Influence Caregiving Propensities

PubMed Central

Senese, Vincenzo Paolo; Shinohara, Kazuyuki; Esposito, Gianluca; Doi, Hirokazu; Venuti, Paola; Bornstein, Marc H.

2018-01-01

Genetics, early experience, and culture shape caregiving, but it is still not clear how genetics, early experiences, and cultural factors might interact to influence specific caregiving propensities, such as adult responsiveness to infant cues. To address this gap, 80 Italian adults (50% M; 18-25 years) were (1) genotyped for two oxytocin receptor gene polymorphisms (rs53576 and rs2254298) and the serotonin transporter gene polymorphism (5-HTTLPR), which are implicated in parenting behaviour, (2) completed the Adult Parental Acceptance/Rejection Questionnaire to evaluate their recollections of parental behaviours toward them in childhood, and (3) were administered a Single Category Implicit Association Test to evaluate their implicit responses to faces of Italian infants, Japanese infants, and Italian adults. Analysis of implicit associations revealed that Italian infant faces were evaluated as most positive; participants in the rs53576 GG group had the most positive implicit associations to Italian infant faces; the serotonin polymorphism moderated the effect of early care experiences on adults’ implicit association to both Italian infant and adult female faces. Finally, 5-HTTLPR S carriers showed less positive implicit responses to Japanese infant faces. We conclude that adult in-group preference extends to in-group infant faces and that implicit responses to social cues are influenced by interactions of genetics, early care experiences, and cultural factors. These findings have implications for understanding processes that regulate adult caregiving. PMID:27650102

Local Matrix Metalloproteinase 9 Level Determines Early Clinical Presentation of ST-Segment-Elevation Myocardial Infarction.

PubMed

Nishiguchi, Tsuyoshi; Tanaka, Atsushi; Taruya, Akira; Emori, Hiroki; Ozaki, Yuichi; Orii, Makoto; Shiono, Yasutsugu; Shimamura, Kunihiro; Kameyama, Takeyoshi; Yamano, Takashi; Yamaguchi, Tomoyuki; Matsuo, Yoshiki; Ino, Yasushi; Kubo, Takashi; Hozumi, Takeshi; Hayashi, Yasushi; Akasaka, Takashi

2016-12-01

Early clinical presentation of ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation myocardial infarction affects patient management. Although local inflammatory activities are involved in the onset of MI, little is known about their impact on early clinical presentation. This study aimed to investigate whether local inflammatory activities affect early clinical presentation. This study comprised 94 and 17 patients with MI (STEMI, 69; non-STEMI, 25) and stable angina pectoris, respectively. We simultaneously investigated the culprit lesion morphologies using optical coherence tomography and inflammatory activities assessed by shedding matrix metalloproteinase 9 (MMP-9) and myeloperoxidase into the coronary circulation before and after stenting. Prevalence of plaque rupture, thin-cap fibroatheroma, and lipid arc or macrophage count was higher in patients with STEMI and non-STEMI than in those with stable angina pectoris. Red thrombus was frequently observed in STEMI compared with others. Local MMP-9 levels were significantly higher than systemic levels (systemic, 42.0 [27.9-73.2] ng/mL versus prestent local, 69.1 [32.2-152.3] ng/mL versus poststent local, 68.0 [35.6-133.3] ng/mL; P<0.01). Poststent local MMP-9 level was significantly elevated in patients with STEMI (STEMI, 109.9 [54.5-197.8] ng/mL versus non-STEMI: 52.9 [33.0-79.5] ng/mL; stable angina pectoris, 28.3 [14.2-40.0] ng/mL; P<0.01), whereas no difference was observed in the myeloperoxidase level. Poststent local MMP-9 and the presence of red thrombus are the independent determinants for STEMI in multivariate analysis. Local MMP-9 level could determine the early clinical presentation in patients with MI. Local inflammatory activity for atherosclerosis needs increased attention. © 2016 American Heart Association, Inc.

Experience with Fingolimod in Clinical Practice

PubMed Central

Hersh, Carrie M.; Hara-Cleaver, Claire; Rudick, Richard A.; Cohen, Jeffrey A.; Bermel, Robert A.; Ontaneda, Daniel

2015-01-01

Aim To report experience with fingolimod in clinical practice. Design/Methods Patients in an academic medical center who were prescribed fingolimod from October 2010 to August 2011 were identified through the electronic medical record and followed for 12 months after fingolimod initiation. Adverse effects, clinical measures, MRI data, and quality of life measures were assessed. Results Three hundred seventeen patients started fingolimod. Eleven patients were treatment naïve (3.5%) and 76 (24.0%) had remote disease modifying therapy use prior to fingolimod. One hundred fifty-one (47.6%) switched because of patient preference and 79 (24.9%) switched because of breakthrough disease. About 11.6% transitioned from natalizumab. Follow-up data were available for 306 patients (96.5%) with mean follow-up time 332 days. Fingolimod was discontinued in 76 of 306 patients (24.8%) at mean 248 days after fingolimod start. Discontinuation most often was due to adverse effects (n=40) or breakthrough disease (n=22). Among patients who started fingolimod with available 12 month follow-up data, 267 (87.3%) remained relapse free and 256 (83.7%) had no relapses or gadolinium enhancement. Time to first relapse occurred at mean 282 days after fingolimod initiation. Quality of life measures remained stable at follow-up. Conclusions Fingolimod was discontinued at a higher rate in clinical practice than in clinical trials. Discontinuation was primarily due to adverse effects or breakthrough disease. Disease activity was adequately controlled in most patients who started fingolimod. This clinical practice cohort is consistent with efficacy data from phase 3 trials and describes the most common tolerability issues in clinical practice. PMID:25271798

Early initial clinical experience with intravitreal aflibercept for wet age-related macular degeneration.

PubMed

Ferrone, Philip J; Anwar, Farihah; Naysan, Jonathan; Chaudhary, Khurram; Fastenberg, David; Graham, Kenneth; Deramo, Vincent

2014-06-01

Age-related macular degeneration (AMD) is a degenerative process that leads to severe vision loss. Wet AMD is defined by choroidal neovascularisation, leading to the accumulation of subretinal fluid (SRF), macular oedema (ME), and pigment epithelium detachments (PED). Purpose To evaluate the initial clinical experience of conversion from bevacizumab or ranibizumab to aflibercept in wet AMD patients. Records of 250 consecutive wet AMD patients were retrospectively reviewed. Of 250 patients, 29 were naive (with no previous treatment), and 221 were previously treated with bevacizumab (1/3) or ranibizumab (2/3). On average, converted patients received 14 injections every 6 weeks on a treat-and-extend regimen with Avastin or Lucentis before being converted to aflibercept every 7 weeks on average (no loading dose) for three doses. For the purposes of this study, we concentrated on the patients converted to aflibercept since the number of naive patients was too small to draw any conclusion from. Snellen (as logMar) visual acuities, and optical coherence tomography (OCT) were compared predrug and postdrug conversion. Converted patients did not show a significant difference in visual acuity or average OCT thickness from preconversion values; however, small improvements in ME (p=0.0001), SRF (p=0.0001), and PED (p=0.008) grading were noted on average after conversion to aflibercept. No significant difference in visual outcome or average OCT thickness was observed when switched from bevacizumab or ranibizumab q6 week to aflibercept 7-week dosing, on average. Mild anatomic improvements did occur in converted patients with regard to ME, SRF and PED improvement, on average, after conversion to aflibercept, and aflibercept was injected less frequently. No serious adverse reactions, including ocular infections or inflammation, as well as ocular and systemic effects were noted. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

Fostering new relational experience: clinical process in couple psychotherapy.

PubMed

Marmarosh, Cheri L

2014-03-01

One of the most critical goals for couple psychotherapy is to foster a new relational experience in the session where the couple feels safe enough to reveal more vulnerable emotions and to explore their defensive withdrawal, aggressive attacking, or blaming. The lived intimate experience in the session offers the couple an opportunity to gain integrative insight into their feelings, expectations, and behaviors that ultimately hinder intimacy. The clinical processes that are necessary include empathizing with the couple and facilitating safety within the session, looking for opportunities to explore emotions, ruptures, and unconscious motivations that maintain distance in the relationship, and creating a new relational experience in the session that has the potential to engender integrative insight. These clinical processes will be presented with empirical support. Experts from a session will be used to highlight how these processes influence the couple and promote increased intimacy. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Dosimetric considerations and early clinical experience of accelerated partial breast irradiation using multi-lumen applicators in the setting of breast augmentation.

PubMed

Akhtari, Mani; Pino, Ramiro; Scarboro, Sarah B; Bass, Barbara L; Miltenburg, Darlene M; Butler, E Brian; Teh, Bin S

2015-12-01

Accelerated partial breast irradiation (APBI) is an accepted treatment option in breast-conserving therapy for early stage breast cancer. However, data regarding outcomes of patients treated with multi-lumen catheter systems who have existing breast implants is limited. The purpose of this study was to report treatment parameters, outcomes, and possible dosimetric correlation with cosmetic outcome for this population of patients at our institution. We report the treatment and outcome of seven consecutive patients with existing breast implants and early stage breast cancer who were treated between 2009 and 2013 using APBI following lumpectomy. All patients were treated twice per day for five days to a total dose of 34 Gy using a high-dose-rate (192)Ir source. Cosmetic outcomes were evaluated using the Harvard breast cosmesis scale, and late toxicities were reported using the Radiation Therapy Oncology Group (RTOG) late radiation morbidity schema. After a mean follow-up of 32 months, all patients have remained cancer free. Six out of seven patients had an excellent or good cosmetic outcome. There were no grade 3 or 4 late toxicities. The average total breast implant volume was 279.3 cc, received an average mean dose of 12.1 Gy, and a maximum dose of 234.1 Gy. The average percentage of breast implant volume receiving 50%, 75%, 100%, 150%, and 200% of the prescribed dose was 15.6%, 7.03%, 4.6%, 1.58%, and 0.46%, respectively. Absolute volume of breast implants receiving more than 50% of prescribed dose correlated with worse cosmetic outcomes. Accelerated partial breast irradiation using a multi-lumen applicator in patients with existing breast implants can safely be performed with promising early clinical results. The presence of the implant did not compromise the ability to achieve dosimetric criteria; however, dose to the implant and the irradiated implant volume may be related with worse cosmetic outcomes.

[Personalized cell therapy for early postoperative bullous keratopathy (experimental proof and clinical results)].

PubMed

Kasparov, A A; Kasparova, Evg A; Fadeeva, L L; Subbot, A M; Borodina, N V; Kasparova, E A; Kobzova, M V; Musaeva, G M; Pavliuk, A S

2013-01-01

The article presents the results of a long-term research on development and clinical application of personalized cell therapy (PCT) for treatment of early postoperative (manifesting within the first 3 months after surgery) bullous keratopathy (BK). The method of intracameral PCT implies in vitro incubation of the patient's blood sample with poly(A:U) stimulator, separation of the serum with activated leukocytes, and injection of the final cell preparation into the anterior chamber. The fundamental part of the research was aimed at a detailed description of the cell preparation and investigation of its possible mechanisms of action. Cytokine and growth factor level in the cell preparation suggested that its high clinical efficacy might be due to its ability to improve regeneration of damaged corneal endothelium. The clinical study was conducted on a group of 52 patients with early BK. A significant effect (smoothing of the Descement's membrane folds, complete resorption of corneal edema, improvement of corneal transparency, reduction of corneal thickness and increase of visual acuity by 0.49 +/- 0.27) was achieved in 44.2% of patients, while partial effect was seen in 21.1% of patients. There was no clinical effect in 34.6% of patients. In those patients who developed significant or partial clinical effect after the PCT, many endotheliocytes appeared to have multiple nuclei (2 and more). In some patients polyploid nuclei persisted for 3-5 years after the treatment. Polyploidy results from incomplete mitosis which might be due to regenerative processes in the endothelium stimulated by the PCT. Obviously, high efficacy and relative simplicity of the method should promote its further clinical introduction.

Implementation of an intraoperative clinical experience for senior level baccalaureate nursing students.

PubMed

Mott, Jason

2012-04-01

Perioperative nursing is a specialty that has been eliminated from many nursing education programs. With the loss of perioperative clinical experiences, the number of students pursuing a career in perioperative nursing after graduation has declined. A faculty member at one Midwestern school of nursing developed and implemented a perioperative clinical experience for senior-level baccalaureate nursing students in a critical care nursing course. This program, developed with the assistance of four local hospitals and the college of nursing, included an eight-hour OR orientation and 56 clinical hours. Students were placed in the OR under preceptor guidance and supervision. Feedback from evaluations was positive and provided recommendations for improving the program, in particular, to allow more clinical hours and more hands-on experience for the students. Copyright © 2012 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Socialization to Student Affairs: Early Career Experiences Associated with Professional Identity Development

ERIC Educational Resources Information Center

Hirschy, Amy S.; Wilson, Maureen E.; Liddell, Debora L.; Boyle, Kathleen M.; Pasquesi, Kira

2015-01-01

In this study, the authors propose and test a model of professional identity development among early career student affairs professionals. Using survey data from 173 new professionals (0-5 years of experience), factor analysis revealed 3 dimensions of professional identity: commitment, values congruence, and intellectual investment. Multivariate…

Developing the Effective Teaching Skills of Teacher Candidates during Early Field Experiences

ERIC Educational Resources Information Center

Welsh, Kelly A.; Schaffer, Connie

2017-01-01

This study examined the development of effective teaching skills in teacher candidates in the context of early field experiences directly tied to a pedagogical course. Evidence from faculty instructors, mentor teachers, and teacher candidates suggests secondary education candidates were able to develop effective teaching skills related to…

Safe Start: How Early Experiences Can Help Reduce Violence. An Ounce of Prevention Fund Paper.

ERIC Educational Resources Information Center

Hawley, Theresa

Noting that many communities have overlooked a promising approach to reducing violence in the United States, this report examines early risk factors for violence and discusses the potential of prevention and intervention programs for children ages birth to 5 years. The report defines violence and discusses the importance of early experiences in…

Coordination of Scheduling Clinical Externship or Clinical Practice Experiences for Students in Physical Therapy Educational Programs.

ERIC Educational Resources Information Center

Patterson, Robert K.; Kass, Susan H.

A project to coordinate the scheduling of allied health occupations students for clinical practice or externship experiences in Southeast Florida is described. A model clinical facility utilization and time schedule matrix was developed for four programs: the physical therapy programs at Florida International University (FIU) and the University of…

Early indicators and risk factors for ethical issues in clinical practice.

PubMed

Pavlish, Carol; Brown-Saltzman, Katherine; Hersh, Mary; Shirk, Marilyn; Nudelman, Olga

2011-03-01

Nurses in all clinical settings encounter ethical issues that frequently lead to moral distress. This critical incident study explored nurses' descriptions of ethically difficult situations to identify risk factors and early indicators of ethical conflicts. Employing the critical incident technique, researchers developed a questionnaire that collected information on ethically difficult situations, their risk factors and early indicators, nurse actions, and situational outcomes. Two nurse researchers independently analyzed and categorized data using a constant comparison technique. Most of the ethically difficult situations pertained to end-of-life care for children and adults. Conflicts in interpersonal relationships were prevalent. Nurses were especially moved by patient and family suffering and concerned about patient vulnerability, harm-benefit ratio, and patient autonomy. Researchers discovered risk factor categories for patients, families, healthcare providers, and health systems. Additionally, researchers found subcategories in six major categories of early indicators: signs of conflict, patient suffering, nurse distress, ethics violation, unrealistic expectations, and poor communication. Nurses are keenly aware of pertinent risk factors and early indicators of unfolding ethical conflicts. Many nurses reported feeling powerless in the face of ethical conflict. Research that develops interventions to strengthen nurses' voices in ethically difficult situation is warranted. Nurses are in a key position to identify patient situations with a high risk for ethical conflict. Initiating early ethics consultation and interventions can alter the course of pending conflicts and diminish the potential for patient and family suffering and nurses' moral distress. © 2011 Sigma Theta Tau International.

Experience of Anti-VEGF Treatment and Clinical Levels of Depression and Anxiety in Patients With Wet Age-Related Macular Degeneration.

PubMed

Senra, Hugo; Balaskas, Konstantinos; Mahmoodi, Neda; Aslam, Tariq

2017-05-01

To investigate detailed patient experiences specific to receiving vascular endothelial growth factor inhibitors (anti-VEGF) for wet age-related macular degeneration (wAMD), and to acquire a snapshot of the frequency of clinically significant levels of depression, anxiety, and posttraumatic stress among patients and levels of burden in patients' carers. Observational cross-sectional mixed-methods study. Three hundred patients with wAMD receiving anti-VEGF treatment and 100 patient carers were recruited. Qualitative data on patients' experience of treatment were collected using a structured survey. Standardized validated questionnaires were used to quantify clinically significant levels of anxiety, depression, and posttraumatic stress, as well as cognitive function and carers' burden. Qualitative data showed that 56% of patients (n = 132) reported anxiety related to anti-VEGF treatment. The main sources of anxiety were fear of going blind owing to intravitreal injections and concerns about treatment effectiveness, rather than around pain. From validated questionnaires, 17% of patients (n = 52) showed clinical levels of anxiety and 12% (n = 36) showed clinical levels of depression. Depression levels, but not anxiety, were significantly higher in patients who received up to 3 injections compared with patients who received from 4 to 12 injections (analysis of variance [ANOVA] P = .027) and compared with patients who received more than 12 injections (ANOVA P = .001). Anti-VEGF treatment is often experienced with some anxiety related to treatment, regardless of the number of injections received. Clinical levels of depression seem to be more frequent in patients at early stages of anti-VEGF treatment. Strategies to improve patient experience of treatment and minimize morbidity are suggested. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Learning and teaching clinical communication in the clinical workplace.

PubMed

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.

[The community-oriented experience of early intervention services in Taipei City].

PubMed

Chu, Feng-Ying

2007-10-01

The purpose of this paper is to emphasize the importance of early intervention. The purpose of early intervention in Taipei City is to help child development, promote parenting skills, and reduce educational and social costs. In order to meet these goals, parenting groups and Taipei City Council have made great efforts to make early intervention work in Taipei City. In April 1995, Taipei City Government started planning and setting up the service network. To date, Taipei City has set up one reporting and referral center?, ?six community resources centers, 22 medical assessment and intervention clinics, 12 child development centers, one early intervention training center, three non-profit foundations and more than 300 inclusion schools, such as kindergartens and day care centers. With parent participation, professional devotion and Taipei City Government's commitment, the number of assisted children has increased from 98 to 2,523 /year. By the end of 2006, Taipei had already funded 25,277 children. We estimate Taipei City early intervention services to have affected at least 75,000 persons, including development-delayed and disabled children, their parents?, ?grandparents and siblings. We found that early intervention services help the children to build up self esteem, grow their potential, learn how to socialize, and receive an education, while the most important aim is to help them to reduce their level of disability or to prevent them from getting worse. At the same time, their families get support and a diverse range of services. An integrated early intervention program should include children, families, and multidisciplinary professionals. The system should therefore be more "family-centered" and "community-oriented" to provide appropriate services to children and families through a positive and aggressive attitude.

Clinical experience with Gray's minithyrotomy procedure.

PubMed

Paniello, Randal C; Sulica, Lucian; Khosla, Siddarth M; Smith, Marshall E

2008-06-01

Endoscopic approaches for submucosal vocal fold surgery may limit the surgeon's ability to release scars or to precisely implant filler material such as fat. In 1999, Gray et al described the "minithyrotomy" approach to this region. Technical aspects of this important new technique, clinical indications, and early results are reviewed. We performed a retrospective review and compiled the data of the office records, clinical notes, and videostroboscopic examinations of all of the four authors' patients who underwent this procedure. Twenty-one patients underwent 22 minithyrotomy procedures for vocal fold scarring (6), lateralizing scar following polytetrafluoroethylene removal or trauma (5), scar with radiation fibrosis (2), sulcus vocalis (2), or presbylarynx or bowing (6) - bilaterally in 14 operations and unilaterally in 8. There were 13 male patients and 8 female patients, with a mean age of 58.3 years (range, 22 to 87 years). The mean follow-up was 9.1 months (range, 1 to 46 months). After submucosal vocal fold exploration, autologous fat was implanted in 20 of the 21 patients. Postoperative videostroboscopy demonstrated improved mucosal pliability in 19 cases and improved glottal closure in 20 cases. Most patients noted voice improvement. Complications were minimal. Gray's minithyrotomy is a highly effective approach for treating vocal fold scar processes, bowing, sulcus vocalis, and, potentially, other conditions.

Clinical reasoning of Filipino physical therapists: Experiences in a developing nation.

PubMed

Rotor, Esmerita R; Capio, Catherine M

2018-03-01

Clinical reasoning is essential for physical therapists to engage in the process of client care, and has been known to contribute to professional development. The literature on clinical reasoning and experiences have been based on studies from Western and developed nations, from which multiple influencing factors have been found. A developing nation, the Philippines, has distinct social, economic, political, and cultural circumstances. Using a phenomenological approach, this study explored experiences of Filipino physical therapists on clinical reasoning. Ten therapists working in three settings: 1) hospital; 2) outpatient clinic; and 3) home health were interviewed. Major findings were: a prescription-based referral system limited clinical reasoning; procedural reasoning was a commonly experienced strategy while diagnostic and predictive reasoning were limited; factors that influenced clinical reasoning included practice setting and the professional relationship with the referring physician. Physical therapists' responses suggested a lack of autonomy in practice that appeared to stifle clinical reasoning. Based on our findings, we recommend that the current regulations governing PT practice in the Philippines may be updated, and encourage educators to strengthen teaching approaches and strategies that support clinical reasoning. These recommendations are consistent with the global trend toward autonomous practice.

A Clinical Update on Delirium: From Early Recognition to Effective Management

PubMed Central

Cerejeira, Joaquim; Mukaetova-Ladinska, Elizabeta B.

2011-01-01

Delirium is a neuropsychiatric syndrome characterized by altered consciousness and attention with cognitive, emotional and behavioural symptoms. It is particularly frequent in elderly people with medical or surgical conditions and is associated with adverse outcomes. Predisposing factors render the subject more vulnerable to a congregation of precipitating factors which potentially affect brain function and induce an imbalance in all the major neurotransmitter systems. Early diagnosis of delirium is crucial to improve the prognosis of patients requiring the identification of subtle and fluctuating signs. Increased awareness of clinical staff, particularly nurses, and routine screening of cognitive function with standardized instruments, can be decisive to increase detection rates of delirium. General measures to prevent delirium include the implementation of protocols to systematically identify and minimize all risk factors present in a particular clinical setting. As soon as delirium is recognized, prompt removal of precipitating factors is warranted together with environmental changes and early mobilization of patients. Low doses of haloperidol or olanzapine can be used for brief periods, for the behavioural control of delirium. All of these measures are a part of the multicomponent strategy for prevention and treatment of delirium, in which the nursing care plays a vital role. PMID:21994844

Early Field Experience Innovations to Increase Positive Impact on K-12 Students

ERIC Educational Resources Information Center

Case, Anny Fritzen; Traynor, John

2016-01-01

This paper describes several innovations to an early field experience emerging from a community, school, and university partnership focused on a middle school serving diverse students from low-income neighborhoods. With the primary goal of utilizing teaching candidates to provide direct academic, social, and instructional support to the middle…

Early Childhood Development and Social Integration: The Mediterranean Experience. A Background Paper.

ERIC Educational Resources Information Center

van Oudenhoven, Nico; Wazir, Rekha

This paper explores early childhood education (ECD) and social integration within a common framework and against the backdrop of experience gained in these fields in the following 12 Mediterranean nations: Algeria, Cyprus, Egypt, Israel, Jordan, Lebanon, Malta, Morocco, Palestine, Syrian Arab Republic, Tunisia, and Turkey. The paper notes that…

Experiences, Perceived Challenges, and Support Systems of Early College High School Students

ERIC Educational Resources Information Center

Sáenz, Karen P.; Combs, Julie P.

2015-01-01

In this qualitative study, the prior experiences, perceived challenges, and support systems of 17 Grade 12 Hispanic students at an early college high school were explored using the framework of social capital theory. Utilizing Moustakas's phenomenological design, data were collected using focus group and individuals interviews. Several themes…

Feedback in clinical practice: Enhancing the students' experience through action research.

PubMed

Adamson, Elizabeth; King, Linda; Foy, Lynn; McLeod, Margo; Traynor, Jennifer; Watson, Wendy; Gray, Morag

2018-05-01

Feedback within clinical practice is known to be central to the learning and development of student nurses and midwives. A study that focused on student experience of assessment identified that a high proportion of students reported that they had received insufficient feedback whilst on clinical placement. In response to this academics and members of the clinical education team set out to explore this with a view to improving the student experience using action research. Key findings indicated that responsibility for feedback on clinical placement lies with both students and mentors, distinct factors can enable effective feedback and that positive outcomes for mentors and students resulted through engaging with the project. The process, outcomes and actions taken to improve practice are the focus of this paper. Copyright © 2018 Elsevier Ltd. All rights reserved.

Identifying key features of early stressful experiences that produce stress vulnerability and resilience in primates

PubMed Central

Parker, Karen J.; Maestripieri, Dario

2010-01-01

This article examines the complex role of early stressful experiences in producing both vulnerability and resilience to later stress-related psychopathology in a variety of primate models of human development. Two types of models are reviewed: Parental Separation Models (e.g., isolate-rearing, peer-rearing, parental separations, and stress inoculation) and Maternal Behavior Models (e.g., foraging demands, variation in maternal style, and maternal abuse). Based on empirical evidence, it is argued that early life stress exposure does not increase adult vulnerability to stress-related psychopathology as a linear function, as is generally believed, but instead reflects a quadratic function. Features of early stress exposure including the type, duration, frequency, ecological validity, sensory modality, and developmental timing, within and between species, are identified to better understand how early stressful experiences alter neurobiological systems to produce such diverse developmental outcomes. This article concludes by identifying gaps in our current knowledge, providing directions for future research, and discussing the translational implications of these primate models for human development and psychopathology. PMID:20851145

Early Generalized Overgrowth in Autism Spectrum Disorder: Prevalence Rates, Gender Effects, and Clinical Outcomes

PubMed Central

Campbell, Daniel J.; Chang, Joseph; Chawarska, Katarzyna

2014-01-01

Objective Although early head and body overgrowth have been well-documented in autism spectrum disorder (ASD), their prevalence and significance remain unclear. It is also unclear whether overgrowth affects males and females differentially, and whether it is associated with clinical outcomes later in life. Method To evaluate prevalence of somatic overgrowth, gender effects, and associations with clinical outcomes, head circumference, height, and weight measurements were collected retrospectively between birth and 2 years of age in toddlers with ASD (n=200) and typically developing (TD; n=147) community controls. Symptom severity, verbal, and nonverbal functioning were assessed at 4 years. Results Abnormalities in somatic growth in infants with ASD were consistent with early generalized overgrowth (EGO). Boys but not girls with ASD were larger and exhibited an increased rate of extreme EGO compared to community controls (18.0% versus 3.4%). Presence of a larger body at birth and postnatal overgrowth were associated independently with poorer social, verbal, and nonverbal skills at 4 years. Conclusion Although early growth abnormalities in ASD are less common than previously thought, their presence is predictive of lower social, verbal, and nonverbal skills at 4 years, suggesting that they may constitute a biomarker for identifying toddlers with ASD at risk for less-optimal outcomes. The results highlight that the search for mechanisms underlying atypical brain development in ASD should consider factors responsible for both neural and non-neural tissue development during prenatal and early postnatal periods, and can be informed by the finding that early overgrowth may be more readily observed in males than females with ASD. PMID:25245350

Early visual experience and the recognition of basic facial expressions: involvement of the middle temporal and inferior frontal gyri during haptic identification by the early blind.

PubMed

Kitada, Ryo; Okamoto, Yuko; Sasaki, Akihiro T; Kochiyama, Takanori; Miyahara, Motohide; Lederman, Susan J; Sadato, Norihiro

2013-01-01

Face perception is critical for social communication. Given its fundamental importance in the course of evolution, the innate neural mechanisms can anticipate the computations necessary for representing faces. However, the effect of visual deprivation on the formation of neural mechanisms that underlie face perception is largely unknown. We previously showed that sighted individuals can recognize basic facial expressions by haptics surprisingly well. Moreover, the inferior frontal gyrus (IFG) and posterior superior temporal sulcus (pSTS) in the sighted subjects are involved in haptic and visual recognition of facial expressions. Here, we conducted both psychophysical and functional magnetic-resonance imaging (fMRI) experiments to determine the nature of the neural representation that subserves the recognition of basic facial expressions in early blind individuals. In a psychophysical experiment, both early blind and sighted subjects haptically identified basic facial expressions at levels well above chance. In the subsequent fMRI experiment, both groups haptically identified facial expressions and shoe types (control). The sighted subjects then completed the same task visually. Within brain regions activated by the visual and haptic identification of facial expressions (relative to that of shoes) in the sighted group, corresponding haptic identification in the early blind activated regions in the inferior frontal and middle temporal gyri. These results suggest that the neural system that underlies the recognition of basic facial expressions develops supramodally even in the absence of early visual experience.

Evaluation of the Clinical Learning Experience of Nursing Students: a Cross-Sectional Descriptive Study.

PubMed

Gurková, Elena; Žiaková, Katarína

2018-05-18

The purpose of the cross-sectional descriptive study was to explore and compare the students' experiences of the clinical environment and supervision in Slovakia. Students' clinical learning experience were measured by the valid and reliable clinical learning instrument. A higher frequency of successful supervisory experience was found in the universities which provided accredited mentor preparation programmes or courses and individualised supervisory approaches. Frequency of supervision meetings, the occupational title of a supervisor and mainly the supervision model have an association with students 'perceptions of different domains of clinical learning environment. The duration of the placement was not related to students' experience and perceptions of the learning environment. Slovak students reported higher score regarding the quality of nursing care or ward culture than in the supervisory relationships between students, clinical and school staff. Further studies in this field, extended to different Eastern European countries and clinical settings, may help us to understand factors affecting workplace training.

Reflective Processes: A Qualitative Study Exploring Early Learning Student Teacher Mentoring Experiences in Student Teaching Practicums

ERIC Educational Resources Information Center

Barnes, Michelle M.

2013-01-01

This doctoral thesis explored mentoring in early learning teacher preparation programs. This study explored the reflective processes embedded in the work between student teachers and their mentors during early learning student teacher experiences at Washington State community and technical colleges. Schon's (1987a) concepts of…

Predicting medical school and internship success: does the quality of the research and clinical experience matter?

PubMed

Paolino, Nathalie D; Artino, Anthony R; Saguil, Aaron; Dong, Ting; Durning, Steven J; DeZee, Kent J

2015-04-01

This article explores specific aspects of self-reported clinical and research experience and their relationship to performance in medical training. This is a retrospective cohort study conducted at the Uniformed Services University. The American Medical College Application Service application was used to discern students' self-reported clinical and research experience. Two authors applied a classification scheme for clinical and research experience to the self-reported experiences. Study outcomes included medical school grade point average (GPA), U.S. Medical Licensing Examination (USMLE) scores, and intern expertise and professionalism scores. A linear regression analysis was conducted for each outcome while controlling for prematriculation GPA. Data were retrieved on 1,020 matriculants. There were several statistically significant but small differences across outcomes when comparing the various categories of clinical experience with no clinical experience. The technician-level experience group had a decrease of 0.1 in cumulative GPA in comparison to students without self-reported clinical experience (p = 0.004). This group also performed 5 points lower on the USMLE Step 2 than students who did not report clinical experience (p = 0.013). The various levels of self-reported research experience were unrelated to success in medical school and graduate medical education. These findings indicate that self-reported technician-level clinical experience is related to a small reduction in typically reported outcomes in medical school. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Quality of breast cancer early detection services conducted by well woman clinics in the district of Gampaha, Sri Lanka.

PubMed

Vithana, Palatiyana Vithanage Sajeewanie Chiranthika; Ariyaratne, May; Jayawardana, Pl

2013-01-01

Breast cancer is the most common cancer diagnosed in females in Sri Lanka and early detection can lead to reduction in morbidity and mortality. To evaluate selected aspects of breast cancer early detection services implemented through well woman clinics (WWCs) in the Gampaha District. The study consisted of two components. A retrospective descriptive arm assessed clinical breast examination (CBE) coverage of target age group women (TGW) of 35-59 years in all the WWCs in Gampaha district over 2003- 2007. A cross sectional descriptive study additionally assessed quality of breast cancer early detection services. The Lot Quality Assurance Sampling (LQAS) technique was used to decide on the lot size and threshold values, which were computed as twenty and six clinics. Checklists were employed in assessing coverage, physical facilities and clinic activities. Client satisfaction on WWC services was assessed among 200 TGW attending 20 WWCs using an interviewer-administered questionnaire. CBE coverage in the Gampaha district increased only from 1.1-2.2% over 2003-2007. With regard to physical facilities, the number of clinics that were rated substandard varied between 7-18 (35- 90%). The items that were lacking included dust bins, notice boards, stationary, furniture and linen, and cleanliness of outside premises and toilets. With regard to clinic activities, punctuality of staff, late commencement of clinics, provision of health education, supervision, CBE and breast self-examination (BSE) were substandard in 7- 20 clinics (35-100%). Client satisfaction for WWC services was 45.2% (IQR: 38.7-54.8%) and only 11% had a score of ≥70%, the cut off set for satisfaction. Breast cancer early detection service coverage in the Gampaha district remained low (2.2%) in 2007, 11 years after commencing WWCs. All 20 clinics were substandard for overall CBE and BSE.

Clinical experience does not correlate with the perceived need for cardiopulmonary resuscitation training.

PubMed

Lunz, Dirk; Brandl, Anita; Lang, Klaus; Weiss, Berthold; Haneya, Assad; Pühler, Thomas; Graf, Bernhard M; Zausig, York A

2013-02-01

The efficiency of cardiopulmonary resuscitation (CPR) training is dependent upon different influencing factors, such as the presented concepts, the participants' willingness to learn, and the interval between training sessions. However, the optimal interval for refreshing CPR training is less clear. We evaluated the perceived need of simulator-based CPR training for nurses and correlated it with their clinical experience. The 60 invited nurses were trained in simulator-based CPR. Knowledge about adult advanced life support was evaluated using a questionnaire after training, and participants rated their desired individual frequency of simulator-based training as well as the value of the presented training using a six-point Likert scale. The same questions were asked again after 1 year. All participants agreed about the usefulness of this type of simulator-based training. The average number of correct answers about typical facts in adult advanced life support showed an almost bell-shaped distribution, with the highest point at 6-15 years of clinical experience and the lowest points at≤5 and≥21 years. The desired training-frequency need was inversely correlated with clinical experience. There is a high interest in CPR training among nursing staff. Self-assessment about the training-frequency need was inversely correlated with clinical experience. However, the average number of correct answers on resuscitation questions decreased with clinical experience. Therefore, the training effectiveness seems to be extremely dependent on clinical experience, and therefore, training experienced senior nurses might be more challenging than training novice nurses. Copyright © 2013 Elsevier Inc. All rights reserved.

Philosophy of experiment in early modern England: the case of Bacon, Boyle and Hooke.

PubMed

Anstey, Peter R

2014-01-01

Serious philosophical reflection on the nature of experiment began in earnest in the seventeenth century. This paper expounds the most influential philosophy of experiment in seventeenth-century England, the Bacon-Boyle-Hooke view of experiment. It is argued that this can only be understood in the context of the new experimental philosophy practised according to the Baconian theory of natural history. The distinctive typology of experiments of this view is discussed, as well as its account of the relation between experiment and theory. This leads into an assessment of other recent discussions of early modern experiment, namely, those of David Gooding, Thomas Kuhn, J.E. Tiles and Peter Dear.

Early experiences with family conflict: implications for arguments with a close friend.

PubMed

Herrera, C; Dunn, J

1997-09-01

This study examined associations between children's early experiences in family disputes and their later management of conflicts with a close friend. Thirty-seven children were observed interacting with their mother and older sibling at 33 months and with a friend at 72 months. Children's early use of argument was not associated with their later behavior during disputes with a friend. However, argument used by the mother and sibling that considered the child needs was positively associated with the child's later use of constructive argument and resolution techniques. The mother's use of argument that focused on her own needs was negatively related to these outcomes. These associations were independent of global characteristics of the mother-child and sibling relationships. Moreover, the mother's use of argument predicted the child's later conflict management independent of the child's early argument patterns, emotion understanding, and verbal fluency.

Teacher Attunement: Supporting Students' Peer Experiences in the Early Elementary Classroom

ERIC Educational Resources Information Center

Hoffman, Abigail S.

2012-01-01

This multi-method, longitudinal study examines the role of teacher attunement (teacher accuracy in identifying the peer group memberships of individual students) in children's peer experiences in early elementary classrooms (1st-3rd grades). Social cognitive mapping (SCM) procedures assessed and compared students' and teachers'…

DNA Methylation: A Mechanism for Embedding Early Life Experiences in the Genome

ERIC Educational Resources Information Center

Szyf, Moshe; Bick, Johanna

2013-01-01

Although epidemiological data provide evidence that early life experience plays a critical role in human development, the mechanism of how this works remains in question. Recent data from human and animal literature suggest that epigenetic changes, such as DNA methylation, are involved not only in cellular differentiation but also in the…

Quantifying risk of early relapse in patients with first demyelinating events: Prediction in clinical practice.

PubMed

Spelman, Tim; Meyniel, Claire; Rojas, Juan Ignacio; Lugaresi, Alessandra; Izquierdo, Guillermo; Grand'Maison, Francois; Boz, Cavit; Alroughani, Raed; Havrdova, Eva; Horakova, Dana; Iuliano, Gerardo; Duquette, Pierre; Terzi, Murat; Grammond, Pierre; Hupperts, Raymond; Lechner-Scott, Jeannette; Oreja-Guevara, Celia; Pucci, Eugenio; Verheul, Freek; Fiol, Marcela; Van Pesch, Vincent; Cristiano, Edgardo; Petersen, Thor; Moore, Fraser; Kalincik, Tomas; Jokubaitis, Vilija; Trojano, Maria; Butzkueven, Helmut

2017-09-01

Characteristics at clinically isolated syndrome (CIS) examination assist in identification of patient at highest risk of early second attack and could benefit the most from early disease-modifying drugs (DMDs). To examine determinants of second attack and validate a prognostic nomogram for individualised risk assessment of clinical conversion. Patients with CIS were prospectively followed up in the MSBase Incident Study. Predictors of clinical conversion were analysed using Cox proportional hazards regression. Prognostic nomograms were derived to calculate conversion probability and validated using concordance indices. A total of 3296 patients from 50 clinics in 22 countries were followed up for a median (inter-quartile range (IQR)) of 1.92 years (0.90, 3.71). In all, 1953 (59.3%) patients recorded a second attack. Higher Expanded Disability Status Scale (EDSS) at baseline, first symptom location, oligoclonal bands and various brain and spinal magnetic resonance imaging (MRI) metrics were all predictors of conversion. Conversely, older age and DMD exposure post-CIS were associated with reduced rates. Prognostic nomograms demonstrated high concordance between estimated and observed conversion probabilities. This multinational study shows that age at CIS onset, DMD exposure, EDSS, multiple brain and spinal MRI criteria and oligoclonal bands are associated with shorter time to relapse. Nomogram assessment may be useful in clinical practice for estimating future clinical conversion.

SheppHeartCABG trial—comprehensive early rehabilitation after coronary artery bypass grafting: a protocol for a randomised clinical trial

PubMed Central

Moons, Philip; Hansen, Niels Viggo; La Cour, Søren; Olsen, Peter Skov; Gluud, Christian; Winkel, Per; Lindschou, Jane; Thygesen, Lau Caspar; Egerod, Ingrid; Berg, Selina Kikkenborg

2017-01-01

Introduction Patients undergoing coronary artery bypass graft surgery often experience a range of symptoms. Studies indicate that non-pharmacological interventions such as exercise training and psychoeducation have a positive physiological and psychological effect in early outpatient rehabilitation. The SheppHeartCABG trial will investigate the effect of early comprehensive rehabilitation in early phase rehabilitation versus usual care. The aim of this paper is to present the protocol for the SheppHeartCABG trial. Methods/analysis SheppHeartCABG is an investigator-initiated randomised clinical superiority trial with blinded outcome assessment, employing 1:1 central randomisation to rehabilitation plus usual care versus usual care alone. On the basis of a sample size calculation, 326 patients undergoing coronary artery bypass grafting will be included from two clinical sites. All patients receive usual care and patients allocated to the experimental intervention follow 4 weeks rehabilitation consisting of an exercise programme, psycho-educative consultations and a compact mindfulness programme. The primary outcome is physical function measured by the 6-min walk test. The secondary outcomes are mental health and physical activity measured by the Medical Outcome Study Short Form (SF-12), anxiety and depression measured by the Hospital Anxiety and Depression Scale questionnaire, physical, emotional and global scores by the HeartQoL questionnaire, sleep measured by the Pittsburgh Sleep Quality Index, pain measured by the Örebro Musculoskeletal Screening Questionnaire and muscle endurance measured by the sit-to-stand test. A number of explorative analyses will also be conducted. Ethics and dissemination SheppHeartCABG is approved by the regional ethics committee (no. H-4-2014-109) and the Danish Data Protection Agency (no. 30-1309) and is performed in accordance with good clinical practice and the Declaration of Helsinki in its latest form. Positive, neutral and

Clinicians' experiences with the fragile X clinical and research consortium.

PubMed

Liu, Jessica A; Hagerman, Randi J; Miller, Robert M; Craft, Lisa T; Finucane, Brenda; Tartaglia, Nicole; Berry-Kravis, Elizabeth M; Sherman, Stephanie L; Kidd, Sharon A; Cohen, Jeffrey

2016-12-01

The objectives of the study were to assess the attitudes and experiences of clinicians involved in a consortium of clinics serving people with fragile X-associated disorders to gauge satisfaction with the consortium and its efforts to improve quality of life for patients and the community. An internet survey was sent to 26 fragile X (FX) clinic directors participating in the Fragile X Clinical and Research Consortium (FXCRC). Respondents were asked to complete 19 questions on consortium performance and outcomes relevant for their own clinic. The response rate was 84% (22/26), with two surveys providing incomplete data. Assistance with clinic establishment, opportunities for research collaborations, and access to colleagues and information were highly valued. Approximately 76% of clinicians reported improvements in patient care and 60% reported an increase in patient services. There was a 57% increase in participation in a FX-related clinical trial among clinics since joining the FXCRC (24% vs. 81%). Overall, respondents reported primarily positive experiences from participation in the FXCRC. Common suggestions for improvement included additional financial support and increased utilization of collected patient data for research purposes. Additionally, a Clinic Services Checklist was administered annually to examine changes in services offered over time. There were several important changes regarding the provision of services by clinics, often with multiple clinics changing with respect to a service. In conclusion, the FXCRC has led to the establishment and sustainment of fragile X clinics in the U.S., fostered cooperation among fragile X clinicians, and provided clinics with a platform to share recommendations and best practices to maximize quality of life for their patients and the overall fragile X community. The results from the survey and checklist also provide suggestions to strengthen the FXCRC and enhance future collaborations among FXCRC members. © 2016

Practicum and clinical experiences: postpracticum students' views.

PubMed

Ralph, Edwin; Walker, Keith; Wimmer, Randolph

2009-08-01

The clinical or practicum component of preservice undergraduate education across all disciplines typically is rated by prebaccalaureate students as the most important phase of their entire professional preparation. This study collected e-mail survey responses from 63 post-practicum nursing students who had just completed their culminating fourth-year clinical course. Students identified the most positive and the most negative aspects of that final practicum experience. These responses were compared with those reported by postpracticum students from the disciplines of engineering and teacher education. The cross-disciplinary similarity of these data related to postpracticum students' perceptions of this experiential learning phase of their preservice professional training was noted. The student voice provides a critical dimension to the program-enhancement process for all professional disciplines, and practicum organizers across the disciplines should value such student input and collaborate to improve the clinical phase of preservice education for all professions. Copyright 2009, SLACK Incorporated.

Getting comfortable with death & near-death experiences. Near-death experiences: an essay in medicine & philosophy.

PubMed

Moody, Raymond A

2013-01-01

Near-death experiences are an ancient and very common phenomenon that spans from ancient philosophy, religion and healing to the most modern clinical practice of medicine. Probably we are not much closer to an ultimate explanation of NDEs than were early thinkers like Plato and Democritus. Puzzling cases of near-death experiences continue to come to light and the ancient debate about what they mean continues unabated.

Synchronising Pedagogy and Musical Experiences in Early Childhood: Addressing Challenges in Preschool Music Education in Kenya

ERIC Educational Resources Information Center

Andang'o, Elizabeth A.

2009-01-01

This paper examines pedagogy in early childhood music education and the resultant learning experiences in music for children in Kenyan preschools. Two important principles proposed for the synchronisation of teaching and learning in early childhood music education are cultural relevance and developmental appropriateness. These terms are…

Learning Clinical Procedures Through Internet Digital Objects: Experience of Undergraduate Students Across Clinical Faculties.

PubMed

Li, Tse Yan; Gao, Xiaoli; Wong, Kin; Tse, Christine Shuk Kwan; Chan, Ying Yee

2015-04-14

Various digital learning objects (DLOs) are available via the World Wide Web, showing the flow of clinical procedures. It is unclear to what extent these freely accessible Internet DLOs facilitate or hamper students' acquisition of clinical competence. This study aimed to understand the experience of undergraduate students across clinical disciplines-medicine, dentistry, and nursing-in using openly accessible Internet DLOs, and to investigate the role of Internet DLOs in facilitating their clinical learning. Mid-year and final-year groups were selected from each undergraduate clinical degree program of the University of Hong Kong-Bachelor of Medicine and Bachelor of Surgery (MBBS), Bachelor of Dental Surgery (BDS), and Bachelor of Nursing (BNurs). All students were invited to complete a questionnaire on their personal and educational backgrounds, and their experiences and views on using Internet DLOs in learning clinical procedures. The questionnaire design was informed by the findings of six focus groups. Among 439 respondents, 97.5% (428/439) learned a variety of clinical procedures through Internet DLOs. Most nursing students (107/122, 87.7%) learned preventive measures through Internet DLOs, with a lower percentage of medical students (99/215, 46.0%) and dental students (43/96, 45%) having learned them this way (both P<.001). Three-quarters (341/439, 77.7%) of students accessed DLOs through public search engines, whereas 93.2% (409/439) accessed them by watching YouTube videos. Students often shared DLOs with classmates (277/435, 63.7%), but rarely discussed them with teachers (54/436, 12.4%). The accuracy, usefulness, and importance of Internet DLOs were rated as 6.85 (SD 1.48), 7.27 (SD 1.53), and 7.13 (SD 1.72), respectively, out of a high score of 10. Self-exploration of DLOs in the unrestricted Internet environment is extremely common among current e-generation learners and was regarded by students across clinical faculties as an important supplement to

The effect of adult Early Warning Systems education on nurses' knowledge, confidence and clinical performance: A systematic review.

PubMed

Saab, Mohamad M; McCarthy, Bridie; Andrews, Tom; Savage, Eileen; Drummond, Frances J; Walshe, Nuala; Forde, Mary; Breen, Dorothy; Henn, Patrick; Drennan, Jonathan; Hegarty, Josephine

2017-11-01

This review aims to determine the effect of adult Early Warning Systems education on nurses' knowledge, confidence and clinical performance. Early Warning Systems support timely identification of clinical deterioration and prevention of avoidable deaths. Several educational programmes have been designed to help nurses recognize and manage deteriorating patients. Little is known as to the effectiveness of these programmes. Systematic review. Academic Search Complete, CINAHL, MEDLINE, PsycINFO, PsycARTICLES, Psychology and Behavioral Science Collection, SocINDEX and the UK & Ireland Reference Centre, EMBASE, the Turning Research Into Practice database, the Cochrane Central Register of Controlled Trials (CENTRAL) and Grey Literature sources were searched between October and November 2015. This is a quantitative systematic review using Cochrane methods. Studies published between January 2011 - November 2015 in English were sought. The risk of bias, level of evidence and the quality of evidence per outcome were assessed. Eleven articles with 10 studies were included. Nine studies addressed clinical performance, four addressed knowledge and two addressed confidence. Knowledge, vital signs recording and Early Warning Score calculation were improved in the short term. Two interventions had no effect on nurses' response to clinical deterioration and use of communication tools. This review highlights the importance of measuring outcomes using standardized tools and valid and reliable instruments. Using longitudinal designs, researchers are encouraged to investigate the effect of Early Warning Systems educational programmes. These can include interactive e-learning, on-site interdisciplinary Early Warning Scoring systems training sessions and simulated scenarios. © 2017 John Wiley & Sons Ltd.

Teachers' Clinical Experiences and Attitudes toward Technology Inclusion

ERIC Educational Resources Information Center

Paganelli, Andrea Lynch

2010-01-01

The purpose of this qualitative multisite case study is to examine participants' attitudes toward technology, types of technology available for participant use, and the extent to which technology is used by preservice and mentor teachers during clinical experiences. Research supports the benefit of improved attitudes toward technology integration…

Clinical monitoring of early caries lesions using cross polarization optical coherence tomography

NASA Astrophysics Data System (ADS)

Fried, Daniel; Staninec, Michal; Darling, Cynthia L.; Chan, Kenneth H.; Pelzner, Roger B.

New methods are needed for the nondestructive measurement of tooth demineralization and remineralization and to monitor the progression of incipient caries lesions (tooth decay) for effective nonsurgical intervention and to evaluate the performance of anti-caries treatments such as chemical treatments or laser irradiation. Studies have shown that optical coherence tomography (OCT) has great potential to fulfill this role, since it can be used to measure the depth and severity of early lesions with an axial resolution exceeding 10-μm. It is easy to apply in vivo and it can be used to image the convoluted topography of tooth occlusal surfaces. In this paper we present early results from two clinical studies underway to measure the effect of fluoride intervention on early lesions. CP-OCT was used to monitor early lesions on enamel and root surfaces before and after intervention with fluoride varnish. The lesion depth and internal structure were resolved for all the lesions examined and some lesions had well defined surface zones of lower reflectivity that may be indicative of arrested lesions. Changes were also noted in the structure of some of the lesions after fluoride intervention.

Pancreatic cancer early detection: Expanding higher-risk group with clinical and metabolomics parameters

PubMed Central

Urayama, Shiro

2015-01-01

Pancreatic ductal adenocarcinoma (PDAC) is the fourth and fifth leading cause of cancer death for each gender in developed countries. With lack of effective treatment and screening scheme available for the general population, the mortality rate is expected to increase over the next several decades in contrast to the other major malignancies such as lung, breast, prostate and colorectal cancers. Endoscopic ultrasound, with its highest level of detection capacity of smaller pancreatic lesions, is the commonly employed and preferred clinical imaging-based PDAC detection method. Various molecular biomarkers have been investigated for characterization of the disease, but none are shown to be useful or validated for clinical utilization for early detection. As seen from studies of a small subset of familial or genetically high-risk PDAC groups, the higher yield and utility of imaging-based screening methods are demonstrated for these groups. Multiple recent studies on the unique cancer metabolism including PDAC, demonstrate the potential for utility of the metabolites as the discriminant markers for this disease. In order to generate an early PDAC detection screening strategy available for a wider population, we propose to expand the population of higher risk PDAC group with combination clinical and metabolomics parameters. PMID:25684935

Korean speech-language pathologists' attitudes toward stuttering according to clinical experiences.

PubMed

Lee, Kyungjae

2014-11-01

Negative attitudes toward stuttering and people who stutter (PWS) are found in various groups of people in many regions. However the results of previous studies examining the influence of fluency coursework and clinical certification on the attitudes of speech-language pathologists (SLPs) toward PWS are equivocal. Furthermore, there have been few empirical studies on the attitudes of Korean SLPs toward stuttering. To determine whether the attitudes of Korean SLPs and speech-language pathology students toward stuttering would be different according to the status of clinical certification, stuttering coursework completion and clinical practicum in stuttering. Survey data from 37 certified Korean SLPs and 70 undergraduate students majoring in speech-language pathology were analysed. All the participants completed the modified Clinician Attitudes Toward Stuttering (CATS) Inventory. Results showed that the diagnosogenic view was still accepted by many participants. Significant differences were found in seven out of 46 CATS Inventory items according to the certification status. In addition significant differences were also found in three items and one item according to stuttering coursework completion and clinical practicum experience in stuttering, respectively. Clinical and educational experience appears to have mixed influences on SLPs' and students' attitudes toward stuttering. While SLPs and students may demonstrate more appropriate understanding and knowledge in certain areas of stuttering, they may feel difficulty in their clinical experience, possibly resulting in low self-efficacy. © 2014 Royal College of Speech and Language Therapists.

Oxytocin mediates early experience-dependent cross-modal plasticity in the sensory cortices.

PubMed

Zheng, Jing-Jing; Li, Shu-Jing; Zhang, Xiao-Di; Miao, Wan-Ying; Zhang, Dinghong; Yao, Haishan; Yu, Xiang

2014-03-01

Sensory experience is critical to development and plasticity of neural circuits. Here we report a new form of plasticity in neonatal mice, where early sensory experience cross-modally regulates development of all sensory cortices via oxytocin signaling. Unimodal sensory deprivation from birth through whisker deprivation or dark rearing reduced excitatory synaptic transmission in the correspondent sensory cortex and cross-modally in other sensory cortices. Sensory experience regulated synthesis and secretion of the neuropeptide oxytocin as well as its level in the cortex. Both in vivo oxytocin injection and increased sensory experience elevated excitatory synaptic transmission in multiple sensory cortices and significantly rescued the effects of sensory deprivation. Together, these results identify a new function for oxytocin in promoting cross-modal, experience-dependent cortical development. This link between sensory experience and oxytocin is particularly relevant to autism, where hypersensitivity or hyposensitivity to sensory inputs is prevalent and oxytocin is a hotly debated potential therapy.

Clinical and economic consequences of early discharge of patients following supratentorial stereotactic brain biopsy.

PubMed

Kaakaji, W; Barnett, G H; Bernhard, D; Warbel, A; Valaitis, K; Stamp, S

2001-06-01

The goal of this study was to determine the clinical and economic consequences of early discharge (< 8 hours) of patients following stereotactic brain biopsy (SBB). The records of all patients who underwent percutaneous SBB at The Cleveland Clinic Foundation, a tertiary care teaching hospital, during 1994 and 1995 (Group A) were retrospectively reviewed to collect data on the nature and timing of perioperative (< 48 hours) clinical and radiological complications. Biopsies were performed using image-guided stereotaxy either with or without a frame. Based on the results, guidelines for early discharge of patients following SBB were implemented. Information on the nature and timing of perioperative complications was also collected prospectively in all patients who underwent percutaneous SBB from January 1996 through July 1998 (Group B). Hospital financial records for patients who underwent SBB in 1997 and 1998 were also reviewed and assessed for net revenue stratified by discharge status: early discharge (< 8 hours), extended outpatient observation (> or = 8 and < 24 hours). and inpatient hospitalization (> or = 24 hours). In Group A, 130 biopsies were performed. There were five serious complications (3.8%), of which four were transient, and there was one death (0.8%). The death and any sustained deficit occurred in patients in whom a clot had been demonstrated on postoperative CT scans. All complications were detected within 6 hours after surgery. Intraoperative bleeding occurred in 12 patients (9.2%), but was associated with only 40% of cases in which hemorrhage appeared on postoperative CT scans. Guidelines for early discharge (< 8 hours) following SBB were developed and stipulated the absence of the following: 1) intraoperative hemorrhage; 2) new postoperative deficit; and 3) clot on a postoperative CT scan. In Group B, 139 biopsies were performed. There were three serious complications (2.2%), one of which was sustained due to a clot that had been demonstrated on

Minding experience: An exploration of the concept of "experience" in the early French anthropology of Durkheim, Lévy-Bruhl, and Lévi-Strauss.

PubMed

Throop, C Jason

2003-01-01

In line with the growing concern with the unexamined reliance upon the concept of "experience" in anthropology, this article explores in some detail the various usages and definitions of the concept in the work of three of early French anthropology's most influential theorists: Emile Durkheim (1858-1918), Lucien Lévy-Bruhl (1857-1939), and Claude Lévi-Strauss (1908-). With its important influence on both British and American anthropology, the early French anthropological tradition, as epitomized in the writings of these three thinkers, has indeed played a pivotal role in shaping many current taken-for-granted understandings of the concept of experience in the discipline of anthropology as a whole. In the process of exploring how experience is viewed by these three scholars, this paper will thus take some initial steps toward the historical contextualization of many of the unquestioned assumptions underpinning current understandings of experience in the discipline of anthropology and the social sciences more generally. Copyright 2003 Wiley Periodicals, Inc.

Medical students' clerkship experiences and self-perceived competence in clinical skills.

PubMed

Katowa-Mukwato, P; Andrews, B; Maimbolwa, M; Lakhi, S; Michelo, C; Mulla, Y; Banda, S S

2014-01-01

In a traditional curriculum, medical students are expected to acquire clinical competence through the apprenticeship model using the Halstedian "see one, do one, and teach one, approach". The University of Zambia School of Medicine used a traditional curriculum model from 1966 until 2011 when a competence-based curriculum was implemented. To explore medical students' clerkships experiences and self-perceived competence in clinical skills. A cross-sectional survey was conducted on 5th, 6 th , and 7 th year medical students of the University of Zambia, School of Medicine two months prior to final examinations. Students were asked to rate their clerkship experiences with respect to specific skills on a scale of 1 to 4 and their level of self-perceived competence on a scale of 1 to 3. Skills evaluated were in four main domains: history taking and communication, physical examination, procedural, and professionalism, team work and medical decision making. Using Statistical Package for Social Scientist (SPSS), correlations were performed between experiences and self-perceived competence on specific skills, within domains and overall. Out of 197 clinical students 138 (70%) participated in the survey. The results showed significant increase in the proportion of students performing different skills and reporting feeling very competent with each additional clinical year. Overall correlations between experience and self-perceived competence were moderate (0.55). On individual skills, the highest correlation between experience and self-perceived competence were observed on mainly medical and surgical related procedural skills with the highest at 0.82 for nasal gastric tube insertion and 0.76 for endotracheal intubation. Despite the general improvement in skills experiences and self-perceived competence, some deficiencies were noted as significant numbers of final year students had never attempted common important procedures especially those performed in emergency situations

Bringing basic research on early experience and stress neurobiology to bear on preventive interventions for neglected and maltreated children.

PubMed

Gunnar, Megan R; Fisher, Philip A

2006-01-01

A major focus in developmental psychopathology is on understanding developmental mechanisms and, armed with this information, intervening to improve children's outcomes. Translational research attempts to bridge the distance between understanding and intervention. In the collaborations that have formed the core of our research network on early experience, stress, and prevention science, we have focused on translating basic research on early experiences and stress neurobiology into preventive interventions for neglected and abused children. Our experiences in attempting to move from bench to bedside have led us to recognize the many challenges that face translational researchers. This review provides a brief synopsis of the animal model literature on early experience and stress neurobiology from which we glean several key bridging issues. We then review what is currently known about the impact of childhood neglect and abuse on stress neurobiology in human adults and children. Next, we describe how this work has informed the evaluation of our preventive interventions with maltreated children. Finally, we discuss several considerations that should facilitate a more complete integration of basic research on early experience and stress neurobiology into preventive intervention strategies.

Seeing What They See--A Photovoice Analysis of Exploratory Early Field Experiences

ERIC Educational Resources Information Center

Baker, Marshall A.; Culbertson, Avery L.; Robinson, J. Shane; Ramsey, Jon W.

2017-01-01

The purpose of this photovoice study was to investigate what and how pre-service teachers conceive and make meaning of exploration observations of early field experiences (EFEs). EFEs are vital components of the teacher preparation program and include all activities that occur in pre-service teacher education prior to student teaching, including…

The management of patients with early Parkinson's disease.

PubMed

Rascol, O; Payoux, P; Ferreira, J; Brefel-Courbon, C

2002-10-01

A major problem in the management of early Parkinson's disease is to choose the first medication to prescribe. This decision should rely on the level of available clinical evidence, largely based, at least for efficacy, on the results of randomised clinical trials. Safety and costs are also crucial to consider. Other factors like for example pathophysiological concepts, individual experience, marketing pressure, socio-economical environment, patients needs and expectations have, however, also their own influence. Levodopa is efficacious and cheap, but induces long-term motor complications. The early use of dopamine agonists is more and more frequently promoted, because large prospective L-dopa-controlled trials demonstrated that this strategy reduces the risk of such long-term complications. Integrating individual clinical expertise to the best available external clinical evidence (evidence-based medicine) is the best strategy in making decisions about the care of individual patients. Copyright 2002 Elsevier Science Ltd.

Echocardiographic and Fluoroscopic Fusion Imaging for Procedural Guidance: An Overview and Early Clinical Experience.

PubMed

Thaden, Jeremy J; Sanon, Saurabh; Geske, Jeffrey B; Eleid, Mackram F; Nijhof, Niels; Malouf, Joseph F; Rihal, Charanjit S; Bruce, Charles J

2016-06-01

There has been significant growth in the volume and complexity of percutaneous structural heart procedures in the past decade. Increasing procedural complexity and accompanying reliance on multimodality imaging have fueled the development of fusion imaging to facilitate procedural guidance. The first clinically available system capable of echocardiographic and fluoroscopic fusion for real-time guidance of structural heart procedures was approved by the US Food and Drug Administration in 2012. Echocardiographic-fluoroscopic fusion imaging combines the precise catheter and device visualization of fluoroscopy with the soft tissue anatomy and color flow Doppler information afforded by echocardiography in a single image. This allows the interventionalist to perform precise catheter manipulations under fluoroscopy guidance while visualizing critical tissue anatomy provided by echocardiography. However, there are few data available addressing this technology's strengths and limitations in routine clinical practice. The authors provide a critical review of currently available echocardiographic-fluoroscopic fusion imaging for guidance of structural heart interventions to highlight its strengths, limitations, and potential clinical applications and to guide further research into value of this emerging technology. Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

Private Management of Public Schools: Early Experiences in Four School Districts. Report to Congressional Committees.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Health, Education, and Human Services Div.

School districts nationwide are experimenting with a range of reform options, one of which is private management of public schools. This General Accounting Office (GAO) report describes the early experiences of four school districts that contracted with private companies for management of their public schools. Specifically, the report describes:…

Early visual experience and the recognition of basic facial expressions: involvement of the middle temporal and inferior frontal gyri during haptic identification by the early blind

PubMed Central

Kitada, Ryo; Okamoto, Yuko; Sasaki, Akihiro T.; Kochiyama, Takanori; Miyahara, Motohide; Lederman, Susan J.; Sadato, Norihiro

2012-01-01

Face perception is critical for social communication. Given its fundamental importance in the course of evolution, the innate neural mechanisms can anticipate the computations necessary for representing faces. However, the effect of visual deprivation on the formation of neural mechanisms that underlie face perception is largely unknown. We previously showed that sighted individuals can recognize basic facial expressions by haptics surprisingly well. Moreover, the inferior frontal gyrus (IFG) and posterior superior temporal sulcus (pSTS) in the sighted subjects are involved in haptic and visual recognition of facial expressions. Here, we conducted both psychophysical and functional magnetic-resonance imaging (fMRI) experiments to determine the nature of the neural representation that subserves the recognition of basic facial expressions in early blind individuals. In a psychophysical experiment, both early blind and sighted subjects haptically identified basic facial expressions at levels well above chance. In the subsequent fMRI experiment, both groups haptically identified facial expressions and shoe types (control). The sighted subjects then completed the same task visually. Within brain regions activated by the visual and haptic identification of facial expressions (relative to that of shoes) in the sighted group, corresponding haptic identification in the early blind activated regions in the inferior frontal and middle temporal gyri. These results suggest that the neural system that underlies the recognition of basic facial expressions develops supramodally even in the absence of early visual experience. PMID:23372547

Early experiences building a software quality prediction model

NASA Technical Reports Server (NTRS)

Agresti, W. W.; Evanco, W. M.; Smith, M. C.

1990-01-01

Early experiences building a software quality prediction model are discussed. The overall research objective is to establish a capability to project a software system's quality from an analysis of its design. The technical approach is to build multivariate models for estimating reliability and maintainability. Data from 21 Ada subsystems were analyzed to test hypotheses about various design structures leading to failure-prone or unmaintainable systems. Current design variables highlight the interconnectivity and visibility of compilation units. Other model variables provide for the effects of reusability and software changes. Reported results are preliminary because additional project data is being obtained and new hypotheses are being developed and tested. Current multivariate regression models are encouraging, explaining 60 to 80 percent of the variation in error density of the subsystems.

Sociodemographic differences in women’s experience of early labour care: a mixed methods study

PubMed Central

Henderson, Jane; Redshaw, Maggie

2017-01-01

Objectives To explore women’s experiences of early labour care focusing on sociodemographic differences, and to examine the effect of antenatal education, using mixed methods. Setting England, 2014. Participants Women who completed postal questionnaires about their experience of maternity care, including questions about antenatal education, early labour and sociodemographic factors, included space for free-text comments. Outcome measures Worries about labour, contact with midwives in early labour and subsequent care. Methods This study was based on secondary analysis of a national maternity survey carried out in England in 2014. Quantitative data were analysed using descriptive statistics and binary logistic regression; qualitative data were analysed using a thematic content analytic approach. Results Completed questionnaires were received from 4578 women (47% response rate). There were significant differences by sociodemographic factors, particularly ethnicity, in women’s worries about early labour. Compared with white women, women from black or minority ethnic groups had an adjusted OR of 1.93 (95% CI 1.56 to 2.39) of feeling worried about not knowing when labour would start. Among women who contacted a midwife at the start of labour, 84% perceived their advice as appropriate, more in older and multiparous women. Overall, 64% of women were asked to come to the hospital at this time, more in multiparous women (adjusted OR 1.63, 95% CI 1.35 to 1.96). Those who did not have access to antenatal education experienced greater worry about early labour. Five themes emerged from the qualitative analysis: ‘Differentiating between early and active labour’, ‘Staff attitudes’, ‘Not being allowed…’, ‘Previous labours’ and ‘Perceived consequences for women’. Conclusion These findings reinforce the importance of providing reassurance to women in early labour, taking care that women do not feel neglected or dismissed. In particular, primiparous and

Effect of experience on clinical decision making by cardiorespiratory physiotherapists in acute care settings.

PubMed

Smith, Megan; Higgs, Joy; Ellis, Elizabeth

2010-02-01

This article investigates clinical decision making in acute care hospitals by cardiorespiratory physiotherapists with differing degrees of clinical experience. Participants were observed as they engaged in their everyday practice and were interviewed about their decision making. Texts of the data were interpreted by using a hermeneutic approach that involved repeated reading and analysis of fieldnotes and interview transcripts to develop an understanding of the effect of experience on clinical decision making. Participants were classified into categories of cardiorespiratory physiotherapy experience: less experienced (<2 years), intermediate experience (2.5-4 years), and more experienced (>7 years). Four dimensions characteristic of increasing experience in cardiorespiratory physiotherapy clinical decision making were identified: 1) an individual practice model, 2) refined approaches to clinical decision making, 3) working in context, and 4) social and emotional capability. Underpinning these dimensions was evidence of reflection on practice, motivation to achieve best practice, critique of new knowledge, increasing confidence, and relationships with knowledgeable colleagues. These findings reflect characteristics of physiotherapy expertise that have been described in the literature. This study adds knowledge about the field of cardiorespiratory physiotherapy to the existing body of research on clinical decision making and broadens the existing understanding of characteristics of physiotherapy expertise.

Concentration-Response Modeling of ECG Data From Early-Phase Clinical Studies as an Alternative Clinical and Regulatory Approach to Assessing QT Risk - Experience From the Development Program of Lemborexant.

PubMed

Murphy, Patricia J; Yasuda, Sanae; Nakai, Kenya; Yoshinaga, Takashi; Hall, Nancy; Zhou, Meijian; Aluri, Jagadeesh; Rege, Bhaskar; Moline, Margaret; Ferry, Jim; Darpo, Borje

2017-01-01

Lemborexant is a novel dual orexin receptor antagonist being developed to treat insomnia. Its potential to cause QT prolongation was evaluated using plasma concentration-response (CR) modeling applied to data from 2 multiple ascending-dose (MAD) studies. In the primary MAD study, placebo or lemborexant (2.5 to 75 mg) was administered for 14 consecutive nights. In another MAD study designed to "bridge" pharmacokinetic and safety data between Japanese and non-Japanese subjects (J-MAD), placebo or lemborexant (2.5, 10, or 25 mg) was administered for 14 consecutive nights. QT intervals were estimated using a high-precision measurement technique and evaluated using a linear mixed-effects CR model, for each study separately and for the pooled data set. When each study was analyzed separately, the slopes of the CR relationship were shallow and not statistically significant. In the pooled analysis, the slope of the CR relationship was -0.00002 milliseconds per ng/mL (90%CI, -0.01019 to 0.01014 milliseconds). The highest observed C max was 400 ng/mL, representing a margin 8-fold above exposures expected for the highest planned clinical dose. The model-predicted QTc effect at 400 ng/mL was 1.1 milliseconds (90%CI, -3.49 to 5.78 milliseconds). In neither the J-MAD study nor the pooled analysis was an effect of race identified. CR modeling of data from early-phase clinical studies, including plasma levels far exceeding those anticipated clinically, indicated that a QT effect >10 milliseconds could be excluded. Regulatory agreement with this methodology demonstrates the effectiveness of a CR modeling approach as an alternative to thorough QT studies. © 2016, The American College of Clinical Pharmacology.

Concept-Based Learning in Clinical Experiences: Bringing Theory to Clinical Education for Deep Learning.

PubMed

Nielsen, Ann

2016-07-01

Concept-based learning is used increasingly in nursing education to support the organization, transfer, and retention of knowledge. Concept-based learning activities (CBLAs) have been used in clinical education to explore key aspects of the patient situation and principles of nursing care, without responsibility for total patient care. The nature of best practices in teaching and the resultant learning are not well understood. The purpose of this multiple-case study research was to explore and describe concept-based learning in the context of clinical education in inpatient settings. Four clinical groups (each a case) were observed while they used CBLAs in the clinical setting. Major findings include that concept-based learning fosters deep learning, connection of theory with practice, and clinical judgment. Strategies used to support learning, major teaching-learning foci, and preconditions for concept-based teaching and learning will be described. Concept-based learning is promising to support integration of theory with practice and clinical judgment through application experiences with patients. [J Nurs Educ. 2016;55(7):365-371.]. Copyright 2016, SLACK Incorporated.

Identifying autism early: The Toddlers at Risk of Autism Clinic model.

PubMed

Davis, Tessa; Clifton, Deirdre; Papadopoulos, Con

2015-07-01

This paper describes the Toddlers at Risk of Autism Clinic (TRAC), which utilises the Social Attention and Communication Study (SACS) and/or Autism Detection in Early Childhood (ADEC) play-based assessments to facilitate the early diagnosis of autism. A retrospective audit was conducted of all 42 children assessed over a 3-year period in the TRAC. A semi-structured interview and play-based assessment (SACS and ADEC) were used to aid experienced clinicians in diagnosing autism. Intervention was recommended, and families were routinely followed up. Analysis was conducted on the tools used, the outcomes of assessment, diagnosis and stability of diagnosis on follow-up. During this period, 35 boys and 7 girls were assessed, with a mean age of 25 months. The average waiting time for clinic was 11.6 weeks. Twenty-five patients were diagnosed with autism; 90.5% of toddlers given an initial diagnosis retained that diagnosis at follow-up. Out of the 17 children who were not diagnosed with autism in the TRAC, one child was later diagnosed with autism. Experienced clinicians can use the SACS and/or ADEC to assist with a Diagnostic and Statistical Manual diagnosis of autism in toddlers. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Pediatricians' Experience with Clinical Ethics Consultation: A National Survey.

PubMed

Morrison, Wynne; Womer, James; Nathanson, Pamela; Kersun, Leslie; Hester, D Micah; Walsh, Corbett; Feudtner, Chris

2015-10-01

To conduct a national survey of pediatricians' access to and experience with clinical ethics consultation. We surveyed a randomly selected sample of 3687 physician members of the American Academy of Pediatrics. We asked about their experiences with ethics consultation, the helpfulness of and barriers to consultation, and ethics education. Using a discrete choice experiment with maximum difference scaling, we evaluated which traits of ethics consultants were most valuable. Of the total sample of 3687 physicians, 659 (18%) responded to the survey. One-third of the respondents had no experience with clinical ethics consultation, and 16% reported no access to consultation. General pediatricians were less likely to have access. The vast majority (90%) who had experience with consultation had found it helpful. Those with fewer years in practice were more likely to have training in ethics. The most frequently reported issues leading to consultation concerned end-of-life care and conflicts with patients/families or among the team. Intensive care unit physicians were more likely to have requested consultation. Mediation skills and ethics knowledge were the most highly valued consultant characteristics, and representing the official position of the hospital was the least-valued characteristic. There is variability in pediatricians' access to ethics consultation. Most respondents reported that consultation had been helpful in the past. Determining ethically appropriate end-of-life care and mediation of disagreements are common reasons that pediatricians request consultation. Copyright © 2015 Elsevier Inc. All rights reserved.

Effects of Experience on the Brain: The Role of Neuroscience in Early Development and Education

ERIC Educational Resources Information Center

Twardosz, Sandra

2012-01-01

Research Findings: Research on the effect of experience on the structure and function of the brain across the lifespan pertains directly to the concerns of professionals involved with children's early development and education. This paper briefly reviews (a) the role of experience in shaping the developing brain, (b) individual adaptation to the…

The CDKL5 disorder is an independent clinical entity associated with early-onset encephalopathy.

PubMed

Fehr, Stephanie; Wilson, Meredith; Downs, Jenny; Williams, Simon; Murgia, Alessandra; Sartori, Stefano; Vecchi, Marilena; Ho, Gladys; Polli, Roberta; Psoni, Stavroula; Bao, Xinhua; de Klerk, Nick; Leonard, Helen; Christodoulou, John

2013-03-01

The clinical understanding of the CDKL5 disorder remains limited, with most information being derived from small patient groups seen at individual centres. This study uses a large international data collection to describe the clinical profile of the CDKL5 disorder and compare with Rett syndrome (RTT). Information on individuals with cyclin-dependent kinase-like 5 (CDKL5) mutations (n=86) and females with MECP2 mutations (n=920) was sourced from the InterRett database. Available photographs of CDKL5 patients were examined for dysmorphic features. The proportion of CDKL5 patients meeting the recent Neul criteria for atypical RTT was determined. Logistic regression and time-to-event analyses were used to compare the occurrence of Rett-like features in those with MECP2 and CDKL5 mutations. Most individuals with CDKL5 mutations had severe developmental delay from birth, seizure onset before the age of 3 months and similar non-dysmorphic features. Less than one-quarter met the criteria for early-onset seizure variant RTT. Seizures and sleep disturbances were more common than in those with MECP2 mutations whereas features of regression and spinal curvature were less common. The CDKL5 disorder presents with a distinct clinical profile and a subtle facial, limb and hand phenotype that may assist in differentiation from other early-onset encephalopathies. Although mutations in the CDKL5 gene have been described in association with the early-onset variant of RTT, in our study the majority did not meet these criteria. Therefore, the CDKL5 disorder should be considered separate to RTT, rather than another variant.

Dosimetric considerations and early clinical experience of accelerated partial breast irradiation using multi-lumen applicators in the setting of breast augmentation

PubMed Central

Akhtari, Mani; Pino, Ramiro; Scarboro, Sarah B.; Bass, Barbara L.; Miltenburg, Darlene M.; Butler, E. Brian

2015-01-01

Purpose Accelerated partial breast irradiation (APBI) is an accepted treatment option in breast-conserving therapy for early stage breast cancer. However, data regarding outcomes of patients treated with multi-lumen catheter systems who have existing breast implants is limited. The purpose of this study was to report treatment parameters, outcomes, and possible dosimetric correlation with cosmetic outcome for this population of patients at our institution. Material and methods We report the treatment and outcome of seven consecutive patients with existing breast implants and early stage breast cancer who were treated between 2009 and 2013 using APBI following lumpectomy. All patients were treated twice per day for five days to a total dose of 34 Gy using a high-dose-rate 192Ir source. Cosmetic outcomes were evaluated using the Harvard breast cosmesis scale, and late toxicities were reported using the Radiation Therapy Oncology Group (RTOG) late radiation morbidity schema. Results After a mean follow-up of 32 months, all patients have remained cancer free. Six out of seven patients had an excellent or good cosmetic outcome. There were no grade 3 or 4 late toxicities. The average total breast implant volume was 279.3 cc, received an average mean dose of 12.1 Gy, and a maximum dose of 234.1 Gy. The average percentage of breast implant volume receiving 50%, 75%, 100%, 150%, and 200% of the prescribed dose was 15.6%, 7.03%, 4.6%, 1.58%, and 0.46%, respectively. Absolute volume of breast implants receiving more than 50% of prescribed dose correlated with worse cosmetic outcomes. Conclusions Accelerated partial breast irradiation using a multi-lumen applicator in patients with existing breast implants can safely be performed with promising early clinical results. The presence of the implant did not compromise the ability to achieve dosimetric criteria; however, dose to the implant and the irradiated implant volume may be related with worse cosmetic outcomes. PMID:26816499

Beyond Surviving: Gender Differences in Response to Early Sexual Experiences with Adults

ERIC Educational Resources Information Center

Hunter, Sally V.

2009-01-01

The aim of this research project was to explore how men and women constructed a sense of self through narrative following an early sexual experience with an adult. Using narrative inquiry methodology, 22 in-depth interviews were conducted in New South Wales, Australia, with 13 women and 9 men ages between 25 and 70. All participants had an early…

Quality assurance of research protocols conducted in the community: the National Institute on Drug Abuse Clinical Trials Network experience.

PubMed

Rosa, Carmen; Campbell, Aimee; Kleppinger, Cynthia; Sampson, Royce; Tyson, Clare; Mamay-Gentilin, Stephanie

2009-04-01

for balancing thoroughness with efficiency, monitoring early, assessing research staff abilities in order to judge the need for proactive, focused attention, providing targeted training sessions, and developing flexible tools. The CTN model can work for sponsors overseeing studies at sites with limited research experience that require more frequent, in-depth monitoring. We recommend that sponsors not develop a rigid monitoring approach, but work with the study principal investigators to determine the intensity of monitoring needed depending on trial complexity, the risks of the intervention(s), and the experience of the staff with clinical research. After careful evaluation, sponsors should then determine the best approach to site monitoring and what resources will be needed.

Quality assurance of research protocols conducted in the community: The National Institute on Drug Abuse Clinical Trials Network Experience

PubMed Central

Rosa, Carmen; Campbell, Aimee; Kleppinger, Cynthia; Sampson, Royce; Tyson, Clare; Mamay-Gentilin, Stephanie

2009-01-01

: The lessons learned from the CTN's experience include the need for balancing thoroughness with efficiency, monitoring early, assessing research staff abilities in order to judge the need for proactive, focused attention, providing targeted training sessions, and developing flexible tools. The CTN model can work for sponsors overseeing studies at sites with limited research experience that require more frequent, in-depth monitoring. We recommend that sponsors not develop a rigid monitoring approach, but work with the study principal investigators to determine the intensity of monitoring needed depending on trial complexity, the risks of the intervention(s), and the experience of the staff with clinical research. After careful evaluation, sponsors should then determine the best approach to site monitoring and what resources will be needed. PMID:19342468

Early tracking would improve the operative experience of general surgery residents.

PubMed

Stain, Steven C; Biester, Thomas W; Hanks, John B; Ashley, Stanley W; Valentine, R James; Bass, Barbara L; Buyske, Jo

2010-09-01

High surgical complexity and individual career goals has led most general surgery (GS) residents to pursue fellowship training, resulting in a shortage of surgeons who practice broad-based general surgery. We hypothesize that early tracking of residents would improve operative experience of residents planning to be general surgeons, and could foster greater interest and confidence in this career path. Surgical Operative Log data from GS and fellowship bound residents (FB) applying for the 2008 American Board of Surgery Qualifying Examination (QE) were used to construct a hypothetical training model with 6 months of early specialization (ESP) for FB residents in 4 specialties (cardiac, vascular, colorectal, pediatric); and presumed these cases would be available to GS residents within the same program. A total of 142 training programs had both FB residents (n = 237) and GS residents (n = 402), and represented 70% of all 2008 QE applicants. The mean numbers of operations by FB and GS residents were 1131 and 1091, respectively. There were a mean of 252 cases by FB residents in the chief year, theoretically making 126 cases available for each GS resident. In 9 defined categories, the hypothetical model would result in an increase in the 5-year operative experience of GS residents (mastectomy 6.5%; colectomy 22.8%; gastrectomy 23.4%; antireflux procedures 23.4%; pancreatic resection 37.4%; liver resection 29.3%; endocrine procedures 19.6%; trauma operations 13.3%; GI endoscopy 6.5%). The ESP model improves operative experience of GS residents, particularly for complex gastrointestinal procedures. The expansion of subspecialty ESP should be considered.

Swedish nursing students' experience of stress during clinical practice in relation to clinical setting characteristics and the organisation of the clinical education.

PubMed

Blomberg, Karin; Bisholt, Birgitta; Kullén Engström, Agneta; Ohlsson, Ulla; Sundler Johansson, Annelie; Gustafsson, Margareta

2014-08-01

To describe nursing students' experience of stress during clinical practice and evaluate the risk of stress in relation to the clinical setting characteristics and the organisation of the clinical education. Stress during clinical practice is well documented, but there is a lack of knowledge concerning whether the clinical setting characteristics and the organisation of the education make a difference. A cross-sectional study with evaluative design. Data were collected by means of a numerical rating scale for the assessment of stress and questions about the clinical setting characteristics and the organisation of the education. One hundred and eighty-four students who had completed their final year on the nursing programme at three universities in Sweden were included. Nearly half of the students (43%) experienced high level of stress during clinical practice. Measured by decision in the tree analysis, the absolute risk of stress was 57% in students with placements in hospital departments, as compared to 13% in students with placements in other clinical settings. The risk of stress increased to 71% if the students with placement in a hospital took the national clinical final examination. Performance of practice in a hospital department overcrowded with patients was also associated with increased risk of stress. The organisation of supervision and number of students at the clinical placement had an effect on the experience of stress, but did not prove to be risk factors in the analysis. The risk of stress in nursing students during their clinical practice differs depending on clinical setting characteristics. The taking of the national clinical final examination could be a source of stress, but this requires further investigation. It is important that supervisors are aware that students in hospital departments overcrowded with patients are at risk of stress and may have increased need of support. © 2014 John Wiley & Sons Ltd.

75 FR 63188 - Draft Guidance for Industry: Early Clinical Trials With Live Biotherapeutic Products: Chemistry...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-14

...] Draft Guidance for Industry: Early Clinical Trials With Live Biotherapeutic Products: Chemistry...: Chemistry, Manufacturing, and Control Information'' dated September 2010. The draft guidance provides... Products: Chemistry, Manufacturing, and Control Information'' dated September 2010. The draft guidance...

Early Experience and the Development of Cognitive Competence: Some Theoretical and Methodological Issues.

ERIC Educational Resources Information Center

Ulvund, Stein Erik

1982-01-01

Argues that in analyzing effects of early experience on development of cognitive competence, theoretical analyses as well as empirical investigations should be based on a transactional model of development. Shows optimal stimulation hypothesis, particularly the enhancement prediction, seems to represent a transactional approach to the study of…

Word learning in deaf children with cochlear implants: effects of early auditory experience.

PubMed

Houston, Derek M; Stewart, Jessica; Moberly, Aaron; Hollich, George; Miyamoto, Richard T

2012-05-01

Word-learning skills were tested in normal-hearing 12- to 40-month-olds and in deaf 22- to 40-month-olds 12 to 18 months after cochlear implantation. Using the Intermodal Preferential Looking Paradigm (IPLP), children were tested for their ability to learn two novel-word/novel-object pairings. Normal-hearing children demonstrated learning on this task at approximately 18 months of age and older. For deaf children, performance on this task was significantly correlated with early auditory experience: Children whose cochlear implants were switched on by 14 months of age or who had relatively more hearing before implantation demonstrated learning in this task, but later implanted profoundly deaf children did not. Performance on this task also correlated with later measures of vocabulary size. Taken together, these findings suggest that early auditory experience facilitates word learning and that the IPLP may be useful for identifying children who may be at high risk for poor vocabulary development. © 2012 Blackwell Publishing Ltd.

On the causes of early life experience effects: evaluating the role of mom.

PubMed

Tang, Akaysha C; Reeb-Sutherland, Bethany C; Romeo, Russell D; McEwen, Bruce S

2014-04-01

Early life experiences are thought to have long-lasting effects on cognitive, emotional, and social function during adulthood. Changes in neuroendocrine function, particularly the hypothalamic-pituitary-adrenal (HPA) axis, contribute to these systems-level behavioral effects. In searching for causal mechanisms underlying these early experience effects, pioneering research has demonstrated an important role for maternal care in offspring development, and this has led to two persistent ideas that permeate current research and thinking: first, environmental impact on the developing infant is mediated through maternal care behavior; second, the more care that a mother provides, the better off her offspring. While a good beginning, the reality is likely more complex. In this review, we critically examine these ideas and propose a computationally-motivated theoretical framework, and within this framework, we consider evidence supporting a hypothesis of maternal modulation. These findings may inform policy decisions in the context of child health and development. Copyright © 2013 Elsevier Inc. All rights reserved.

Word learning in deaf children with cochlear implants: effects of early auditory experience

PubMed Central

Houston, Derek M.; Stewart, Jessica; Moberly, Aaron; Hollich, George; Miyamoto, Richard T.

2013-01-01

Word-learning skills were tested in normal-hearing 12- to 40-month-olds and in deaf 22- to 40-month-olds 12 to 18 months after cochlear implantation. Using the Intermodal Preferential Looking Paradigm (IPLP), children were tested for their ability to learn two novel-word/novel-object pairings. Normal-hearing children demonstrated learning on this task at approximately 18 months of age and older. For deaf children, performance on this task was significantly correlated with early auditory experience: Children whose cochlear implants were switched on by 14 months of age or who had relatively more hearing before implantation demonstrated learning in this task, but later implanted profoundly deaf children did not. Performance on this task also correlated with later measures of vocabulary size. Taken together, these findings suggest that early auditory experience facilitates word learning and that the IPLP may be useful for identifying children who may be at high risk for poor vocabulary development. PMID:22490184

Learning Clinical Procedures Through Internet Digital Objects: Experience of Undergraduate Students Across Clinical Faculties

PubMed Central

Li, Tse Yan; Wong, Kin; Tse, Christine Shuk Kwan; Chan, Ying Yee

2015-01-01

Background Various digital learning objects (DLOs) are available via the World Wide Web, showing the flow of clinical procedures. It is unclear to what extent these freely accessible Internet DLOs facilitate or hamper students’ acquisition of clinical competence. Objective This study aimed to understand the experience of undergraduate students across clinical disciplines—medicine, dentistry, and nursing—in using openly accessible Internet DLOs, and to investigate the role of Internet DLOs in facilitating their clinical learning. Methods Mid-year and final-year groups were selected from each undergraduate clinical degree program of the University of Hong Kong—Bachelor of Medicine and Bachelor of Surgery (MBBS), Bachelor of Dental Surgery (BDS), and Bachelor of Nursing (BNurs). All students were invited to complete a questionnaire on their personal and educational backgrounds, and their experiences and views on using Internet DLOs in learning clinical procedures. The questionnaire design was informed by the findings of six focus groups. Results Among 439 respondents, 97.5% (428/439) learned a variety of clinical procedures through Internet DLOs. Most nursing students (107/122, 87.7%) learned preventive measures through Internet DLOs, with a lower percentage of medical students (99/215, 46.0%) and dental students (43/96, 45%) having learned them this way (both P<.001). Three-quarters (341/439, 77.7%) of students accessed DLOs through public search engines, whereas 93.2% (409/439) accessed them by watching YouTube videos. Students often shared DLOs with classmates (277/435, 63.7%), but rarely discussed them with teachers (54/436, 12.4%). The accuracy, usefulness, and importance of Internet DLOs were rated as 6.85 (SD 1.48), 7.27 (SD 1.53), and 7.13 (SD 1.72), respectively, out of a high score of 10. Conclusions Self-exploration of DLOs in the unrestricted Internet environment is extremely common among current e-generation learners and was regarded by students

Leaders' and followers' individual experiences during the early phase of simulation-based team training: an exploratory study.

PubMed

Meurling, Lisbet; Hedman, Leif; Felländer-Tsai, Li; Wallin, Carl-Johan

2013-06-01

A growing body of evidence shows that team training can develop essential team skills and contribute to better patient outcomes. Current simulation-based team training (SBTT) programmes most often include targets and feedback focused on the whole team and/or leader, ignoring the follower as a unique entity. By considering followers' individual experiences, and tailoring behavioural targets for training and feedback, SBTT could be improved. Our aim was to explore the individual experiences and behaviours of leaders and followers during the early phase of SBTT, and we hypothesised that leaders and followers would show different responses. Medical students (n=54) participated in half-day SBTT including three video-recorded scenarios. Self-efficacy was assessed pretraining and post-training. For each scenario (n=36), the individual teamwork behaviours, concentration, mental strain and the team's clinical performance were recorded. Data were analysed using a mixed model allowing for participants to be their own control in their roles as leader or follower. Self-efficacy improved. In the role of leader, participants communicated to a greater extent and experienced higher mental strain and concentration than they did in the role of follower. The increased self-efficacy enables a positive learning outcome after only three scenarios. Individual experiences and behaviours differed between the role of leader and that of follower. By shedding further light on leaders' and followers' individual experiences and behaviours, targets for training and feedback could be specified in order to improve SBTT.

[Early clinical trials in paediatric oncology in Spain: a nationwide perspective].

PubMed

Bautista, Francisco; Gallego, Soledad; Cañete, Adela; Mora, Jaume; Díaz de Heredia, Cristina; Cruz, Ofelia; Fernández, José María; Rives, Susana; Berlanga, Pablo; Hladun, Raquel; Juan Ribelles, Antonio; Madero, Luis; Ramírez, Manuel; Fernández Delgado, Rafael; Pérez-Martínez, Antonio; Mata, Cristina; Llort, Anna; Martín Broto, Javier; Cela, María Elena; Ramírez, Gema; Sábado, Constantino; Acha, Tomás; Astigarraga, Itziar; Sastre, Ana; Muñoz, Ascensión; Guibelalde, Mercedes; Moreno, Lucas

2017-09-01

Cancer is the leading cause of death between the first year of life and adolescence, and some types of diseases are still a major challenge in terms of cure. There is, therefore, a major need for new drugs. Recent findings in cancer biology open the door to the development of targeted therapies against individual molecular changes, as well as immunotherapy. Promising results in adult anti-cancer drug development have not yet been translated into paediatric clinical practice. A report is presented on the activity in early paediatric oncology trials (phase I-II) in Spain. All members of the Spanish Society of Paediatric Haematology Oncology (SEHOP) were contacted in order to identify early clinical trials in paediatric cancer opened between 2005 and 2015. A total of 30 trials had been opened in this period: 21 (70%) in solid tumours, and 9 (30%) in malignant haemopathies. A total of 212 patients have been enrolled. The majority was industry sponsored (53%). Since 2010, four centres have joined the international consortium of Innovative Therapies for Children with Cancer (ITCC), which has as its aim to develop novel therapies for paediatric tumours. A significant number of new studies have opened since 2010, improving the treatment opportunities for our children. Results of recently closed trials show the contribution of Spanish investigators, the introduction of molecularly targeted agents, and their benefits. The activity in clinical trials has increased in the years analysed. The SEHOP is committed to develop and participate in collaborative academic trials, in order to help in the advancement and optimisation of existing therapies in paediatric cancer. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Clinical Experience and Learning Style of Flight Nurse and Aeromedical Evacuation Technician Students.

PubMed

De Jong, Marla J; Dukes, Susan F; Dufour, Karey M; Mortimer, Darcy L

2017-01-01

The clinical experience and preferred learning style of U.S. Air Force flight nurses and aeromedical evacuation technicians are unknown. Using a cross-sectional survey design, we gathered data regarding the clinical experience, level of comfort providing clinical care, and preferred learning style of 77 active duty (AD), Air Force Reserve (AFR), and Air National Guard (ANG) nurses enrolled in the U.S. Air Force School of Aerospace Medicine Flight Nurse course, and 121 AD, AFR, and ANG medical technicians enrolled in the Aeromedical Evacuation Technician course. Nurses and medical technicians reported 7.6 ± 5.5 and 3.9 ± 4.5 yr of experience, respectively. AD, AFR, and ANG nurses had comparable years of experience: 5.8 ± 3.2, 8.3 ± 6.6, and 7.9 ± 4.2 yr, respectively; however, AD medical technicians had more years of experience (5.6 ± 4.4 yr) than AFR (3.1 ± 4.8 yr) and ANG (1.9 ± 2.8 yr) medical technicians. Both nurses and medical technicians reported infrequently caring for patients with various disease processes and managing equipment or devices that they will routinely encounter when transporting patients as an aeromedical evacuation clinician. Nurses and medical technicians preferred a kinesthetic learning style or a multimodal learning style that included kinesthetic learning. Nearly all (99%) nurses and 97% of medical technicians identified simulation as their preferred teaching method. These findings confirm faculty concerns regarding the clinical experience of flight nurse and aerospace evacuation technician students.De Jong MJ, Dukes SF, Dufour KM, Mortimer DL. Clinical experience and learning style of flight nurse and aeromedical evacuation technician students. Aerosp Med Hum Perform. 2017; 88(1):23-29.

Effectiveness of the Lidcombe Program for early stuttering in Australian community clinics.

PubMed

O'Brian, Sue; Iverach, Lisa; Jones, Mark; Onslow, Mark; Packman, Ann; Menzies, Ross

2013-12-01

This study explored the effectiveness of the Lidcombe Program for early stuttering in community clinics. Participants were 31 speech-language pathologists (SLPs) using the Lidcombe Program in clinics across Australia, and 57 of their young stuttering clients. Percentage of syllables stuttered (%SS) was collected 9 months after beginning treatment along with information about variables likely to influence outcomes. The mean %SS for the 57 children 9 months after starting treatment was 1.7. The most significant predictor of outcome was Lidcombe Program Trainers Consortium (LPTC) training. The children of trained SLPs (n = 19), compared to the children of untrained SLPs, took 76% more sessions to complete stage 1, but achieved 54% lower %SS scores, 9 months after starting treatment. Results suggest that outcomes for the Lidcombe Program in the general community may be comparable to those obtained in clinical trials when SLPs receive formal training and support.

The Multidimensional Relationship between Early Adult Body Weight and Women’s Childbearing Experiences

PubMed Central

Frisco, Michelle L.; Weden, Margaret M.; Lippert, Adam M.

2011-01-01

This study has three primary goals that make an important contribution to the literature on body weight and childbearing experiences among United States’ women. It sheds light on the physiological and social nature of this relationship by examining whether the consequences of early adult weight for lifetime childbearing are shaped by historical social context, women’s social characteristics, and their ability to marry. We analyze data from two female cohorts who participated in the National Longitudinal Study of Youth (NLSY79). Cohort 1 entered early adulthood before the U.S. obesity prevalence increased. Cohort 2 entered early adulthood after the obesity prevalence increased. We find that early adult weight is negatively related to the childbearing trajectories and marital status of Cohort 1 but not Cohort 2. Failing to account for race/ethnicity and women’s educational background as confounders masks some of these associations, which are evident for both White and Black women. Our results suggest that the health consequences of body weight do not fully drive its impact on childbearing. Rather, the lifetime fertility consequences of early adult weight are malleable, involve social processes, and are dependent on social context. PMID:21944717

A balancing act in an unknown territory: a metasynthesis of first-time mothers' experiences in early labour.

PubMed

Eri, Tine S; Bondas, Terese; Gross, Mechthild M; Janssen, Patricia; Green, Josephine M

2015-03-01

to integrate findings of individual studies in order to broaden the understanding of first-time mothers' experiences of early labour. the methodology was metasynthesis which is based on the interpretive meta-ethnography described by Noblit and Hare (1988). Metasynthesis is research on research which synthesises the findings of previous qualitative studies, and the focus is on interpretation and the creation of new knowledge. all included studies originated from high resource countries (USA 2, UK 4, and Scandinavia 5) and all were carried out in a context of hospital based maternity care. a total of 231 women participated in the studies. 11 articles were included. The main results are presented with the metaphor a balancing act in an unknown territory. The 'unknown territory' has a double meaning: as the personal experience of going into labour for the first time and as encountering the maternity care system. On both levels women have to make significant decisions: whether labour really has started and subsequently when to go to the hospital. A key challenge is to balance the arrival on the labour ward at the 'right' time, not too early and not too late. Arriving at the 'right' time leads to a positive path, while arriving 'too soon' might lead to a cascade of negative experiences. The results are further presented with five central themes: 'Finding out if labour has started is absorbing'; 'Dealing with labour at home'; 'Trying to arrive at the labour ward at the right time'; 'There is always a risk of being sent home'; 'Encountering health professionals arouses strong emotions'. the metasynthesis broadens the understanding of first-time mothers' experiences of early labour, and suggests that women's needs when planning a hospital birth are not being adequately met at this stage in the labour process. Three areas of future research are suggested: how to support and strengthen women during pregnancy in order to cope with early labour; women's experiences of early

Convergent Validity of the Early Memory Index in Two Primary Care Samples.

PubMed

Porcerelli, John H; Cogan, Rosemary; Melchior, Katherine A; Jasinski, Matthew J; Richardson, Laura; Fowler, Shannon; Morris, Pierre; Murdoch, William

2016-01-01

Karliner, Westrich, Shedler, and Mayman (1996) developed the Early Memory Index (EMI) to assess mental health, narrative coherence, and traumatic experiences in reports of early memories. We assessed the convergent validity of EMI scales with data from 103 women from an urban primary care clinic (Study 1) and data from 48 women and 24 men from a suburban primary care clinic (Study 2). Patients provided early memory narratives and completed self-report measures of psychopathology, trauma, and health care utilization. In both studies, lower scores on the Mental Health scale and higher scores on the Traumatic Experiences scale were related to higher scores on measures of psychopathology and childhood trauma. Less consistent associations were found between the Mental Health and Traumatic Experiences scores and measures of health care utilization. The Narrative Coherence scale showed inconsistent relationships across measures in both samples. In analyses assessing the overall fit between hypothesized and actual correlations between EMI scores and measures of psychopathology, severity of trauma symptoms, and health care utilization, the Mental Health scale of the EMI demonstrated stronger convergent validity than the EMI Traumatic Experiences scale. The results provide support for the convergent validity of the Mental Health scale of the EMI.

How do general practice registrars learn from their clinical experience? A critical incident study.

PubMed

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.

Patients' Experiences With Vehicle Collision to Inform the Development of Clinical Practice Guidelines: A Narrative Inquiry.

PubMed

Lindsay, Gail M; Mior, Silvano A; Côté, Pierre; Carroll, Linda J; Shearer, Heather M

2016-01-01

The purpose of this narrative inquiry was to explore the experiences of persons who were injured in traffic collisions and seek their recommendations for the development of clinical practice guideline (CPG) for the management of minor traffic injuries. Patients receiving care for traffic injuries were recruited from 4 clinics in Ontario, Canada resulting in 11 adult participants (5 men, 6 women). Eight were injured while driving cars, 1 was injured on a motorcycle, 2 were pedestrians, and none caused the collision. Using narrative inquiry methodology, initial interviews were audiotaped, and follow-up interviews were held within 2 weeks to extend the story of experience created from the first interview. Narrative plotlines across the 11 stories were identified, and a composite story inclusive of all recommendations was developed by the authors. The research findings and composite narrative were used to inform the CPG Expert Panel in the development of new CPGs. Four recommended directions were identified from the narrative inquiry process and applied. First, terminology that caused stigma was a concern. This resulted in modified language ("injured persons") being adopted by the Expert Panel, and a new nomenclature categorizing layers of injury was identified. Second, participants valued being engaged as partners with health care practitioners. This resulted in inclusion of shared decision-making as a foundational recommendation connecting CPGs and care planning. Third, emotional distress was recognized as a factor in recovery. Therefore, the importance of early detection and the ongoing evaluation of risk factors for delayed recovery were included in all CPGs. Fourth, participants shared that they were unfamiliar with the health care system and insurance industry before their accident. Thus, repeatedly orienting injured persons to the system was advised. A narrative inquiry of 11 patients' experiences with traffic collision and their recommendations for clinical

Early clinical experience utilizing scintillator with optical fiber (SOF) detector in clinical boron neutron capture therapy: its issues and solutions.

PubMed

Ishikawa, Masayori; Yamamoto, Tetsuya; Matsumura, Akira; Hiratsuka, Junichi; Miyatake, Shin-Ichi; Kato, Itsuro; Sakurai, Yoshinori; Kumada, Hiroaki; Shrestha, Shubhechha J; Ono, Koji

2016-08-09

Real-time measurement of thermal neutrons in the tumor region is essential for proper evaluation of the absorbed dose in boron neutron capture therapy (BNCT) treatment. The gold wire activation method has been routinely used to measure the neutron flux distribution in BNCT irradiation, but a real-time measurement using gold wire is not possible. To overcome this issue, the scintillator with optical fiber (SOF) detector has been developed. The purpose of this study is to demonstrate the feasibility of the SOF detector as a real-time thermal neutron monitor in clinical BNCT treatment and also to report issues in the use of SOF detectors in clinical practice and their solutions. Clinical measurements using the SOF detector were carried out in 16 BNCT clinical trial patients from December 2002 until end of 2006 at the Japanese Atomic Energy Agency (JAEA) and Kyoto University Research Reactor Institute (KURRI). The SOF detector worked effectively as a real-time thermal neutron monitor. The neutron fluence obtained by the gold wire activation method was found to differ from that obtained by the SOF detector. The neutron fluence obtained by the SOF detector was in better agreement with the expected fluence than with gold wire activation. The estimation error for the SOF detector was small in comparison to the gold wire measurement. In addition, real-time monitoring suggested that the neutron flux distribution and intensity at the region of interest (ROI) may vary due to the reactor condition, patient motion and dislocation of the SOF detector. Clinical measurements using the SOF detector to measure thermal neutron flux during BNCT confirmed that SOF detectors are effective as a real-time thermal neutron monitor. To minimize the estimation error due to the displacement of the SOF probe during treatment, a loop-type SOF probe was developed.

First-Year Practicum Experiences for Preservice Early Childhood Education Teachers Working with Birth-to-3-Year-Olds: An Australasian Experience

ERIC Educational Resources Information Center

White, E. Jayne; Peter, Mira; Sims, Margaret; Rockel, Jean; Kumeroa, Maureen

2016-01-01

This article reports on a project, "Collaboration of Universities Pedagogies of Infants' and Toddlers' Development-'down under' (CUPID)," in which the practicum experiences of 1st-year preservice initial teacher education (ITE) students at five universities across Australia and New Zealand (NZ) engaging in early childhood education (ECE)…

The clinical and histopathological characteristics of early-onset basal cell carcinoma in Asians.

PubMed

Yang, M Y; Kim, J M; Kim, G W; Mun, J H; Song, M; Ko, H C; Kim, B S; Kim, H S; Kim, M B

2017-01-01

Basal cell carcinoma (BCC) is by far the most common cancer in white populations. In addition, recent reports have demonstrated an increasing incidence of BCC in Korea. We have observed a significant number of early-onset BCC cases in which the disease occurred in patients younger than 50 years. To investigate the clinicopathological characteristics of early-onset BCC in an Asian population, specifically in Koreans. One hundred and five patients with early-onset BCC were enrolled from a total of 1047 BCC patients who underwent surgery between January 1997 and December 2014 (942 patients over the age of 50 years were designated as the control group). Early-onset BCC accounted for 10.03% of all 1047 cases and the incidence over time displayed an incremental trend. The early-onset group displayed similar results as the control group, with a predominance of female BCC patients and the majority of tumours displaying the following characteristics: small in size, occurring in sun-exposed areas and belonging to the noduloulcerative clinical subtype and nodular histopathological subtype. In comparison with a previous study in a Western population, the incidence of the disease in non-exposed areas of the body, as well as the proportion of tumours of the superficial histological subtype, were lower in Asian patients. Although the clinicopathological characteristics of BCC are well-known, these characteristics have not been determined for early-onset BCC in an Asian population. Therefore, this study is the first report on early-onset BCC in Asians, specifically in a Korean patient group. © 2016 European Academy of Dermatology and Venereology.

Early trauma, negative affect, and anxious attachment: the role of metacognition.

PubMed

Myers, Samuel G; Wells, Adrian

2015-01-01

Metacognition is linked to the etiology and maintenance of negative emotions and psychological disorder in the Self-Regulatory Executive Function Model. Although there is significant evidence supporting the model, little is currently known about the situational factors for developing dysfunctional metacognitions. The current study explored the hypothesis that early aversive experiences might be important and also tested if metacognitions could mediate the relationship between such experiences and psychological symptoms. Three hundred and fifty non-clinical adults completed a retrospective early trauma measure, as well as measures of current metacognitive beliefs, negative affect, and anxious attachment. Early emotional abuse positively and significantly correlated with several metacognitive belief dimensions but other forms of early trauma did not. Metacognition fully mediated the relationship between emotional abuse and negative affect. Anxious attachment was also positively and significantly associated with metacognitive beliefs and specific relationships remained after controlling for early emotional abuse and current negative affect. Findings are consistent with the ideas that: (i) early negative experiences, and emotional abuse in particular, could be a factor in the formation of problematic metacognitions and (ii) these metacognitions may be important in determining the effects of abuse on subsequent psychological symptoms.

Early childhood experiences, parenting and the process of drug dependency among young people in Tehran, Iran.

PubMed

Mirlashari, Jila; Demirkol, Apo; Salsali, Mahvash; Rafiey, Hassan; Jahanbani, Jahanfar

2012-06-01

Substance abuse has become a major public health problem in Iran. The process of developing an addiction is complex and multifaceted. Early childhood experiences are thought to be one of the important determinants of addictive behaviour. The aim of this qualitative study is to explore the early childhood experiences, especially the experiences within the immediate family, of current substance-using young adults in Iran. The study is qualitative in nature. In-depth interviews were conducted with 15 young men and women who were either in treatment for their addiction or were active drug users at the time of the interviews. Moreover, four interviews have been conducted with family members of participants. The majority of the participants experienced traumatic events during childhood and came from dysfunctional families. There appears to be a significant disconnect between these individuals and their families. An obedience-instilling parenting style and parents' knowledge and attitude toward drug using and prevention were also identified as important determinants of substance use. The results of this research point out the need for early interventions for at-risk families as well as at-risk individuals. © 2011 Australasian Professional Society on Alcohol and other Drugs.

The clinical utility of naturalistic action test in differentiating mild cognitive impairment from early dementia in memory clinic.

PubMed

Bruce, Irene; Ntlholang, Ontefetse; Crosby, Lisa; Cunningham, Conal; Lawlor, Brian

2016-03-01

This study aimed to examine the validity of the Naturalistic Action Test in differentiating Mild Cognitive Impairment from early dementia compared to clinical diagnosis and ascertain Naturalistic Action Test cut-off points. This was a cross-sectional study of 70 consecutive patients diagnosed with Mild Cognitive Impairment attending the memory clinic in St James's Hospital, Dublin, Ireland. Patients with a diagnosis of Mild Cognitive Impairment who attended for routine annual assessment were asked to participate in the study. The Naturalistic Action Test was carried out after the patient had completed their routine assessment in the clinic. The Area under the Curve, AUC ± SE was 0.808 ± 0.058, p < 0.001 with 95% CI (0.695-0.922). There was concordance in 40 and discrepancy in 30 patients between the NAT and the gold standard consensus diagnosis (PPV 38%, NPV 96%, sensitivity 94%, specificity 46% and accuracy 59%) using cut-off point of ≥14 for normal function on Naturalistic Action Test. The difference was not related to age, sex, level of education or informant. Using the Youden index, we determined a Naturalistic Action Test cut-off score of ≥11 for Mild Cognitive Impairment in our study (PPV 50%, NPV 91%, sensitivity 78%, specificity 73% and accuracy of 74%). There was discrepancy in 18 patients using the new cut-off point (≥11 for Mild Cognitive Impairment vs ≤10 for dementia). The Naturalistic Action Test is a useful tool that can increase diagnostic accuracy in differentiating Mild Cognitive Impairment from early dementia. Copyright © 2015 John Wiley & Sons, Ltd.

Authenticity in Learning--Nursing Students' Experiences at a Clinical Education Ward

ERIC Educational Resources Information Center

Manninen, Katri; Henriksson, Elisabet Welin; Scheja, Max; Silen, Charlotte

2013-01-01

Purpose: This study aims to explore and understand first year nursing students' experiences of learning at a clinical education ward. Design/methodology/approach: The setting is a clinical education ward for nursing students at a department of infectious diseases. A qualitative study was carried out exploring students' encounters with patients,…

Evidence That a Psychopathology Interactome Has Diagnostic Value, Predicting Clinical Needs: An Experience Sampling Study

PubMed Central

van Os, Jim; Lataster, Tineke; Delespaul, Philippe; Wichers, Marieke; Myin-Germeys, Inez

2014-01-01

Background For the purpose of diagnosis, psychopathology can be represented as categories of mental disorder, symptom dimensions or symptom networks. Also, psychopathology can be assessed at different levels of temporal resolution (monthly episodes, daily fluctuating symptoms, momentary fluctuating mental states). We tested the diagnostic value, in terms of prediction of treatment needs, of the combination of symptom networks and momentary assessment level. Method Fifty-seven patients with a psychotic disorder participated in an ESM study, capturing psychotic experiences, emotions and circumstances at 10 semi-random moments in the flow of daily life over a period of 6 days. Symptoms were assessed by interview with the Positive and Negative Syndrome Scale (PANSS); treatment needs were assessed using the Camberwell Assessment of Need (CAN). Results Psychotic symptoms assessed with the PANSS (Clinical Psychotic Symptoms) were strongly associated with psychotic experiences assessed with ESM (Momentary Psychotic Experiences). However, the degree to which Momentary Psychotic Experiences manifested as Clinical Psychotic Symptoms was determined by level of momentary negative affect (higher levels increasing probability of Momentary Psychotic Experiences manifesting as Clinical Psychotic Symptoms), momentary positive affect (higher levels decreasing probability of Clinical Psychotic Symptoms), greater persistence of Momentary Psychotic Experiences (persistence predicting increased probability of Clinical Psychotic Symptoms) and momentary environmental stress associated with events and activities (higher levels increasing probability of Clinical Psychotic Symptoms). Similarly, the degree to which momentary visual or auditory hallucinations manifested as Clinical Psychotic Symptoms was strongly contingent on the level of accompanying momentary paranoid delusional ideation. Momentary Psychotic Experiences were associated with CAN unmet treatment needs, over and above PANSS

The CDKL5 disorder is an independent clinical entity associated with early-onset encephalopathy

PubMed Central

Fehr, Stephanie; Wilson, Meredith; Downs, Jenny; Williams, Simon; Murgia, Alessandra; Sartori, Stefano; Vecchi, Marilena; Ho, Gladys; Polli, Roberta; Psoni, Stavroula; Bao, Xinhua; de Klerk, Nick; Leonard, Helen; Christodoulou, John

2013-01-01

The clinical understanding of the CDKL5 disorder remains limited, with most information being derived from small patient groups seen at individual centres. This study uses a large international data collection to describe the clinical profile of the CDKL5 disorder and compare with Rett syndrome (RTT). Information on individuals with cyclin-dependent kinase-like 5 (CDKL5) mutations (n=86) and females with MECP2 mutations (n=920) was sourced from the InterRett database. Available photographs of CDKL5 patients were examined for dysmorphic features. The proportion of CDKL5 patients meeting the recent Neul criteria for atypical RTT was determined. Logistic regression and time-to-event analyses were used to compare the occurrence of Rett-like features in those with MECP2 and CDKL5 mutations. Most individuals with CDKL5 mutations had severe developmental delay from birth, seizure onset before the age of 3 months and similar non-dysmorphic features. Less than one-quarter met the criteria for early-onset seizure variant RTT. Seizures and sleep disturbances were more common than in those with MECP2 mutations whereas features of regression and spinal curvature were less common. The CDKL5 disorder presents with a distinct clinical profile and a subtle facial, limb and hand phenotype that may assist in differentiation from other early-onset encephalopathies. Although mutations in the CDKL5 gene have been described in association with the early-onset variant of RTT, in our study the majority did not meet these criteria. Therefore, the CDKL5 disorder should be considered separate to RTT, rather than another variant. PMID:22872100

The practical application of adaptive study design in early phase clinical trials: a retrospective analysis of time savings.

PubMed

Lorch, U; Berelowitz, K; Ozen, C; Naseem, A; Akuffo, E; Taubel, J

2012-05-01

The interest in adaptive study design is evident from the growing amount of clinical research employing this model in the mid to later stages of medicines development. Little has been published on the practical application and merits of adaptive study design in early phase clinical research. This paper describes a retrospective analysis performed on a sample of 29 industry lead adaptive early phase studies commencing between 1 January 2006 and 31 December 2010 in a clinical trials unit in London, England. All studies containing at least one adaptive feature in the original protocol were included in the analysis. The scope of the analysis was to assess whether the use of adaptive study designs provided tangible benefits over the use of conventional study designs using time savings as the main measure. We conclude that the use of adaptive study design saves time in early phase research programs. This is achieved by abolishing the need for substantial amendments or by mitigating their impact on timelines and by using adaptive scheduling efficiencies.

Clinical user experiences of observation and response charts: focus group findings of using a new format chart incorporating a track and trigger system.

PubMed

Elliott, Doug; Allen, Emily; Perry, Lin; Fry, Margaret; Duffield, Christine; Gallagher, Robyn; Iedema, Rick; McKinley, Sharon; Roche, Michael

2015-01-01

Optimising clinical responses to deteriorating patients is an international indicator of acute healthcare quality. Observation charts incorporating track and trigger systems are an initiative to improve early identification and response to clinical deterioration. A suite of track and trigger 'Observation and Response Charts' were designed in Australia and initially tested in simulated environments. This paper reports initial clinical user experiences and views following implementation of these charts in adult general medical-surgical wards. Across eight trial sites, 44 focus groups were conducted with 218 clinical ward staff, mostly nurses, who received training and had used the charts in routine clinical practice for the preceding 2-6 weeks. Transcripts of audio recordings were analysed for emergent themes using an inductive approach. In this exploration of initial user experiences, key emergent themes were: tensions between vital sign 'ranges versus precision' to support decision making; using a standardised 'generalist chart in a range of specialist practice' areas; issues of 'clinical credibility', 'professional autonomy' and 'influences of doctors' when communicating abnormal signs; and 'permission and autonomy' when escalating care according to the protocol. Across themes, participants presented a range of positive, negative or mixed views. Benefits were identified despite charts not always being used up to their optimal design function. Participants reported tensions between chart objectives and clinical practices, revealing mismatches between design characteristics and human staff experiences. Overall, an initial view of 'increased activity/uncertain benefit' was uncovered. Findings particularly reinforced the significant influences of organisational work-based cultures, disciplinary boundaries and interdisciplinary communication on implementation of this new practice chart. Optimal use of all chart design characteristics will be possible when these

Exploring School-Employer Partnerships to Expand Career Development and Early Work Experiences for Youth with Disabilities

ERIC Educational Resources Information Center

Carter, Erik W.; Trainor, Audrey A.; Cakiroglu, Orhan; Cole, Odessa; Swedeen, Beth; Ditchman, Nicole; Owens, Laura

2009-01-01

Although career development and early work experiences are associated with improved postschool employment outcomes for youth with disabilities, transition personnel report having few natural community partners to support and enhance these experiences. We surveyed 135 chambers of commerce and other employer networks to examine (a) whether and how…

An Enzymatic Clinical Chemistry Laboratory Experiment Incorporating an Introduction to Mathematical Method Comparison Techniques

ERIC Educational Resources Information Center

Duxbury, Mark

2004-01-01

An enzymatic laboratory experiment based on the analysis of serum is described that is suitable for students of clinical chemistry. The experiment incorporates an introduction to mathematical method-comparison techniques in which three different clinical glucose analysis methods are compared using linear regression and Bland-Altman difference…

[Clinical experience with 53 consecutive heart transplants].

PubMed

Villavicencio, Mauricio; Rossel, Víctor; Larrea, Ricardo; Peralta, Juan Pablo; Larraín, Ernesto; Sung Lim, Jong; Rojo, Pamela; Gajardo, Francesca; Donoso, Erika; Hurtado, Margarita

2013-12-01

Heart transplantation is the therapy of choice for advance heart failure. Our group developed two transplant programs at Instituto Nacional del Tórax and Clínica Dávila. We report our clinical experience based on distinctive clinical policies. Fifty-three consecutive patients were transplanted between November 2008 and April 2013, representing 51% of all Chilean cases. Distinctive clinical policies include intensive donor management, generic immunosuppression and VAD (ventricular assist devices) insertion. Ischemic or dilated cardiomyopathy were the main indications (23 (43%) each), age 48 ± 13 years and 48 (91%) were male. Transplant listing Status: IA 14 (26%) (VAD or 2 inotropes), IB 14 (26%) (1 inotrope) and II25 (47%) (no inotrope). Mean waiting time 70 ± 83 days. Twelve (24%) were transplanted during VAD support (median support: 36 days). orthotopic bicaval transplant with ischemia time: 175 ± 54 min. Operative mortality: 3 (6%), all due to right ventricular failure. Re-exploration for bleeding 2 (4%), stroke 3 (6%), mediastinitis 0 (0%), pneumonia 4 (8%), and transient dialysis 6 (11%). Mean follow-up was 21 ± 14 months. Three-year survival was 86 ± 6%. One patient died of Pneumocystis jirovecii pneumonia and the other died suddenly (non-compliance). Freedom from rejection requiring specific therapy was 80 ± 7% at 3 years of follow-up. Four hundred eighty four endomyocardial biopsies were done: 11 (2.3%) had 2R rejection. All survivors are in NYHA (New York Heart Association) functional class I and all but one have normal biventricular function. Mid-term results are similar to those reported by the registry of the International Society for Heart and Lung Transplantation. This experience has a higher proportion of VAD support than previous national series. Rejection rates are low in spite of generic immunosuppression.

Clinical exposures during internal medicine acting internship: profiling student and team experiences.

PubMed

Smith, Todd I; LoPresti, Charles M

2014-07-01

The clinical learning model in medical education is driven by knowledge acquisition through direct patient-care experiences. Despite the emphasis on experiential learning, the ability of educators to quantify the clinical exposures of learners is limited. To utilize Veterans Affairs (VA) electronic medical record information through a data warehouse to quantify clinical exposures during an inpatient internal medicine rotation. We queried the VA clinical data warehouse for the patients encountered by each learner completing an acting internship rotation at the Cleveland VA Medical Center from July 2008 to November 2011. We then used discharge summary information to identify team exposures-patients seen by the learner's inpatient team who were not primarily assigned to the learner. Based on the learner and team exposures, we complied lists of past medical problems, medications prescribed, laboratory tests that resulted, radiology evaluated, and primary discharge diagnoses. Primary learner and team-based clinical exposures were evaluated for a total of 128 acting internship students. The percentage of learners who had a primary exposure to a medication/lab value/imaging result/diagnosis was calculated. The percentage of learners with at least 1 primary or team-based exposure to an item was also calculated. The most common exposures in each category are presented. Analysis of the clinical exposures during an inpatient rotation can augment the ability of educators to understand learners' experiences. These types of analyses could provide information to improve learner experience, implement novel curricula, and address educational gaps in clinical rotations. © 2014 Society of Hospital Medicine.

How Supervisor Experience Influences Trust, Supervision, and Trainee Learning: A Qualitative Study.

PubMed

Sheu, Leslie; Kogan, Jennifer R; Hauer, Karen E

2017-09-01

Appropriate trust and supervision facilitate trainees' growth toward unsupervised practice. The authors investigated how supervisor experience influences trust, supervision, and subsequently trainee learning. In a two-phase qualitative inductive content analysis, phase one entailed reviewing 44 internal medicine resident and attending supervisor interviews from two institutions (July 2013 to September 2014) for themes on how supervisor experience influences trust and supervision. Three supervisor exemplars (early, developing, experienced) were developed and shared in phase two focus groups at a single institution, wherein 23 trainees validated the exemplars and discussed how each impacted learning (November 2015). Phase one: Four domains of trust and supervision varying with experience emerged: data, approach, perspective, clinical. Early supervisors were detail oriented and determined trust depending on task completion (data), were rule based (approach), drew on their experiences as trainees to guide supervision (perspective), and felt less confident clinically compared with more experienced supervisors (clinical). Experienced supervisors determined trust holistically (data), checked key aspects of patient care selectively and covertly (approach), reflected on individual experiences supervising (perspective), and felt comfortable managing clinical problems and gauging trainee abilities (clinical). Phase two: Trainees felt the exemplars reflected their experiences, described their preferences and learning needs shifting over time, and emphasized the importance of supervisor flexibility to match their learning needs. With experience, supervisors differ in their approach to trust and supervision. Supervisors need to trust themselves before being able to trust others. Trainees perceive these differences and seek supervision approaches that align with their learning needs.

Clinical Practice of Adjuvant Chemotherapy in Patients with Early-Stage Epithelial Ovarian Cancer.

PubMed

Frielink, Lindy M J; Pijlman, Brenda M; Ezendam, Nicole P M; Pijnenborg, Johanna M A

2016-01-01

Adjuvant platinum-based chemotherapy improves survival in women with early-stage epithelial ovarian cancer (EOC). Yet, there is a wide variety in clinical practice. All patients diagnosed with FIGO I and IIa EOC (2006-2010) in the south of the Netherlands were analyzed. The percentage of patients that received adjuvant chemotherapy was determined as well as the comprehensiveness of staging and outcome. Forty percent (54/135) of the patients with early-stage EOC received adjuvant chemotherapy. Treatment with adjuvant chemotherapy was associated with FIGO stage, clear-cell histology and nonoptimal staging. Optimal staging was achieved in 50%, and nonoptimal staging was associated with advanced age, comorbidity and treatment in a non-referral hospital. Overall, there was no difference in outcome between patients with and without adjuvant chemotherapy. Yet, in grade 3 tumors, adjuvant chemotherapy seems beneficial. Selective treatment of patients with early-stage EOC might reduce adjuvant chemotherapy without compromising outcome. © 2016 S. Karger AG, Basel.

Early repolarization in Wolff-Parkinson-White syndrome: prevalence and clinical significance.

PubMed

Mizumaki, Koichi; Nishida, Kunihiro; Iwamoto, Jotaro; Nakatani, Yosuke; Yamaguchi, Yoshiaki; Sakamoto, Tamotsu; Tsuneda, Takayuki; Inoue, Hiroshi; Sakabe, Masao; Fujiki, Akira

2011-08-01

Idiopathic ventricular fibrillation (IVF) with early repolarization (ER) has recently been reported; however, ER is a common finding in healthy subjects and is also found sporadically in patients with Wolff-Parkinson-White (WPW) syndrome. The present study was designed to evaluate the prevalence and clinical significance of ER in patients with WPW syndrome. One hundred and eleven patients with WPW syndrome were studied retrospectively. Early repolarization was defined as QRS slurring or notching with J-point elevation ≥ 1 mm. The prevalence of ER was determined before and after successful catheter ablation. Before ablation, ER was found in 35 of 75 patients with a left free wall, 6 of 23 with a right free wall, and 7 of 13 with a septal accessory pathway (48 of 111, 43% as a whole). Early repolarization was always observed in leads with positive deflection of the initial part of the delta wave. After successful ablation of accessory pathways, ER was preserved in 28 (25%), disappeared in 20 (18%), and newly developed in 8 (7%) patients. In the remaining 55 (50%) patients, ER was not observed either before or after ablation. In patients with persistent ER, the amplitude and width of ER were significantly decreased 3-7 days after the ablation (1.7 ± 0.7 vs. 1.4 ± 0.6 mm, P < 0.005 and 42 ± 11 vs. 34 ± 9 ms, P < 0.001, respectively). In patients with WPW syndrome, ER could be partly related to early depolarization through the accessory pathway. However, persistent ER and new ER appearing after the ablation were frequently found. Therefore, in these patients, mechanisms other than early depolarization may be involved in the genesis of ER.

Relationship of Basal laminar deposit and membranous debris to the clinical presentation of early age-related macular degeneration.

PubMed

Sarks, Shirley; Cherepanoff, Svetlana; Killingsworth, Murray; Sarks, John

2007-03-01

To correlate basal laminar deposit (BLamD) and membranous debris, including basal linear deposit (BLinD), with the evolution of early age-related macular degeneration (AMD). A clinicopathologic collection of 132 eyes with a continuous layer of BLamD was reviewed. The thickness and type of BLamD and the sites of membranous debris deposition were correlated with the clinical progression of the disease. Two types of BLamD, termed early and late, were identified based on light microscopic appearance by using the picro-Mallory stain. The progressive accumulation of late type BLamD correlated well with increasing BLamD thickness, advancing RPE degeneration, poorer vision, increasing age, and clinically evident pigment changes. Membranous debris initially accumulated diffusely as BLinD, most eyes with BLinD and early BLamD remaining funduscopically normal. However, membranous debris also formed focal collections as basal mounds internal to the RPE basement membrane and as soft drusen external to the basement membrane. Eyes in which membranous debris remained confined to basal mounds belonged to older patients with poorer vision, whereas patients with soft drusen were younger and had better vision. The presence of BLinD and early BLamD define threshold AMD, which manifests clinically as a normal fundus. Although late BLamD correlates most closely with clinical pigment abnormalities, it is the quantity and sites of membranous debris accumulation that appear to determine whether the disease develops pigment changes only or follows the alternative pathway of soft drusen formation with its attendant greater risk of choroidal neovascularization (CNV).

Clinical nursing leaders', team members' and service managers' experiences of implementing evidence at a local level.

PubMed

Kitson, Alison; Silverston, Heidi; Wiechula, Rick; Zeitz, Kathryn; Marcoionni, Danni; Page, Tammy

2011-05-01

To describe the experiences of 14 clinical nursing leaders introducing a knowledge translation (KT) project into one metropolitan acute care hospital in South Australia. The study also explored team members' and service managers' experiences. KT strategies assume that local (nursing) clinical leaders have the capacity and capability to champion innovation combining positional leadership roles (ward leader) with a project lead role. There is limited evidence to support these assumptions. Semi-structured interviews of clinical nursing leaders and managers were undertaken at month 4 and 12 of the project. Data were also collected from the interdisciplinary team members (n = 28). Clinical nursing leaders identified risks and anxieties associated with taking on an additional leadership role, whereas managers acknowledged the multiple pressures on the system and the need for local level innovation. Team members generally reported positive experiences. With support, clinical nursing leaders can effectively embrace KT project leadership roles that complement their positional leadership roles. Clinical nursing leaders' experiences differed from nursing and medical managers' experiences.   Managers need to be more attuned to the personal risks local leaders experience, providing support for leaders to experiment and innovate. Managers need to integrate local priorities with broader system wide agendas. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

Troubling Messages: Agency and Learning in the Early Schooling Experiences of Children of Latina/o Immigrants

ERIC Educational Resources Information Center

Adair, Jennifer Keys; Colegrove, Kiyomi Sánchez-Suzuki; McManus, Molly

2018-01-01

Background/Context: Early childhood education in the United States is currently suspended between the belief that young children learn through dynamic experiences in which they are able to create and experiment, and the belief that young children's emerging literacy and math skills require formal instruction and assessments to ensure future…

Experience of Sexual Abuse in Childhood and Abortion in Adolescence and Early Adulthood

ERIC Educational Resources Information Center

Boden, Joseph M.; Fergusson, David M.; Horwood, L. John

2009-01-01

Objective: The present study examined the associations between the experience of sexual abuse in childhood (CSA) and the number of abortions in adolescence and early adulthood. Method: A 25-year prospective longitudinal study of the health, development, and adjustment of a birth cohort of 1,265 New Zealand children (630 females). Measures included…

[Leadership Experience of Clinical Nurses: Applying Focus Group Interviews].

PubMed

Lee, Byoung Sook; Eo, Yong Sook; Lee, Mi Aie

2015-10-01

The purpose of this study was to understand and describe the leadership experience of clinical nurses. During 2014, data were collected using focus group interviews. Three focus group interviews were held with a total of 20 clinical nurses participating. All interviews were recorded as they were spoken and transcribed and data were analyzed using qualitative content analysis. Fifteen categories emerged from the five main themes. 1) Thoughts on the leadership category: to lead others, to cope with problem situations adequately and to serve as a shield against difficulties. 2) Situations requiring leadership: situation that requires correct judgement, coping and situations that need coordination and cooperation. 3-1) Leadership behaviors: other-oriented approach and self-oriented approach. 3-2) Leadership behavior consequences: relevant compensation and unfair termination. 4-1) Facilitators of leadership: confidence and passion for nursing and external support and resources. 4-2) Barriers to leadership: non-supportive organization culture and deficiency in own leadership competencies. 5) Strategies of leadership development: strengthen leadership through self-development and organizational leadership development. In conclusion, the results indicate that it is necessary to enhance clinical nurses' leadership role in healthcare. Enhancement can be achieved through leadership programs focused on enlarging leadership experience, constant self-development, leadership training, and development of leadership competencies suited to the nursing environment.

Nursing Faculty Experiences of Virtual Learning Environments for Teaching Clinical Reasoning

ERIC Educational Resources Information Center

Zacharzuk-Marciano, Tara

2017-01-01

Nurses need sharp, clinical reasoning skills to respond to critical situations and to be successful at work in a complex and challenging healthcare system. While past research has focused on using virtual learning environments to teach clinical reasoning, there has been limited research on the experiences of nursing faculty and there is a need for…

Diagnostic games: from adequate formalization of clinical experience to structure discovery.

PubMed

Shifrin, Michael A; Kasparova, Eva I

2008-01-01

A method of obtaining well-founded and reproducible results in clinical decision making is presented. It is based on "diagnostic games", a procedure of elicitation and formalization of experts' knowledge and experience. The use of this procedure allows formulating decision rules in the terms of an adequate language, that are both unambiguous and clinically clear.

Association Between Medicare Summary Star Ratings for Patient Experience and Clinical Outcomes in US Hospitals.