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PubMed · 8352328

Combining practice and research.

Abstract

Although many authors advocate research involvement for occupational therapists involved in clinical practice, no formal studies existed of the personal, educational, and workplace environmental factors though to affect therapists' ability to integrate clinical research with practice. This exploratory, descriptive study surveyed 103 occupational therapists reporting work functions of both direct patient care and research. Major findings included: (a) workplace learning circumstances focusing on performance and application of clinical research were important for adopting a dual practice-research role, (b) research activities reflected the evolving character of the role, (c) administrative support and a personal commitment to research were critical for success, and (d) formal research courses were important, but so were informal discussions regarding application and problem solving. The findings have implications for university curricula, continuing education, and clinical environments.

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A P Colborn. 1993. Combining practice and research.. https://doi.org/10.5014/ajot.47.8.693

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Nutritional support and the surgical patient.

PURPOSE: Data on the impact of nutritional support (NS) on outcomes in surgical patients are reviewed. SUMMARY: While most patients will progress to oral nutrition after surgery and require little or no intervention, major surgery or postoperative complications can delay the prescription of an oral diet. In such patients, nutritional requirements are often increased to support wound healing and hypermetabolism associated with surgical recovery. Without adequate nutrition, muscle wasting, immune dysfunction, and declining visceral protein status are observed. While it would seem intuitive that early nutritional intervention is warranted for most patients, the literature to date suggests that early parenteral nutrition (PN) does not improve clinical outcomes. An exception may be for severely malnourished patients if NS is provided for at least seven days preoperatively. Such patients should be identified early through nutritional assessment. Early enteral nutrition (EN) may potentially improve patient outcomes compared with PN, but there are insufficient data to confirm this. High-dose parenteral glutamine may reduce infectious complications and the length of hospitalization for surgical patients, but a significant reduction in mortality has not been observed. Early EN with immune-enhancing formulas appears promising for general surgery patients. However, their use in the critically ill surgical patient is not unanimously supported, and some studies suggest potential harm. CONCLUSION: Surprisingly little evidence is available to support a significant impact of early NS on postoperative clinical outcomes.

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