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At least 289 records · Page 16Linked to original sources
PubMed1995

Nuclear cardiology, current applications in clinical practice.

The clinical applications of nuclear cardiology have rapidly expanded since the introduction of suitable imaging cameras and readily applicable isotopes. The currently available methods can provide useful data on estimates of ventricular function and detection of myocardial ischemia for adequate patient management. Two standard procedures are routinely used: (1) myocardial perfusion scintigraphy, eg, with thallium 201; and (2) radionuclide angiocardiography by using technetium 99m-labeled red blood cells. Myocardial perfusion scintigraphy provides information on regional viability and estimates regional myocardial perfusion by measuring regional tracer activity. Thallium 201 is the agent used for noninvasive assessment of myocardial perfusion and for improving the results of exercise electrocardiography. Alternative tests, such as pharmacologic stress testing with dipyridamole, have been proposed as a reliable substitute for exercise testing. Additional quantitative analysis and computed tomography have increased the sensitivity and specificity of thallium scintigraphy. Radionuclide angiography techniques are used for the noninvasive evaluation of cardiac function, right and left ventricular function, and wall motion abnormalities. As in perfusion scintigraphy, radionuclide angiography has proven its value for the detection of coronary artery disease (CAD). Abnormal regional wall motion abnormalities are specific for CAD.

Coronary Disease↗
PubMed1981

Studies of play: implications for growth, development, and for clinical practice.

The clinical yields of studies of play conducted by graduate students in occupational therapy are identified, and the boundaries of the studies are described. The theme of change in play over time is acknowledged as prominent in all the studies. Open systems and hierarchy are helpful concepts for understanding the process of change in growth and development through play. Clinical tasks to facilitate the change process are cited.

Adolescent↗
PubMed2001

Application of Resistance Reversal Agents in Hematologic Malignancies; Malignancy; Current Clinical Practice.

The clinical application of resistance reversal drugs for patients with hematologic malignancies is reviewed. The phenomenon of multidrug resistance versus other mechanisms are discussed. The pump-like mechanisms of P-glycoprotein, multidrug resistance associated protein, lung resistance protein and of other ATP binding cassette transporter proteins are reviewed briefly, as well as the important substrate drugs and pump-blocking compounds. The problems associated with resistance protein assays in clinical samples and the concept of prognostic versus therapeutic clinical relevance are described, within the context of selected hematologic malignancies. Toxicities and treatment outcomes of phase II and III trials of reversal agents in lymphoma, multiple myeloma, myelodysplastic syndromes, acute myeloid leukemia and blast phase of chronic myeloid leukemia are reviewed. Finally, current options for on-study management of relapsed or refractory hematologic malignancy patients are discussed.

Journal Article↗
PubMed1992

The pharmacologic treatment of alcohol and cocaine abuse. Integration of recent findings into clinical practice.

The clinical evidence available to date does not yet support the routine use of pharmacologic interventions in the majority of cases of alcohol or cocaine abuse. The available data suggest, however, that interventions should be considered, especially in patients who relapse or drop out of treatment, in more difficult cases, and in instances in which there are associated psychiatric disorders. Education and prevention should be reconsidered as the important "treatments" they are today.

Adolescent↗
PubMed1982

The electro-encephalogram in clinical practice.

The clinical ambit of the electro-encephalogram (EEG) is discussed for the benefit of practitioners who do not regularly use this procedure. Some topics covered are: what is measured by an EEG; the report; epileptiform and nonspecific signs in relation to a diagnosis of epilepsy; and limitations and advantages of the EEG.

Electroencephalography↗
PubMed2006

The translational clinical practice system: a way to implement the evidence-based approach in the dental office.

Evidence-based decision-making in dental practice is challenging and rewarding. But for many clinicians, the evidence-based approach is an abstract and even theoretical idea that sounds good, but is not very practical. The Translational Clinical Practice System provides an overriding domain and a system within which the evidence-based approach may be more effectively utilized in clinical practice. Most would agree that using good evidence, information, and data as the basis for decisions are the starting points toward reaching the best results for the patient. However, there are clearly insufficiencies in the currently available best scientific evidence for many of the procedures patients need. The good news is that the evidence environment is improving and better quality information is becoming available in the office where it is needed. This article describes a logical and straightforward approach for clinicians to use in order to put together complex and often interwoven factors involved with patient care. Specific clinical examples are provided.

Databases as Topic↗
PubMed2001

Principles of pediatric combination vaccines and practical issues related to use in clinical practice.

BACKGROUND: During the past two decades the number of injections that are required per office visit to fulfill the recommended childhood immunization schedule has increased dramatically. METHODS: By reviewing the literature, the principles associated with pediatric combination vaccines are discussed, and practical issues related to their use in clinical practice are evaluated. RESULTS: The ideal combination vaccine is safe, effective and easy to store and use, and its antigenic components fit within the recommended immunization schedule. The ideal combination is associated with fewer adverse reactions than the separately administered antigens, with improved efficacy and higher immune responses compared with its component vaccines. An acceptable combination vaccine must provide comparable efficacy and safety to its component vaccines. Although there are a limited number of combination vaccines already available [diphtheria-tetanus-pertussis, inactivated poliovirus vaccine (IPV) and measles-mumps-rubella], effort is being focused on combining these vaccines with other routine vaccines of infancy including Haemophilus influenzae type b (Hib) and hepatitis B vaccine (HepB). Currently under review by the Food and Drug Administration are diphtheria-tetanus-acellular pertussis (DTPa)-HepB-IPV and DTPa-Hib-IPV combination vaccines, and two DTPa-HepB-IPV-Hib vaccines have been licensed in Europe. As more combination vaccines become available, issues such as interchangeability and administration of extra doses are raised; however, it is important not to miss a vaccination opportunity. CONCLUSIONS: The number of injections required to fulfill the recommended childhood immunization schedule at each visit creates problems for patients and practitioner, sometimes risking a missed opportunity for vaccination. The development of combination vaccines will circumvent this problem and increase compliance and vaccination coverage rates.

Clinical Trials as Topic↗
PubMed2000

Realities of practice. Engaging parents and GPs in developing clinical practice guidelines.

OBJECTIVE: To integrate evidence based medicine with the experience and expectations of consumers and GPs in the development of clinical practice guidelines for acute respiratory infections (ARI) in young children. METHOD: Focus groups and workshops were held with 21 GPs and 27 patients of young children involved in a 2 year randomised controlled trial. RESULTS: The acceptability of the guideline development process for participants was determined. Barriers were identified which would impede clinical change, including: inadequate time; lack of knowledge; fear of patient dissatisfaction; and fear of poor health outcome. CONCLUSION: This paper details a process of guideline development that addresses the realities of general practice in Australia and the concerns of consumers. We identified potential barriers to change and integrated intervention strategies with the evidence to produce realistic clinical practice guidelines.

Acute Disease↗
PubMed2003

Clinical practice development in Central Coast Health.

Engagement in clinical practice development may be achieved in a range of ways. In this paper we describe the formation of a strategic plan for clinical practice development for Central Coast Health. The plan specifically builds on the work that has already been achieved by clinicians and is inclusive of the multi-disciplinary team. In order to clarify the strategic direction, three levels of clinical practice development are offered as examples of increasingly intensive clinical practice development. In the strategic plan senior personnel are recruited to support area-wide developments. At the same time clinicians are supported to work on specific local projects creating a simultaneous top-down and bottom-up approach. Preparation of clinicians for the challenges of team building and change in practice ensures that people choosing to engage in clinical practice have realistic expectations of the commitment and rewards that may be expected.

Australia↗
PubMed2005

[Efficacy and safety of vardenafil in men with erectile dysfunction in general clinical practice].

Since fixed-dose vardenafil clinical trails don't fully represent utilization of phosphodiesterase-5 (PDES) inhibitor in general clinical practice. This article reviews flexible-dose and community practice studies, to assess the efficacy and safety of vardenafil in general clinical practice. The results show that vardenafil improves erectile function in most men treated for ED in clinical practice, and well tolerated.

Adult↗
PubMed1998

Residents find clinical practice guidelines valuable as educational and clinical tools.

BACKGROUND AND OBJECTIVES: Information regarding clinical practice guideline (CPG) use in residency education is limited. We surveyed a regional population of family practice residents to determine use, attitudes, and curricular needs for practice guidelines. METHODS: A written survey was developed that measured residents' exposure to, frequency of use, attitudes, access, and knowledge about use of CPGs. The survey was mailed to 114 family practice residents. RESULTS: The response rate was 75%. The most frequently seen guidelines were immunization schedules, cancer screening, hyperlipidemia, and hypertension management. The residents reported positive attitudes toward CPGs; 75% thought CPGs were easy to use, 80% thought they improved their efficiency, 78% thought they improved their residency education, and 75% thought they improved patient care. Barriers to effective use of practice guidelines were also identified; 20% knew where to find guidelines in their clinic, 35% had faculty modeling, and 22% knew how to evaluate the validity of a guideline. Eighty-nine percent of respondents desired instruction on CPG use and interpretation. CONCLUSIONS: The surveyed family practice residents have similar usage rates for CPGs as the literature reports for practicing physicians, but residents report more positive attitudes. Barriers that prevent effective use of CPGs in training environments include lack of critical appraisal abilities and faculty role modeling.

Curriculum↗
PubMed2002

Clinical practice guidelines. Managing oral anticoagulant therapy.

Clinical practice guidelines (CPG) provide recommendations based on the summary of large volumes of literature and expert opinion. They are not absolute care directives, but are intended to facilitate individualized decision making related to patient care situations. Each month this column reviews a CPG of direct relevance to clinical practice. Readers are urged to contact the author, Mary Jo Goolsby (mjgoolsby@aanp.org) with requests for reviews of specific clinical guidelines or submissions of manuscripts addressing major guidelines that readers have found helpful in their practice. The Clinical Practice Guideline column is designed to inform practitioners of the wide range of accessible and current recommendations on a myriad of clinical topics. The guideline reviewed this month is actually one part of a large report stemming from the Sixth American College of Chest Physicians (ACCP) Consensus Conference on Antithrombotic Therapy. The management of oral anticoagulant therapy is but one portion of the overall report, complemented and supported by other components, including a preceding chapter that summarizes the mechanisms of action, clinical effectiveness, and therapeutic range of oral agents. This CPG focuses on following issues: (a) initiating and maintaining dosage, (b) managing non-therapeutic dosages, (c) managing the agents during invasive procedures, and (d) recognizing and responding to adverse events. Special situations are discussed, including management of patients who are elderly or pregnant, and comparisons of the management in different models of care. There is in-depth discussion of the literature, accompanied by a summary of recommendations.

Anticoagulants↗
PubMed2005

A model of ambiguity and vagueness in clinical practice guideline recommendations.

Ambiguity and vagueness in clinical practice guidelines reduce the likelihood of clinician adherence. They lead to inconsistent interpretation and, in turn, to inappropriate practice variation and medical errors. Resolving ambiguity and vagueness is an essential step in the computerized implementation of clinical practice guidelines. Successful resolution of ambiguity and vagueness requires an understanding of their characteristics, yet ambiguity and vagueness have not been differentiated, classified and described in medical context. In this paper, we propose a tri-axial model to describe ambiguity and vagueness in clinical practice guidelines: differentiation of true ambiguity from vagueness, classification of ambiguity and vagueness, intentionality and components involved. Our goals in introducing this model are: (a) to provide guidance to guideline authors to enable them to reduce inadvertent use of ambiguous or vague language, (b) to improve transparency when vague language is used deliberately and (c) to create a framework for the development of tools to apply the model during authoring and implementation of clinical practice guidelines.

Decision Making, Computer-Assisted↗
PubMed2005

Incorporation of research into clinical practice: the development of a clinical nurse researcher position.

The role of research within nursing is gaining a higher profile, as nurses move towards advanced practice roles, and concepts such as evidence based practice and clinical governance are accepted. Research has long been incorporated in both undergraduate and post graduate nursing education, but has often been viewed by nurse clinicians as too difficult and expensive, with little direct clinical relevance. The current focus on developing Nurse Practitioners has emphasised the need for a research component in such practice, but it is not only the 'advanced' practitioners who can benefit from a greater understanding and involvement with the research process. The development of an innovative research role in Christchurch Hospital has the potential to demonstrate that research can be incorporated and accepted into a clinical area. The role of Clinical Nurse Researcher in the Emergency Department has resulted in a higher profile for research, and the gradual integration of research as a clinical skill with direct practical relevance.

Clinical Nursing Research↗
PubMed2004

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

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

Academic Medical Centers↗
PubMed2005

A qualitative study of nursing student experiences of clinical practice.

BACKGROUND: Nursing student's experiences of their clinical practice provide greater insight to develop an effective clinical teaching strategy in nursing education. The main objective of this study was to investigate student nurses' experience about their clinical practice. METHODS: Focus groups were used to obtain students' opinion and experiences about their clinical practice. 90 baccalaureate nursing students at Shiraz University of Medical Sciences (Faculty of Nursing and Midwifery) were selected randomly from two hundred students and were arranged in 9 groups of ten students. To analyze the data the method used to code and categories focus group data were adapted from approaches to qualitative data analysis. RESULTS: Four themes emerged from the focus group data. From the students' point of view," initial clinical anxiety", "theory-practice gap"," clinical supervision", professional role", were considered as important factors in clinical experience. CONCLUSION: The result of this study showed that nursing students were not satisfied with the clinical component of their education. They experienced anxiety as a result of feeling incompetent and lack of professional nursing skills and knowledge to take care of various patients in the clinical setting.

Journal Article↗
PubMed1997

An evidence-based approach to clinical practice guidelines in periodontics.

The use of clinical practice guidelines has received considerable attention in medicine and dentistry for improving clinical decision making and cost-effective care. Leaders in dentistry are increasingly calling for improved standardization of treatment through the development of clinical practice guidelines based on empiric clinical evidence. Guidelines have been shown to minimize treatment variability and ensure the quality and cost-effectiveness of care. Other potential applications include educating individuals or groups; development of quality indicators; improved allocation of resources such as insurance payment decisions; and reduced risk of liability for negligent care. Recently, a series of evidence-based clinical algorithms and practice guidelines were developed for regenerative periodontal treatment. Such guidelines have the potential to improve outcomes of periodontal care for providers, patients, and other interested parties. This review discusses the rationale for guideline development and the role of clinical practice guidelines in the area of periodontal decision making and provision of care.

Decision Making↗