Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Institutional Practice”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 289 records · Page 16Linked to original sources
PubMed1997

Radiotherapy after chemotherapy for metastatic seminoma--a diminishing role. MRC Testicular Tumour Working Party.

In a retrospective study, data from 302 patients with metastatic testicular seminoma treated with chemotherapy between 1978 and 1990 in 10 European centres were analysed to evaluate the role, if any, of postchemotherapy treatment with irradiation. The primary endpoint of this study was the progression-free survival rate after chemotherapy with or without additional radiotherapy. This was related to the type of primary chemotherapy, sites and sizes of pre- and postchemotherapy masses, the extent of surgical resection after chemotherapy and the use of radiotherapy. 174 patients had residual disease at the end of chemotherapy. The most important prognostic factors for progression were the presence of any visceral metastases or raised LDH prechemotherapy, and the presence of residual disease at visceral sites after chemotherapy. Approximately half the patients with residual masses underwent postchemotherapy radiotherapy, with selection based predominantly on institutional practice. In patients receiving platinum-based chemotherapy, no significant difference was detected in progression-free survival whether or not radiotherapy was employed. Patients receiving BEP (bleomycin, etoposide and cisplatin) had a progression-free survival rate of 88% (95% CI, 80-96%) uninfluenced by postchemotherapy radiotherapy. In patients with residual masses confined to the abdomen after platinum-based chemotherapy, the absolute benefit to radiotherapy was estimated to be 2.3%. The potential benefit of postchemotherapy radiotherapy is minimal, and so it is concluded that the use of adjuvant radiotherapy to residual masses after platinum-based chemotherapy for metastatic seminoma is unnecessary.

Abdominal Neoplasms↗
PubMed1996

Endometriosis in an adolescent population: the Emory experience.

OBJECTIVE: To determine the incidence, clinical stage, and lesion type of endometriosis in adolescent girls. DESIGN: Retrospective review of patient records of adolescent girls (11-19) admitted to Emory University Affiliated Hospitals. SETTING: Patients from a private practice institutional setting. PATIENTS: 67 adolescent girls who had not responded to analgesia or oral contraceptives for pelvic pain. INFORMATION: Laparoscopy or exploratory laparotomy to determine the etiology of pelvic pain. MAIN OUTCOME MEASURE: Stage of endometriosis by the American Fertility Society classification system and description of lesion type. RESULTS: Endometriosis was diagnosed in 49 (73%) patients. The majority of patients had stage I disease. Superficial red lesions were most commonly observed. CONCLUSIONS: Adolescent girls with pelvic pain have a high incidence of endometriosis. Minimal disease is most often encountered. Meticulous inspection of the pelvic peritoneal surfaces will often reveal superficial or atypical lesions.

Adolescent↗
PubMed2005

Higher education and psychiatric disabilities: national survey of campus disability services.

Students with psychiatric disabilities are an increasing presence on college and university campuses. However, there is little factual information about the services available to these students in campus disability services offices or the extent to which they use these services. This article reports the results of a survey of disability services offices at colleges and universities in 10 states. Data from 275 schools revealed the number of students with psychiatric disabilities seeking assistance from disability services offices, characteristics of these offices, and the types of services they provide. Survey data also identified barriers to full participation of these students in academic settings. Implications of the study are discussed to inform policy and postsecondary institutional practices with the goal of better serving psychiatrically disabled students to maximize their talents and potential.

Adult↗
PubMed2005

Retinal pigment epithelial tear following photodynamic therapy for choroidal neovascularization secondary to AMD.

PURPOSE: To describe retinal pigment epithelial tear following photodynamic therapy (PDT) for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). DESIGN: Retrospective interventional case series. METHODS: A retrospective study in an institutional practice. We describe seven cases of retinal pigment epithelial (RPE) tear, which developed in seven eyes of seven patients following PDT. All eyes had subfoveal CNV secondary to AMD. RESULTS: Six eyes had occult subfoveal CNV, and one eye had recurrent classic subfoveal CNV. In five patients, the eye that developed the tear was the second eye, whereas the first eye had a disciform scar. In four eyes, the RPE tear developed after one PDT, in one eye the RPE tear developed after the second PDT, and in two eyes the RPE tear developed after the third PDT. In five of seven cases, there was a significant visual deterioration following the RPE tear. CONCLUSIONS: RPE tear is a complication that may occur following PDT in particular when the PDT is applied to an occult subfoveal CNV.

Aged↗
PubMed2002

Are medical postgraduate certification processes valid? A systematic review of the published evidence.

OBJECTIVE: To collate the published works on validation of assessments used in postgraduate medical certification. DESIGN: Systematic review of original papers on reliability and validity of assessments used in medical postgraduate certification. SETTING: Medical and education research databases. RESULTS: Fifty-five papers were identified from 1985 to 2000. A wide range of approaches to validation were employed. Inter-rater reliability and internal consistency were the most reported foci for validation. There were just two papers on consequential validity, and only a few on construct validity. These two forms of validity are considered central in recent general education writing. The majority of papers were from general and family practice. There was a noticeable lack of papers from the UK Royal Colleges (except the Royal College of General Practitioners), despite 5 years of the new unified grade and the renewed emphasis on the role of the Royal Colleges in setting assessment criteria. CONCLUSIONS: There is a relative scarcity of published papers on validation of assessment for postgraduate medical certification considering the influence these high stakes processes have on doctors career progression and employment opportunities. General and family practice institutions in a number of English speaking countries have set an example to others, by showing that rigour and transparency in assessment development and implementation can be reflected in publication.

Certification↗
PubMed1998

From angels to handmaidens: changing constructions of nursing's public image in post-war Britain.

The public image of nursing is an important barometer of how the profession is valued in society. Recent research into images of nurses tends to use content analysis to substantiate claims that the mass media misrepresent the profession, perpetuating outmoded conceptions of nursing work. Such a strategy treats the nature of nursing itself as unproblematic, an object to be more or less accurately 'represented'. But these are assumptions that need to be questioned. The systems of belief and value that produce representations of nursing both reveal and constitute the institutional practices that regulate nursing as a profession, which in turn shape the material form and substance of representational constructs. Drawing on fictional and factual popular and official representations of nursing and nursing work on film, television and in recruitment literature, it is argued that although nursing was consistently constructed as 'women's work' for much of the 20th century, a noticeable shift is perceivable in the status of nursing's public image between the late 1930s and early 1970s.

Attitude to Health↗
PubMed2002

Comparison of knee extensor strength between limbs in individuals with bilateral total knee replacement.

OBJECTIVES: To determine and compare force production of the knee extensors between limbs after bilateral total knee arthroplasty (TKA). DESIGN: Two repeated-measures designs (2 factors: limb, time) assessing for differences in strength between limbs over 3 times at 2 different testing speeds. SETTING: Private and institutional practice. PARTICIPANTS: Fourteen volunteers (6 men, 8 women; mean age +/- standard deviation, 74.57 +/- 5.5 y; height, 169.91 +/- 9.43 cm; weight, 76.42 +/- 9.85 kg) with bilateral TKA. Open-chain knee extensor strength was measured in both legs before surgery and 30 and 60 days after TKA at 60 degrees /s and 180 degrees /s. INTERVENTION: Rehabilitation 3 times weekly for 8 weeks. Treatment consisted of gait, transfer training, stationary cycle work, and a progressive resistance-training program. MAIN OUTCOME MEASURE: Peak torque measured isokinetically. RESULTS: Limb by time interaction was not significant for either 60 degrees /s (F(2,26) =.75, P =.351) or 180 degrees /s (F(2,26) =.78, P =.393). A significant main effect of time was found at 60 degrees /s (F(2,26) = 14.22, P =.0001) and 180 degrees /s (F(2,26) = 10.47, P =.003). CONCLUSIONS: During the first month after TKA, bilateral knee extensor force-production decreased significantly compared with preoperative force production.

Aged↗
PubMed2002

Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity.

OBJECTIVE: To investigate the immediate effect of physical therapeutic modalities on myofascial pain in the upper trapezius muscle. DESIGN: Randomized controlled trial. SETTING: Institutional practice. PATIENTS: One hundred nineteen subjects with palpably active myofascial trigger points (MTrPs). INTERVENTION: Stage 1 evaluated the immediate effect of ischemic compression, including 2 treatment pressures (P1, pain threshold; P2, averaged pain threshold and tolerance) and 3 durations (T1, 30s; T2, 60s; T3, 90s). Stage 2 evaluated 6 therapeutics combinations, including groups B1 (hot pack plus active range of motion [ROM]), B2 (B1 plus ischemic compression), B3 (B2 plus transcutaneous electric nerve stimulation [TENS]), B4 (B1 plus stretch with spray), B5 (B4 plus TENS), and B6 (B1 plus interferential current and myofascial release). MAIN OUTCOME MEASURES: The indexes of changes in pain threshold (IThC), pain tolerance (IToC), visual analog scale (IVC), and ROM (IRC) were evaluated for treatment effect. RESULTS: In stage 1, the IThC, IToC, IVC, and IRC were significantly improved in the groups P1T3, P2T2, and P2T3 compared with the P1T1 and P1T2 treatments (P<.05). In stage 2, groups B3, B5, and B6 showed significant improvement in IThC, ItoC, and IVC compared with the B1 group; groups B4, B5, and B6 showed significant improvement in IRC compared with group B1 (P<.05). CONCLUSIONS: Ischemic compression therapy provides alternative treatments using either low pressure (pain threshold) and a long duration (90s) or high pressure (the average of pain threshold and pain tolerance) and short duration (30s) for immediate pain relief and MTrP sensitivity suppression. Results suggest that therapeutic combinations such as hot pack plus active ROM and stretch with spray, hot pack plus active ROM and stretch with spray as well as TENS, and hot pack plus active ROM and interferential current as well as myofascial release technique, are most effective for easing MTrP pain and increasing cervical ROM.

Adult↗
PubMed2002

Race: predictor versus proxy variable? Outcomes after spinal cord injury.

OBJECTIVE: To examine the impact of race on acute, rehabilitation, and long-term outcomes after spinal cord injury (SCI). DESIGN: Two case control studies (study 1: acute and rehabilitation outcomes, study 2: long-term outcomes) in which white and nonwhite individuals were matched case for case on multiple demographic, medical, and geographic characteristics with the rationale being that a case-control methodology would increase the internal validity of the design, thereby increasing confidence in the assertion that any between-group differences observed may be specifically attributed to race. SETTING: Data drawn from the Spinal Cord Injury Model Systems. Institutional practice and general community. PARTICIPANTS: Study 1: 187 pairs of individuals, study 2: 158 pairs of matched individuals. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Outcome measures assessed included economic (eg, cost of care), treatment-related (eg, length of hospital stay), functional (eg, FIM instrument), and medical (eg, number of medical complications) variables, as well as self-reported life satisfaction, level of handicap, and mental and physical health. RESULTS: In study 1, none of the outcome measures differed significantly across racial groups. Similarly, study 2 failed to indicate significant differences in any of the outcome variables across racial groups, with the exception that nonwhites were at increased risk of greater self-reported handicap in the area of mobility. Power analyses indicated these finding were not merely the result of inadequate power. CONCLUSION: For the outcomes assessed in studies 1 and 2, race appeared to act primarily as a proxy for other variables (eg, injury severity, age, educational achievement), which in turn may be associated with poor outcome after SCI. Theoretical implications and recommendations are discussed.

Activities of Daily Living↗
PubMed2000

Physiologic decrease of single thenar motor units in the F-response in stroke patients.

OBJECTIVE: To investigate the left-right difference and the reproducibility by the F-wave motor unit number estimation and to compare the motor unit number between the hemiplegic and unaffected side in stroke patients. SETTING: A referral center and institutional practice providing outpatient care. SUBJECTS: Seven healthy volunteers and 15 consecutive stroke patients. DESIGN: Diagnostic statistical test and correlational study. METHOD: Submaximal stimuli were used to evoke a sample of surface motor unit action potentials (S-MUAPs) in the F-waves that are entirely representative of the relative numbers of detected S-MUAPs of different sizes. The average S-MUAP amplitude was calculated from a selected population of F-wave responses for each abductor pollicis brevis (APB) muscle. The motor unit number was calculated by dividing the maximum M-potential negative peak amplitude by the average S-MUAP negative peak amplitude. RESULT: There was no statistical difference between motor unit numbers on either side and between test and retest in this motor unit number estimation method among normal subjects. The motor unit number on the hemiplegic side was significantly lower than on the unaffected side (p < .05, Mann-Whitney test) among stroke patients. CONCLUSION: The motor unit could decrease in the hemiplegic side after a moderate-to-severe hemiplegic stroke and this decrement might be due to the transsynaptic degeneration secondary to an upper motor neuron lesion.

Action Potentials↗
PubMed2000

Guidelines for perioperative cardiac evaluation from the American College of Cardiology/American Heart Association task force are effective for stratifying cardiac risk before aortic surgery.

PURPOSE: We assessed whether the American College of Cardiology/American Heart Association (ACC/AHA) task force guidelines for perioperative cardiac evaluation could reliably stratify cardiac risk before aortic surgery. METHODS: We retrospectively applied the guidelines to a closed database, set up prospectively. The setting was a referral center in an institutional practice with hospitalized patients. The closed database included 133 patients who had a routine cardiac examination, which comprised an estimation of functional capacity and noninvasive testing, before aortic surgery. This cardiac evaluation led to the proposal of coronarography in 23 patients and to treating an underlying coronary artery disease in 21 patients (including three myocardial revascularizations). One patient died after myocardial revascularization, and two patients died of cardiac causes after aortic surgery. The algorithm of the ACC/AHA guidelines was applied independently by two investigators to each patient's file that was included in the existing database. The main outcome measure was a comparison between cardiac risk stratification with the ACC/AHA guidelines and the results of the routine cardiac evaluation. RESULTS: The ACC/AHA guidelines were successfully applied to all 133 files by the two investigators. After applying the algorithm, 73 patients were stratified as low cardiac risk, and 60 patients were stratified as high risk. The 21 patients who had undergone a preoperative coronary artery disease optimization were stratified as high risk by means of the ACC/AHA guidelines. The patients who died from cardiac causes were stratified as high risk by means of the ACC/AHA guidelines, whereas none of the patients stratified as low risk died during hospitalization. CONCLUSION: The ACC/AHA guidelines were effective in stratifying cardiac risk by using clinical predictors and an estimate of the physical capacity of the patient. Their use may allow a reduction in unnecessary noninvasive testing in patients stratified as being at low risk, while permitting the selection of all patients likely to benefit from preoperative coronary artery disease optimization.

Algorithms↗
PubMed2001

Concerns for the durability of the proximal abdominal aortic aneurysm endograft fixation from a 2-year and 3-year longitudinal computed tomography angiography study.

OBJECTIVE: To provide a long-term perspective on the durability of the proximal abdominal aortic aneurysm endograft fixation from a single device series with perpendicular neck measurements in two groups of patients with complete 2- and 3-year follow-up. DESIGN: This was a prospective study of postoperative, radiologic images. SETTING: The study used a referral center, institutional practice, and ambulatory patients. SUBJECTS: From January 1994 until May 1998, 37 endografts were implanted for abdominal aortic aneurysm. In the first postoperative year, there were four unrelated deaths and six conversions, leaving 27 patients with complete 24-month data and 13 with complete 36-month data. MAIN OUTCOME MEASURE: Computed tomography angiograms were processed on a work station to measure the neck perpendicular to the central lumen line of the aorta. The surface area at the proximal endovascular anastomosis was recorded at each follow-up interval and related to the postoperative size at the same level. RESULTS: Significant dilatation of the surface area was found: 20% (16% to 27%) at 24 months (c2 = 30; P < .001, Friedman) and 23% (18% to 28%) at 36 months (c2 = 27; P < .001, Friedman). This increase in neck size was continuous and linear, with a yearly rate of approximately 10% surface area; translated into diameter, this approximates 1 mm/y. CONCLUSION: A continuous aortic enlargement of approximately 1 mm/y at the level of the proximal endovascular anastomosis was found. Because of the practice of oversizing the endograft relative to the infrarenal aortic neck, a loss of the endovascular seal may not become apparent until several years after endovascular abdominal aortic aneurysm repair is performed.

Aged↗
PubMed2005

Laser Doppler flowmetry in asymmetric glaucoma.

PURPOSE: To evaluate the relationship between extent of glaucoma damage and optic nerve blood flow, we investigated optic nerve head bloodflow in patients with asymmetric glaucoma damage between their two eyes and also in glaucomatous eyes with asymmetric damage inferiorly versus superiorly. METHODS: From our institutional practice, 16 subjects with asymmetric glaucoma damage between their two eyes and 25 eyes of 20 patients with asymmetric damage superiorly versus inferiorly were included in the study. Determinations of relative optic nerve head blood flow, velocity, and volume were obtained with laser Doppler flowmetry in the superotemporal and inferotemporal neuroretinalrim and in the cup. Means of flow (Flow(3)), velocity (Vel(3)), and volume (Vol(3))were calculated from these three measurement sites, and eyes or hemidisks with greater glaucomatous damage were compared to eyes or hemidisks with less damage. RESULTS: For subjects with asymmetric glaucoma damage between eyes, Flow(3) and Vel(3) were significantly lower in the eyes with worse glaucoma damage(mean difference = 2.09, p = 0.005, and mean difference = 0.05, p = 0.002,respectively). When comparing optic disks displaying within-eye asymmetry, the hemidisk with greater damage showed significantly lower blood velocity than the hemidisk with less damage (mean difference = 0.05, p = 0.013); however,no difference in blood flow or volume was detected. CONCLUSIONS: This study provides additional evidence that impaired optic nerve circulation is associated with the extent of glaucomatous pathology.

Adult↗
PubMedDate not supplied

Sterile endophthalmitis following intravitreal injection of triamcinolone acetonide.

PURPOSE: To investigate clinical findings and ocular characteristics of sterile endophthalmitis following intravitreal injection (IVI) of triamcinolone for the treatment of macular edema. METHODS: IVI is an institutional practice at our hospital. From March 2002 to January 2003, a total of 21 IVIs of triamcinolone acetonide were performed on 19 patients with macular edema secondary to various retinal disorders. Cases diagnosed as sterile endophthalmitis after IVI of triamcinolone were selected for the study. Fisher's discriminant linear analysis was used to determine whether a significant correlation existed between specific ocular features and the occurrence of post-injection sterile endophthalmitis. RESULTS: Five of 21 eyes (23.8%) had sterile endophthalmitis with hypopyon formation after the injection. Of the five sterile endophthalmitis patients, three were pseudophakic with impaired posterior capsule and four had a diagnosis of Irvine-Gass syndrome. The rate of sterile endophthalmitis was significantly higher in pseudophakic patients with impaired posterior capsule (p = 0.0075) and in patients with Irvine-Gass syndrome (p = 0.0008). The best-corrected visual acuity (BCVA) in these patients remained unchanged or even improved when the inflammation subsided. CONCLUSION: Pseudophakia with impaired posterior capsule and the diagnosis of cystoid macular edema due to Irvine-Gass syndrome are two risk factors of sterile endophthalmitis following IVI triamcinolone. No loss of BCVA was noted in the patients with post-injection sterile endophthalmitis.

Adult↗
PubMed2003

Problems with HIV/AIDS prevention, care and treatment in Togo, West Africa: professional caregivers' perspectives.

This paper used accounts of professional caregivers to HIV/AIDS patients in Lomé, Togo, West Africa to explore the impacts of cultural, institutional and socio-economic factors in the fight against HIV/AIDS. Thirteen health professionals and 17 non-health professionals who work with people living with HIV/AIDS were interviewed in June and July 2002 in Lomé, Togo. The study found that, in Togo there are some cultural, socio-economic and institutional practices that put Togolese at risk of contracting HIV and complicate the care of those who become infected. People with HIV/AIDS face socio-economic, emotional and psychological battles as they attempt to deal with their physical health and the social reactions to such a stigmatizing disease. Thus, in order to contain the spread of HIV/AIDS, people living with HIV/AIDS, family caregivers, traditional healers as well as the public must be educated about the importance of preventing the disease and how each group can help achieve success in its control. Interventions in prevention and care should be designed with an awareness of these structural factors that contribute to the spread of AIDS and compromise the quality of care given to those who become infected.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Lowering the dose of hydroxyurea minimizes toxicity and maximizes anti-HIV potency.

The goal of this study was to optimize the hydroxyurea dosage in HIV-infected patients, and to minimize the toxicity and maximize the antiviral efficacy of the hydroxyurea-didanosine combination. In a randomized, open-label study (RIGHT 702, a multicenter trial performed in private and institutional practices), three daily doses (600 microg, 800-900 microg, and 1200 microg) of hydroxyurea were administered in combination with didanosine and stavudine to 115 chronically HIV-infected patients, one-third antiretroviral drug naive, with viremia between 5000 and 200,000 copies/ml regardless of CD4+ cell count. The primary efficacy end point was the proportion of patients with plasma HIV-1 RNA levels below 400 copies/ml after 24 weeks of therapy. In the RIGHT 702 intent-to-treat population the lowest (600 mg) dose of hydroxyurea was better tolerated, associated with fewer adverse events, and more potent by all efficacy parameters, including the primary end point (76 versus 60% patients with viremia<400 copies/ml at week 24 for the 600-mg and 800- to 900-mg dose groups, respectively; p=0.027), the mean area under the curve (60.3 versus 65.8; p=0.016), and the mean log10 decrease (-1.95 versus -0.77; p=0.001). Patients receiving 600 mg of hydroxyurea daily also had the highest CD4+ cell count, CD4+/CD8+ cell ratio, and lowest CD8+ cell count and percentage (p=0.035). The RIGHT 702 trial provides an explanation for the increased toxicity and decreased efficacy of hydroxyurea when it was used at high dosage (1200 mg daily). At the optimal dosage of 600 mg daily, hydroxyurea, in combination with didanosine, deserves reevaluation for the long-term management of HIV/AIDS worldwide, because of its excellent resistance profile, durability, and affordability.

Anti-HIV Agents↗