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At least 469 records · Page 26Linked to original sources
PubMedDate not supplied

Treatment of hypertension and adherence to treatment guidelines in clinical practice: an Italian study.

Despite the results from clinical trials in patients with hypertension and the development of a long list of guidelines for the management of hypertension, many physicians and other healthcare professionals still manage hypertension using approaches that clearly diverge at least partially from the recommendations of these guidelines. Whatever the underlying reasons for physicians' failure to adhere to these guidelines, it is one of the main causes of the high percentage of treated patients with uncontrolled hypertension. This article is a report of the outcomes of a project designed to identify specific discrepancies between hypertension guidelines and clinical practice in Italy then guide the physicians to reach a consensus on hypertension management through discussions with their peers. A total of 1120 internists from all 20 regions in Italy were recruited to participate in workshops conducted between June 2002 and July 2004. They were divided into 57 groups to discuss at least 7 key topics, including the blood pressure level at which to start drug therapy, target-organ damage, isolated systolic hypertension, pulse pressure, clinical trials, generic drugs, and fixed combination drug therapy. The project findings confirmed that the vast majority of internists agree with the guidelines but do not adhere to them completely in clinical practice. Through open discussions that allowed them to identify common viewpoints, the participants may have developed a better awareness of and insight into the guidelines for hypertension management. Hopefully this strategy for group participation will lead to improvements in the management of hypertension throughout Italy.

Guideline Adherence↗
PubMed2026

Final-year nursing students' clinical practice experiences: a reflection study.

OBJECTIVES: This study aimed to explore the most impactful clinical practice experiences of final-year nursing students and the future-oriented actions developed in response to these experiences. METHODS: A retrospective descriptive qualitative design was used. Following reflection training in the internship practice course, 134 final-year nursing students were asked to describe the experience that affected them most during clinical practice. A total of 123 written reflections were analyzed using content analysis. RESULTS: Three themes emerged: near-miss events, incivility behaviors, and positive preceptoring roles. Negative experiences were mainly related to patients, relatives, and nurses and often led students to feel fear and inadequacy. Students reported action plans focused on effective communication, safe patient care, and becoming positive role models. CONCLUSIONS: These findings highlight the importance of supportive clinical learning environments and positive professional socialization during the transition from student to nurse. IMPLICATIONS FOR INTERNATIONAL AUDIENCE: Nursing students worldwide may encounter incivility and near-miss events during clinical practice, potentially adversely affecting their learning experiences and professional development.

Humans↗
PubMed1995

Teaching clinical ethics as a professional skill: bridging the gap between knowledge about ethics and its use in clinical practice.

Ethical reasoning and decision-making may be thought of as 'professional skills', and in this sense are as relevant to efficient clinical practice as the biomedical and clinical sciences are to the diagnosis of a patient's problem. Despite this, however, undergraduate medical programmes in ethics tend to focus on the teaching of bioethical theories, concepts and/or prominent ethical issues such as IVF and euthanasia, rather than the use of such ethics knowledge (theories, principles, concepts, rules) to clinical practice. Not surprisingly, many students and clinicians experience considerable difficulty in using what they know about ethics to help them make competent ethical decisions in their day-to-day clinical practice. This paper describes the development of a seminar programme for teaching senior medical students a more systematic approach to ethical reasoning and analysis and clinical decision-making.

Curriculum↗
PubMed2003

[Clinical practice guideline on radiation therapy for lung cancer].

Clinical practice guidelines for radiation therapy in the treatment of lung cancer were prepared by an expert multidisciplinary Panel. This project was supported by a Grant-in-Aid from the Ministry of Health, Labour and Welfare of Japan, with the primary objective to develop efficient practice guidelines for the treatment of lung cancer by systematic review of currently available evidence. We reviewed pertinent evidence from the published literature with a computerized search on MEDLINE, and filled in abstract forms for the most relevant. All abstract forms were reviewed by other experts in the panel. The extracted problems were as follows: the basics for radiotherapy including machines, planning equipments and quality assurance, definitive radiotherapy for medically inoperable or unresectable non-small cell lung cancer, chemoradiotherapy for non-small or small cell lung cancer, prophylactic cranial irradiation, and palliative irradiation for bone and brain metastases. Values for levels of evidence and grades of recommendation for each problem were discussed and approved by the panel. Essentially, the guidelines propose the minimum requirements for clinical practice. These guidelines, therefore, are expected to be useful for individualized treatments for lung cancer patients.

Bone Neoplasms↗
PubMedDate not supplied

Variability in the clinical practice of maintaining the patency of peripheral intravenous catheters.

OBJECTIVE: To establish variations in clinical practice associated with maintaining the patency of peripheral intravenous catheters (PIC) and to determine to what extent such clinical practice falls within the limits of the available scientific evidence, based on a random sample Spanish public hospitals. METHODS: A cross-sectional, descriptive study was carried out in non-psychiatric public hospitals and their associated medical and surgical units. Cluster (hospitals), stratified (hospital size), and single level (all units) sampling was applied. A questionnaire was mailed to all of the units involved. RESULTS: A sample of 341 valid questionnaires was analysed (response rate 54.5%). Only one praxis-modality was carried out in the majority of units. Intermittent flushing and heparin saline versus normal saline was the most frequent modality employed, over those of continuous flushing and non-heparinised saline. There was a high degree of variation in the quantity of heparin administered: 81.7% when flushing was carried out with heparinised saline and 48.2% when it was conducted with concentrated heparin. About 40% of this variation was associated with the hospital in question, rather than with the unit. The clinical practice fell within the limits of available scientific evidence in fewer than half of the units studied. CONCLUSIONS: There was a high degree of variability in the practice of maintaining PIC patency. A significant part of this variation was attributable to the hospital in which the practice was carried out. Moreover, most of this practice was carried out beyond the limits of available scientific evidence.

Analysis of Variance↗
PubMed1989

[The report of the 12th and 13th clinical practical training of the Tsurumi University School of Dental Medicine].

This report concerns the state of the patients and the progress of the 12th and 13th clinical practical training. A questionnaire was carried out with the trainees of the 13th clinical practical training and their leaders. Consequently it was learned that a trainee was in charge of ten patients on the average a year. He was able to complete the treatments of 3.5 patients, but was obligated to discontinue them for 1.4 patients, while handling over treatments for 5.2 patients to the next year's trainees or doctors. The progress of the clinical practical training was slow during the first 9 months but the pace increased rapidly during the last 3 months. The results of the questionnaire showed 37% of the trainees were satisfied with the present clinical practical training, but 17% of the trainees were not satisfied. On the other hand 15% of the leaders were satisfied with it, but 48% of the leaders were not satisfied.

Education, Dental↗
PubMed1983

Clinical practice plans in family practice residency programs.

This paper examines clinical practice plans (CPPs), systems for remunerating physician faculty based on their clinical productivity, in family practice residency programs. A stratified random sample of residency directors responded to a CPP survey. CPPs were found significantly more frequently in residencies (usually operated by universities) either with CPPs in their parent institutions or with high patient volume. Residencies operated by community hospitals were more likely to distribute CPP benefits to faculty based on individual clinical activity, whereas residencies operated by universities were more likely to distribute equal benefits to all faculty or to include academic as well as clinical activities in the benefit determination. While most residency directors felt that CPPs brought financial benefits to a residency and to individual faculty, many directors who did not have CPPs feared that such a plan would create conflicts between patient care and teaching. A case report tracing the evolution of a CPP in one university-administered residency is presented.

Faculty, Medical↗
PubMed2006

[Evaluation of clinical practices: methods of data collection and information sources?].

OBJECTIVE: The aim of our study is to present the methods used to observe clinical practices, to evaluate their advantages and limits, and to specify the context in which they are preformed. METHODS: We conducted a bibliographical search on MEDLINE using key words, completed by an offline search. We selected articles published in French or English between 1985 and 2003. RESULTS: Thirty articles, of which 3 were reviews, as well as an additional 5 reports and 9 books, were selected. We distinguished direct or objective approaches to clinical practices as well as indirect or declarative approaches. We also noted whether the approach was individual with data collected from individual practitioners, or collective, with data coming from databases. Most methods of collecting data used medical records, often in the context of internal or external clinical audits or peer reviews. The other sources of data were self-administered questionnaires, written case simulations and simulated patients. Data was also extracted from previously existing databases: claims databases, registries and ad hoc databases. CONCLUSION: An objective individual approach insures the highest quality of information, but possible high costs can limit the use of this approach. It is necessary to continue researching the best means of collecting data on clinical practices, because of the obligation of each practitioner to evaluate individual clinical practices.

Data Collection↗
PubMedDate not supplied

The quality of clinical practice guidelines in hand therapy.

Clinical practice guidelines (CPGs) should consist of treatment recommendations that assist hand therapists in providing high-quality cost-effective care to specific patients based on the highest level of available evidence. This requires CPGs to be developed using a rigorous process based on evidence, appraisal of both original studies and expert opinion, and a process for multiple reviewers to evaluate the draft CPG. This study identified CPGs relevant to hand therapy and then evaluated their quality using the AGREE quality assessment tool. The majority of guidelines were not evidence-based and were of extremely low quality. Two guidelines were produced using a rigorous process that emphasized comparative clinical trials. These were able to provide only a single treatment recommendation, that ultrasound is effective for calcific tendinitis of the shoulder. Hand therapists need to move away from opinion- or clinic-based protocols and toward more evidence-based treatment guidelines. However, the value of treatment guidelines must be tested, not assumed, regardless of the development process.

Hand↗
PubMed1997

Clinical practice guidelines: to what end?

The move to develop clinical practice guidelines in Australia is gaining momentum as part of a national approach to improving the quality of clinical practice. The National Health and Medical Research Council has published a "guidelines for guidelines". While it has also produced guidelines for nine specific clinical topics, it is now passing this role to professional organisations, such as clinical colleges and learned societies, and reverting to an overseeing, facilitating and credentialling role.

Australia↗
PubMed1996

The current status of targeted radiotherapy in clinical practice.

Biologically targeted radiotherapy in clinical practice requires a molecule which has a relative specificity for tumour tissue--the missile--coupled to a radionuclide with appropriate physical characteristics--the warhead. When administered to a patient this combination should result in selective irradiation of the target tumour cells with relative sparing of normal tissues. Simple ions and small molecules which follow physiological pathways as either the natural substrates or analogues form the best examples of biological targeting. Clinically valuable results are seen with, for instance, iodine uptake by normal and malignant thyroid cells, incorporation of the calci-mimetic element strontium in areas of increased bone metabolism and accumulation of the catecholamine analogue meta-iodobenzylguanidine in neuroblastoma. The use of monoclonal antibodies as targeting vehicles has not proved to be a panacea, yet some patients with lymphoma, hepatoma and ovarian carcinoma have obtained benefit. Current clinical studies in targeted radiotherapy focus on the integration of radionuclide treatment with conventional treatments, and the optimization of such combined approaches. The development of modifications to offset the limitations inherent in the use of crude antibodies also offers an opportunity for improved clinical outcomes.

3-Iodobenzylguanidine↗
PubMedDate not supplied

Practical uses of individual pharmacokinetic parameters in drug development and clinical practice: examples and simulations.

This article summarizes the practical uses of the six key pharmacokinetic parameters, i.e. elimination half-life, volume of distribution, total clearance, fraction of administered dose eliminated by the kidneys, free fraction in plasma, and bioavailability. Emphasis is on the practical medical uses of these parameters in clinical practice and drug development. Numerous pharmacokinetic simulations are used to illustrate the different practical uses. The principles underlying drug dosage regimen design, drug concentration monitoring and adjustment, and dosage adjustment in renal disease are also discussed.

Clinical Protocols↗
PubMed1995

Clinical practice and medical research: bridging the divide between the two cultures.

The failure of the results of many research studies to be integrated into everyday clinical practice is both well documented and much decried. In the writings on why medical research and clinical practice have remained separate cultures, two issues have not been sufficiently debated. First, are medical researchers addressing the problems that cause clinicians the most concern in their consultations with patients, and secondly, are the results of research studies being presented in a manner that clinicians can both understand and use? This discussion paper highlights primary care clinicians' urgent need for information on the predictive value of the symptoms and signs seen in everyday clinical practice. Medical research has still to provide this information, often leaving general practitioners with inadequate predictive information on which to make early diagnoses, for example, on whether a patient with chest pain has a pulmonary embolus, or a child with pyrexia and rash has meningococcal septicaemia. The format in which research information is commonly presented is discussed; it has been shown that epidemiological terms used in studies are impenetrable to most clinicians. Additional ways of framing research information need to be devised that present such research information in a narrative format and numerical format, emphasizing the effects of management decisions as well as diagnostic categories, and for use in individual consultations as well as describing populations. Only then will clinicians be able to integrate into their everyday clinical practice the potentially valuable information provided by medical research.

Communication↗
PubMed1999

Free prostate-specific antigen 'in the field': a useful adjunct to standard clinical practice.

OBJECTIVES: To determine the clinical utility of the ratio of free to total prostate-specific antigen (f/tPSA), which may improve the discrimination of PSA testing in the assessment of patients with prostatic disease, in a busy clinical practice. PATIENTS AND METHODS: A series of 198 men undergoing transrectal ultrasonography (TRUS)-guided biopsy, because of a high total PSA level or an abnormal digital rectal examination or both, had blood samples taken for the assessment of both free and total PSA before any form of prostatic manipulation. The histological findings were compared with tPSA, fPSA and f/tPSA, evaluating three different thresholds of f/tPSA. RESULTS: PSA levels, PSA density and fPSA density differed significantly between those with benign histology and neoplasia. The f/tPSA only differed significantly in men with a PSA level of 10. 1-15 ng/mL. The f/tPSA threshold of 0.25 was the most useful clinically, with a negative predictive value for prostate cancer of 91%. Using this threshold would reduce the negative biopsy rate by 30%. CONCLUSION: The f/tPSA is of clinical value in reducing the negative biopsy rate and in the management of patients with a high PSA level and previous negative biopsies.

Humans↗
PubMedDate not supplied

Reflections on speech-language therapists' talk: implications for clinical practice and education.

BACKGROUND: Research into the practices of speech-language therapists in clinical sessions is beginning to identify the way communication in clinical interactions both facilitates and potentially impedes the achievement of therapy goals. AIMS: This target article aims to raise the issues that arise from critical reflections on the communication of speech-language therapists for both clinical practice and clinical education of future speech-language therapists. METHODS & PROCEDURES: The paper reviews the past and current literature into the communication of speech-language therapists with their clients and provide examples drawn from the authors' own empirical research. OUTCOMES & RESULTS: It is argued that one cannot assume that the current rhetoric regarding collaborative practice matches what is currently done in clinical work. CONCLUSIONS: This paper calls attention to the need to evaluate critically the processes and nature of acculturation that occurs during the first stages of professional development as a student speech-language therapist through to the ongoing development of professional practice.

Acculturation↗
PubMed1998

Transferability to clinical practice of the results of controlled clinical trials: the case of antiemetic prophylactic treatment for cancer chemotherapy-induced nausea and vomiting. Italian Group for Antiemetic Research.

BACKGROUND: There is convincing evidence from randomized clinical trials that the use of 5-HT3 antagonists has brought about a substantial improvement in the control of chemotherapy-induced nausea and vomiting. However, no data exist to indicate how this new research evidence can be applied to the individual patient. PATIENTS AND METHODS: We carried out a prospective, observational study on the use and effectiveness of antiemetic drugs in patients undergoing cancer chemotherapy in 33 Italian oncology departments. RESULTS: A total of 1,956 consecutive patients entered the study; 1,238 of them underwent a one-day chemotherapy and 718 a chemotherapy fractionated over several consecutive days. The 5-HT3 antagonists, used either alone or in combination with a corticosteroid, have almost completely supplanted all other types of antiemetic regimens for preventing cancer chemotherapy-induced emesis. In fact, 80% of patients, irrespective of whether their emesis was acute or delayed, or of the emetogenic potential of the cancer chemotherapy they received, have been treated with these compounds. However, the practice of participating oncologists with respect to prescriptions has been far from consistent with the evidence provided by randomized controlled trials. Both overtreatment and undertreatment have occurred in many patients, creating unjustified costs and placing the patients at greater risk for emesis. However, when antiemetics are properly used their effectiveness is similar to that seen in randomized controlled trials. CONCLUSIONS: Powerful barriers exist between the evidence provided by sound research and clinical practice, and this issue hampers progress toward the optimal use of antiemetic drugs.

Adult↗
PubMedDate not supplied

Assessing the impact of psychological intervention on family practice clinic visits.

The effects of brief psychological intervention on rates of medical utilization were investigated in a family practice clinic. Patients referred to the psychology service served as experimental subjects. These subjects underwent psychological assessment and treatment from supervised clinical psychology externs in joint working arrangements with family practice residents. Control subjects were other family practice patients, matching the experimental group in age, sex, and race. The number of medical visits to the family practice clinic, specialty clinics, and the emergency room were the dependent measures. The study period was two years. Results indicated that the experimental subjects were more likely than control subjects to decrease medical utilization of the family practice clinic. The findings are consistent with earlier work showing an association between brief psychosocial intervention and decreases in the frequency of clinic visits. However, this study suggests that preinternship-level clinical psychology trainees can be equally as effective in providing this intervention as mental health professionals who have completed their training.

Adolescent↗
PubMed2002

Quality and impact of problem-oriented drug information: a method to change clinical practice among physicians?

OBJECTIVES: Problem-oriented drug information is characterised by health professionals actively seeking drug information through various sources. In this study our objective was to determine the quality and impact of problem-oriented drug information among physicians. METHODS: Evaluation forms accompanying 163 written answers to physicians from a drug information centre were used to examine the quality and impact of problem-oriented drug information during the period December 1996 to June 1998. Physicians were asked whether the preliminary telephone answer was useful and, furthermore, whether the written answer was fast enough, relevant, adequately comprehensive and had valuable references. Physicians were also asked whether the answer had caused any change in their clinical practice. If yes, they were then asked to describe the actual changes. RESULTS: Of 163 evaluation forms, 117 (72%) were returned by physicians. Eighty-six physicians received a preliminary telephone answer and 83 (97%) stated that this was useful. Among the physicians, 92 (79%) found that the answer was fast enough, relevant, adequately comprehensive and with valuable references, while 19 (16%) found that the answer satisfied three of these four quality criteria. Seventy-one evaluation forms stated that the answer had caused a change in clinical practice. Sixty-eight (96%) of these contained a description of the change. Thirty-five evaluation forms that stated that the answers did not cause any change in clinical practice showed the same quality score as for the total group. Thus, 28 (80%) of these satisfied four and 5 (14%) satisfied three of the quality criteria. Improved routines for and control of ongoing pharmacotherapy was the most common change in clinical practice reported by physicians. CONCLUSION: The results show that, in general, physicians found problem-oriented drug information to be of high quality, and that it had an impact on their clinical practice. Problem-oriented drug information could be a method to change clinical practice among physicians.

Drug Information Services↗