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At least 523 records · Page 29Linked to original sources
PubMed2006

[The practice guideline 'Diabetes mellitus type 2' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The publication of the practice guideline 'Diabetes mellitus' by the Dutch College of General Practitioners in 1989 marked the start of an era of publication of several guidelines that helped general practitioners using evidence-based medicine in clinical practice; the guidelines also helped to teach students. The second revision of this guideline presents many improvements, especially simplifications in the medication-schedules. However, the new recommendation to use thiazolidines is based on only one large study and has some unpractical aspects. The new guidelines do not mention preventive action, nor advice regarding early detection. Clinical practice has changed in recent years with the introduction of nurses specialising in diabetes and, despite published research on this subject, the guidelines do not give any recommendations for this. What is also missing are national clinical guidelines for doctors specialising in internal medicine. When patients do not respond to treatment according to the general practitioners' guidelines and are referred to a specialist in internal medicine, the treatment is diverse and seems to be doctor-dependent. It is important that treatment there be standardised as well so that general practitioners can refer more effectively.

Diabetes Mellitus, Type 2↗
PubMed1994

Matching physician practice style to patient informational issues and decision-making preferences. An approach to patient autonomy and medical paternalism issues in clinical practice.

The movement away from traditional medical paternalism toward increased patient autonomy presents difficult practical and ethical problems for the physician treating the wide variety of patients seen in clinical practice. A review of the literature supports the concept of matching the physician's practice style with both patient informational issues and the patient's desire to actively participate in medical decision making. Studies also support that this matching principle not only improves physician-patient relationships but is ethically defensible and results in improved clinical outcomes. This article presents such a patient-physician match model as an aid to the practicing clinician.

Comprehension↗
PubMed1997

Is good clinical research practice for clinical trials good clinical practice?

This article presents results of monitoring of the recruitment process for a phase III study of a new antidepressant drug in elderly patients with depressive disorders, focusing on the peculiarities of recruitment posed by the presence of comorbidity and coadministration of medications. Data are derived from screening of 188 patients, the majority of whom lived at home, referred for trial inclusion. One hundred and seventy-one (91%) had Hamilton Rating Scale score in excess of 18 and met inclusion criteria. Only eight (4.2%) elderly depressed subjects could be recruited, after application of exclusion criteria. The trial data so obtained may be scientifically credible, but the conclusions reached by trials with very stringent exclusion criteria do not reflect the practice environment in which the product will be prescribed by clinicians. This raises questions of the relevance of good clinical research practice and good clinical practice guidelines to the reality of good clinical practice beyond the trial situation.

Aged↗
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↗
PubMed2005

Promoting the implementation of practices that are supported by research: the National Implementing Evidence-Based Practice Project.

The National Implementing Evidence-Based Practice Project is an ongoing effort to promote the implementation of effective practices for adults who have severe mental illnesses. The project members designed and developed integrated packages of materials and services to help practice sites implement evidence-based practices and is field-testing the approach in eight states. These implementations are being evaluated carefully to learn how to make the technology transfer process more efficient in the future. This article describes the project and provides some early reflections on the implementation experience.

Adolescent↗
PubMed2005

Academic practice plans have been detrimental to the practice of assisted reproductive technology.

The clinical practice of assisted reproductive technology combines cutting-edge medical science and its nearly immediate application to clinical practice, thus epitomizing academic medical practice. However, assisted reproductive technology programs find it difficult to remain within the academic setting, owing to the lack of flexibility of academic practice plans.

Academic Medical Centers↗
PubMed2003

Integrating biologic therapies into a dermatology practice: practical and economic considerations.

This article discusses the issues involved in the integration of biologic therapies for psoriasis into a dermatology practice. The requirements for staff, space, and other office adaptations are reviewed for infliximab, efalizumab, etanercept, and alefacept in their current injectable forms. Dermatologists will likely elect to offer some or all of these therapies depending on the adjustments necessary within their current practice, patient satisfaction, and the economic possibilities. This article provides information needed to guide dermatology practices in practical decisions regarding the use of biologic therapies.

Alefacept↗
PubMed2003

Difficult airway management practice patterns among anesthesiologists practicing in the United States: have we made any progress?

STUDY OBJECTIVE: To determine the extent instruction and practice in the use of airway devices and techniques varies among anesthesiologists practicing in the United States. DESIGN: Survey questionnaire. SETTING: University medical center. MEASUREMENTS: Questionnaires were completed by American-trained anesthesiologists who attended the 1999 American Society of Anesthesiologists (ASA) Annual Meeting. Data collected included demographics, education, skills with airway devices/techniques, management of clinical difficult airway scenarios, and the use of the ASA Difficult Airway Algorithm. MAIN RESULTS: 1) DEMOGRAPHICS: 452 questionnaires were correctly completed; 62% attending anesthesiologists, 70% <50 years, 81% males, 44% from academic institutions, 63% >10 years of practice, 81% night duty, 77% board certified. 2) Education: 71% had at least one educational modality: difficult airway rotation, workshops, conferences, books, and simulators. 3) Skills: Miller blade 61%, Bullard laryngoscope 32%, LMA 86%, Combitube 43%, bougie 43%, exchangers 47%, cuffed oropharyngeal airway (COPA) 34%, retrograde 41%, transtracheal needle jet ventilation 34%, cricothyrotomy 21%, fiberoptics 59%, and blind nasal intubation 78%. The average reported use of special airway devices/techniques was 47.5%. 4) Management choices: failed intubation/ventilation: LMA (81%) and for all other situations: fiberoptic intubation. Use of ASA Difficult Airway Algorithm in clinical practice (86%). CONCLUSION: Fiberoptic intubation and the LMA are most popular in management of the difficult airway.

Anesthesia, Conduction↗
PubMed2005

The international classification for nursing practice: a tool to support nursing practice?

Nurses have been slow to realise the uniqueness of their data and the importance of data management across the profession. This has resulted in nursing being neglected as a partner in healthcare because the data nurses collect cannot be easily retrieved from the patient record and is not widely used to support nursing practice. Nurses, as they should, have rejected language classification systems that are inadequate or inappropriate, but with the implementation of electronic health records, consensus on language classification must be achieved. One problem has been finding an appropriate terminology/s that represents the spectrum of nursing practice while making sense to both the user and computer. In 1989 the International Council of Nurses began work to achieve this and the International Classification for Nursing Practice (ICNP) was born. This paper provides an insight into language classification, explores the ICNP as a tool for nursing practice and discusses some of the projects undertaken thus far.

Australia↗
PubMed2004

Mental health provider attitudes toward adoption of evidence-based practice: the Evidence-Based Practice Attitude Scale (EBPAS).

UNLABELLED: Mental health provider attitudes toward organizational change have not been well studied. Dissemination and implementation of evidence-based practices (EBPs) into real-world settings represent organizational change that may be limited or facilitated by provider attitudes toward adoption of new treatments, interventions, and practices. A brief measure of mental health provider attitudes toward adoption of EBPs was developed and attitudes were examined in relation to a set of provider individual difference and organizational characteristics. METHODS: Participants were 322 public sector clinical service workers from 51 programs providing mental health services to children and adolescents and their families. RESULTS: Four dimensions of attitudes toward adoption of EBPs were identified: (1) intuitive Appeal of EBP, (2) likelihood of adopting EBP given Requirements to do so, (3) Openness to new practices, and (4) perceived Divergence of usual practice with research-based/academically developed interventions. Provider attitudes varied by education level, level of experience, and organizational context. CONCLUSIONS: Attitudes toward adoption of EBPs can be reliably measured and vary in relation to individual differences and service context. EBP implementation plans should include consideration of mental health service provider attitudes as a potential aid to improve the process and effectiveness of dissemination efforts.

Adolescent↗
PubMed2006

Pathways to alcohol use among Dutch students in regular education and education for adolescents with behavioral problems: the role of parental alcohol use, general parenting practices, and alcohol-specific parenting practices.

The present study explored the role of parents' alcohol use, general parenting practices (support and behavioral control), and alcohol-specific parenting practices (alcohol-specific rule enforcement and alcohol availability at home) on adolescent alcohol use. Structural equation analyses were performed on cross-sectional data from adolescents who received special education because of behavioral problems (n=411) and from adolescents who received regular education (n=428). The main findings show that alcohol-specific parenting practices appear to be highly important in regulating adolescent alcohol use. Parental alcohol use was related to alcohol-specific rule enforcement and alcohol availability at home. Behavioral control was also related to alcohol-specific rule enforcement. Furthermore, the relationships between parental alcohol use, parenting practices, and adolescent alcohol use did not appear to differ substantially for students in special and regular education.

Adolescent↗
PubMed2006

Evidence-based practice: an examination of its ramifications for the practice of speech-language pathology.

PURPOSE: The purpose of this article is to consider some of the ramifications that arise when a discipline newly endorses evidence-based practice (EBP) as a primary guiding principle. Although EBP may appear straightforward, events experienced by peer disciplines that have preceded us in the implementation of EBP raise questions about defining acceptable forms of evidence for treatment effectiveness and efficacy, the potential roles of nonspecific or common factors, therapist quality in achieving therapy outcomes, and eventual applications of EBP that may overly confine which treatments are considered acceptable and reimbursable. METHOD: Through narrative review of the literature, the article examines valuable as well as controversial features of EBP in addition to obstacles that may impede the transition of evidence (research findings) to clinical practice. CONCLUSION: EBP is a valuable construct in ensuring quality of care. However, bridging between research evidence and clinical practice may require us to confront potentially difficult issues and establish thoughtful dialogue about best practices in fostering EBP itself.

Biomedical Research↗
PubMed1999

Guide to practice or 'load of rubbish'? The influence of care plans on nursing practice in five clinical areas in Northern Ireland.

A nursing care plan is a written, structured plan of action for patient care. There is strong evidence that care plans are viewed negatively by nurses and poorly implemented, with little evidence to suggest that they have any positive effect on quality of care or patient outcomes. The project reported in this paper aimed to investigate how nursing care plans were being used in five clinical areas, and to assess their influence on nursing practice. An exploratory, predominantly qualitative research design was selected utilizing participant observation, focus groups and diaries. In four of the five clinical areas, the 'activities of daily living' section of care plans had no apparent positive influence on nursing practice which was driven by other factors and sources of information. Care plans in the remaining ward were clinically led and locally owned, and in this setting they operated as an important guide to practice. It is concluded that a reinvention of the nursing care plan is needed without the constraint of a nursing model as its necessary foundation. New and imaginative plans of action for patient care should be encouraged, developed at ward level and tailored to the demands of the clinical area. These should contain a minimum of documentation and integrate with nursing practice.

Adult↗
PubMed1999

Evidence-based practice: a retrograde step? The importance of pluralism in evidence generation for the practice of health care.

The origin of evidence-based medicine is explored and its connection to evidence-based practice examined. Widespread acceptance of the dominant scientific paradigm supporting evidence-based practice is challenged. Knowledge classifications and their relevance for nursing practice are considered, with the need for a critical balance to be pursued. Recommendations are made, regarding the future of evidence for practice, and a brief example of emerging evidence concerning values of professional caring is offered in redressing the balance.

Cultural Diversity↗
PubMedDate not supplied

Developing best practice in critical care nursing: knowledge, evidence and practice.

Because the current drive towards evidence-based critical care nursing practice is based firmly within the positivist paradigm, experimentally derived research tends to be regarded as 'high level' evidence, whereas other forms of evidence, for example qualitative research or personal knowing, carry less weight. This poses something of a problem for nursing, as the type of knowledge nurses use most in their practice is often at the so-called 'soft' end of science. Thus, the 'Catch 22' situation is that the evidence base for nursing practice is considered to be weak. Furthermore, it is argued in this paper that there are several forms of nursing knowledge, which critical care nurses employ, that are difficult to articulate. The way forward requires a pragmatic approach to evidence, in which all forms of knowledge are considered equal in abstract but are assigned value according to the context of a particular situation. It is proposed that this can be achieved by adopting an approach to nursing in which practice development is the driving force for change.

Benchmarking↗
PubMed2004

Vascular access results from the Dialysis Outcomes and Practice Patterns Study (DOPPS): performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines.

BACKGROUND: The Kidney Disease Outcomes Quality Initiative Guidelines for Vascular Access in hemodialysis patients recommend native arteriovenous (AV) fistulae over AV grafts or catheters for permanent vascular access. They recommend letting fistulae mature > or =1 month before cannulation. METHODS: The Dialysis Outcomes and Practice Patterns Study (DOPPS) provides an unparalleled means to examine vascular access practice patterns and guidelines internationally, with particular attention to associations with mortality risk. RESULTS: Most patients in Europe and Japan dialyze through AV fistulae and very few use AV grafts; in the United States, more patients use grafts than fistulae. Patients who receive nephrologic care for over 30 days before starting dialysis have significantly higher chances of commencing via AV fistula. Medical directors of dialysis facilities in the United States commonly prefer grafts; in Europe and Japan, most prefer fistulae. In the United States, there is a relatively long average time between fistula creation and cannulation but significantly worse fistula survival than that seen in Europe. Tunneled catheters pose a higher mortality risk than permanent accesses and are associated with increased risk of failure of a subsequent fistula. The percentage of prevalent patients in the DOPPS countries using catheters has increased in recent years. DOPPS data suggest that performance in some countries falls short of practices achieved in other countries. AV fistula use is low in the United States but has been improving. The trend of increasing use of catheters in most countries is discouraging. CONCLUSION: The DOPPS will continue to monitor practice trends and explore whether greater application of guidelines will lead to fewer access complications and improved longevity for hemodialysis patients.

Arteriovenous Shunt, Surgical↗
PubMed2003

A scope-of-practice survey leading to the development of standards of practice for health promotion in higher education.

To review and analyze the scope of practice of health promotion services and draft standards of quality indicators for higher education communities, the American College Health Association (ACHA) initiated a Task Force on Health Promotion in Higher Education in May 1996. Members of the task force developed a National Survey on Health Promotion and Education in Institutions of Higher Education and mailed the survey to a stratified random sample of 600 ACHA member institutions, as well as to 97 key "best-practice health promotion leaders". The larger sample produced a 75.3% response rate, and 90.7% of the key informants returned usable surveys. The authors report selected findings from both groups that chronicle the state of health promotion practice in higher education at the close of the 20th century. The task force used the findings to establish a data-driven framework for the Year 2001 Standards of Practice for Health Promotion in Higher Education.

Health Promotion↗
PubMed2001

Using research to improve literacy practice and practice to improve literacy research.

The disconnection between research and practice is not a new phenomenon, but as researchers and educators look toward the future of deaf education, it seems crucial to look back at the reasons behind this disconnection with the goal of creating a professional milieu in which we use research to improve literacy practice and practice to improve literacy research with deaf students. This article examines the issues underlying the relatively insignificant impact of research on literacy practice from the perspectives of the fields of literacy, special education, and deaf education.

Journal Article↗