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At least 1,063 records · Page 59Linked to original sources
PubMed2006

The Charlson comorbidity score: a superior comorbidity assessment tool for the prostate cancer multidisciplinary meeting.

INTRODUCTION: Multidisciplinary team (MDT) meetings use precise prognostic factors to select treatment options for patients with prostate cancer. Comorbidity is judged subjectively. Recent publications favour the Charlson comorbidity score (CS) for the use in the management of prostate cancer. We assess the feasibility of using the CS by our MDT in planning the treatment of patients with prostate cancer. PATIENTS AND METHODS: Patients from the histopathology database aged less than 75 years and with a diagnosis of localized prostate cancer between 1993 and 1995 were included in a notes audit. A second group consisted of patients recommended for curative treatment for localized prostate cancer by the local MDT in 2004. Data on comorbidity, prostatic malignancy and survival up to 10 years was collected. The prognostic accuracy of the CS was assessed for those patients offered radical treatment between 1993 and 1995. RESULTS: Of 1043 patients initially assessed, 37 patients with localized prostate cancer were identified. Using Cox regression, we found the CS to be a statistically significant predictor of survival, following radical treatment for localized prostate cancer (P=0.005). Current practice in 2004 (56 patients) shows a mean (range) Charlson probability of 10-year survival for radical prostatectomy of 0.823 (0.592-0.923) and for radical radiotherapy of 0.653 (0.07-0.936). CONCLUSIONS: Our results support the findings of recent research. We also found the CS easy to calculate and therefore feasible to use in our MDT setting. We propose the introduction of the Charlson score by prostate cancer MDTs to assess age and comorbidity.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Linkage of genetics and ethics: more crossing over is needed.

Since the development of recombinant DNA technology in the mid 1970s, there has been increasing interest in the ethical, legal, and social implications of genetics and related fields. The web sites of five different organizations (government, academic, and independent not-for-profit) that deal explicitly with genetics and ethics are reviewed here. Some of the sites cover genetics and other issues in bioethics while others cover human genetics exclusively. The target audiences for the sites include medical and scientific professionals, students, and the general public. Among the issues examined are genetic testing, genetic discrimination in employment and health insurance, genetically modified foods, stem cells and DNA patenting. Resources for those interested in legal issues are particularly well-represented on these sites.

Bioethics↗
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↗
PubMed2006

Cross talking.

Explore the source record for details and available documents.

Humans↗
PubMed2005

Nonmodularity of the central auditory nervous system: implications for (central) auditory processing disorder.

This response to A. T. Cacace and D. J. McFarland (2005) identifies points of agreement and disagreement regarding the concept of modularity in the diagnosis of (central) auditory processing disorder [(C)APD]. We concur that the evaluation of (C)APD must take into consideration the influence of higher order global or pansensory issues on performance on tests of central auditory function. To accomplish this goal, multidisciplinary (e.g., multimodal) testing is an integral part of differential diagnosis of (C)APD. We also agree that the efficiency of diagnostic tests of (C)APD should not be evaluated by imprecise criteria [e.g., "presumed" or "suspected" (C)APD], which do not provide accurate measures of the true sensitivity and specificity of these tests. Our conceptualization and recommendations for clinical practice in this area diverge, however, from that of Cacace and McFarland in a number of pivotal ways. Based on the current limitations of multimodal assessment relative to issues related to scope of practice and test efficiency, as well as the accumulated basic science and clinical literature that demonstrates the nonmodularity and interactive organization of the brain, we recommend use of the sensitized test battery of the central auditory nervous system (CANS) in combination with multidisciplinary testing to differentially diagnose (C)APD and to guide treatment of the disorder. We assert that sensitivity and specificity measures derived from individuals with well-circumscribed lesions of the CANS provide an important guide to establishing the validity of central auditory diagnostic tests. We note that researchers in the area of auditory science and (C)APD must acknowledge the challenges of the clinical arena, and we encourage their continued help to develop diagnostic tools that are both efficient and practical for the differential diagnosis of (C)APD. We conclude that our approach, which combines multidisciplinary evaluation and specific tests of central auditory function that have demonstrated sensitivity and specificity for disorders of the CANS, allows us to identify (and thus rehabilitate) the auditory deficits present in individuals with (C)APD in its "purest" form. It also permits the identification and rehabilitation of auditory deficits in individuals who exhibit auditory perceptual problems that coexist with other processing problems, while ruling out those who perform poorly on auditory tests because of a global, supramodal problem involving cognition, attention, language, memory, or related skills.

Auditory Diseases, Central↗
PubMed2003

Clinical librarianship: a systematic review of the literature.

Clinical librarianship (CL), currently receiving renewed interest world-wide, seeks to provide quality-filtered information to health professionals at the point of need to support clinical decision-making. This review builds upon the work of Cimpl (Bulletin of the Medical Library Association 1985, 73, 21-8) and attempts to establish the evidence base for CL. The objectives were to determine, from the literature, whether CL services are used by clinicians, have an effect on patient care, and/or clinicians' use of literature in practice and/or are cost-effective. The methodology used was a systematic review of the literature, following, where possible, the NHS Centre for Reviews and Dissemination (CRD) framework. Modifications to this methodology included the resources searched, and the critical appraisal checklist (CriSTAL) used. Two hundred and eighty-four unique references were retrieved. Seventeen (16 unique) evaluative and a further 33 descriptive studies met the inclusion criteria. The quality of reporting of the literature was generally poor. CL programmes appear to be well-used and received by clinicians. However, there is insufficient evidence available on their effect on patient care, clinicians' use of literature in practice, and their cost-effectiveness, thus highlighting the need for further high-quality research.

Cost-Benefit Analysis↗
PubMed1994

Registered nurses' and physicians' reflections on their narratives about ethically difficult care episodes.

Thirteen registered nurses and eight physicians in medical and oncological care reflected on their previous narratives about ethically difficult care situations. Although the interviewees had narrated different kinds of stories there were more similarities than differences in their reflections. Common themes were: meeting death, balancing between being open to one's own and others' reactions and being sheltered, handling advanced medical technology and grasping care as a whole. The two groups, however, disclosed different cognitive styles and types of rationality. The nurses referred to their personal experience of giving care and also receiving care very much within a praxis perspective, while physicians referred to science and proven experience within a poiesis perspective.

Adult↗
PubMed2002

Power and control: forensic community mental health nurses' perceptions of team-working, legal sanction and compliance.

This is the second of two papers reporting on a descriptive mixed methods study of community forensic mental health nurses' experiences of restriction orders and supervised discharge mechanisms. Forensic community mental health nurses (FCMHNs) have a body of experience of working with mentally disordered offenders in the community. A number of these patients will be subject to conditions on discharge. This in effect acts as compulsory community treatment with the sanction of recall to hospital. This paper examines nurses' perceptions of team-working, legal powers and their effects upon compliance. Findings include that FCMHNs express general satisfaction with their input to decision-making but some concerns were raised that challenge the ethic of team-working. Respondents were broadly in favour of increased professional responsibility, although this may be related to a quest for status. A pragmatic if equivocal support for the use of compulsion in community mental healthcare was also expressed.

Anecdotes as Topic↗
PubMed2002

Multi-disciplinary working in a forensic mental health setting: ethical codes of reference.

This paper reports on a small research project on multidisciplinary team-working within a medium secure forensic unit in the United Kingdom. Although multidisciplinary team working is widely accepted as an effective strategy for the delivery of healthcare services in modern society it is also recognized that interdisciplinary problems can also occur. This study developed two questionnaires, one being delivered to a number of groups and teams in the secure unit, whilst the second one was geared to individuals. A thematic analysis was employed to develop category building and concept formation. The results highlighted a three-level ethical code referencing system that was employed by both individuals and groups. Within this, three domains, or trajectories, were identified that were polarized continuums of main tensions for multidisciplinary staff working in forensic practice.

Clinical Competence↗
PubMed2002

Philosophy, care and treatment on the psychiatric intensive care unit: themes, trends and future practice.

Psychiatric intensive care units (PICUs) were first developed in the UK in the early 1970s and have become an integral part of inpatient services. This paper reviews all aspects of PICU provision from its origins to the most recent studies of intensive care treatment and philosophy. A search of CINAHL, MEDLINE and British Nursing Index databases revealed ample research and discussion papers from the past 30 years to permit a thorough review of the available literature. This divides roughly into discussion and descriptive research on topics related to: (a) the infrastructure of PICUs, including bed numbers, staffing levels, admission criteria and aspects of the physical environment; and (b) the treatment provided to patients on the PICU, both pharmacological and psychosocial, plus a limited amount of evaluative research on the efficacy of PICU care. This paper provides a summary and overview of these issues based upon currently available literature. It concludes that there is strong evidence for wide variation in the provision and nature of PICU care, reflecting idiosyncratic and localized development of services. Moreover, there is an almost complete lack of evidence on the efficacy of PICU care for particular types of patients and problems, leaving a paucity of research upon which PICU infrastructure, policy and therapeutic approach can be based.

Ethics, Clinical↗
PubMed2002

Towards a 'forensic lens' model of multidisciplinary training.

This paper reports on research undertaken to identify if common areas of multidisciplinary training exist in the literature. The literature that specifically focused on training issues in forensic practice (mental health) was located and reviewed by coding analysis. Thirteen common areas were identified and approximately 250 content items were acknowledged. A 'forensic lens' model was established to provide a framework in which multidisciplinary training could be located. Further research is promulgated to establish the actual importance of each training area for specific forensic disciplinary groups.

Clinical Competence↗
PubMed2003

Coping with conflict and confusing agendas in multidisciplinary community mental health teams.

This paper arises from a study, conducted in the final year of general practitioner fundholding in Britain, which was designed to explore the factors influencing client allocation within six community mental health teams in the north of England. It describes the strategies employed to manage the problems created by the disparity between the stated and agreed purpose of the teams and the actual pattern of referrals. A number of strategies were identified in the six teams to manage this fundamental conflict--isolation, homogenization, fraternization, negotiation and manipulation. A sixth strategy was designed to ameliorate the loss of professional identity experienced by those who were operating in a 'foreign' milieu--that of demarcation.

Adaptation, Psychological↗
PubMed2003

A study of collaboration inpatient treatment between the community psychiatric health services and a psychiatric hospital in Norway.

The aim of this study was to examine factors that may have an influence on the collaboration between the health-care professionals in a psychiatric hospital and two communities' psychiatric health service departments. Interviews were conducted with three psychiatric nurses, one medical practitioner, one health and social manager and one cultural worker; thus a total of nine informants. The transcribed interview texts were analysed by means of qualitative content analysis. The main results showed that the community psychiatric nurses felt a need for more systematic interdisciplinary collaboration. The existing collaboration was characterized by ad hoc meetings. In addition, the need for information about their colleagues' professional competence was reported. The respondents called for a more regular forum for professional guidance and coordination in relation to particular client cases in order to improve the quality of psychiatric care. There was also a need for collaboration within community health care and a link to psychiatric hospital care in order to better evaluate the outcomes of care provided. In conclusion, the lack of continuity in the collaboration between health-care professionals may affect the quality of community health services because continuity is a vital component of care.

Adult↗