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At least 163 records · Page 9Linked to original sources
PubMed2000

Ipsilateral neck cancer recurrences after elective supraomohyoid neck dissection.

DESIGN: Retrospective analysis of a case series. SETTING: Referral center, private or institutional practice, hospitalized care. OBJECTIVE: To analyze the level (site) of ipsilateral neck recurrences after supraomohyoid (SOH) dissection in patients with lip, oral, and oropharyngeal cancer treated in a single institution. INTERVENTION: Supraomohyoid neck dissection. PATIENTS AND METHODS: From 1979 to 1997, 154 patients with oral and oropharyngeal carcinoma and no palpable lymph nodes at the neck underwent ipsilateral elective SOH dissection. RESULTS: Tumor sites were the lip, 5 cases (3.3%); oral cavity, 128 cases (83.1%); and oropharynx, 21 cases (13.6%). Tumor stages were T1, 13 cases (8.4%); T2, 77 cases (50.0%); T3, 40 cases (27.0%); and T4, 22 cases (14.3%). There were 7 cases (4.5%) of ipsilateral neck recurrences. Three were beyond the limits of the SOH dissection, and 4 were inside these limits. There was no association of neck recurrences with the pathological status of the lymph nodes. Six of the 7 recurrences were in patients who underwent postoperative radiotherapy. CONCLUSIONS: The incidence of neck recurrence after selective neck dissection was 4.5%, and it occurred either inside (57.1%) or beyond (42.9%) the limits of the selective neck dissection.

Adult↗
PubMed2006

Power and client-centred practice: an insider exploration of occupational therapists' experiences.

BACKGROUND: Although problems with power sharing are frequently described in discussions about client-centred practice, little research has explored occupational therapists' experiences with this model of service delivery. To critically examine this aspect of occupational therapy, an insider study was conducted. PURPOSE: The objectives of the study were to explore therapists' experiences with client-centred practice and to reveal how power works within this practice and in the health service environment. METHOD: Semi-structured interviews with 9 therapists were conducted, and a thematic analysis of these transcripts was completed. A variety of institutional documents were reviewed and analysed. RESULTS: Three main themes were identified: the different interpretations of occupational therapy discourse, the power of context, and the continuum of client-therapist interactions. CLINICAL IMPLICATIONS: It is important to consider the various competing discourses and institutional practices that frame the therapeutic relationship when evaluating methods to improve client-centred practice.

Adult↗
PubMed2006

Complementary and alternative medicine in pediatric oncology: availability and institutional policies in Canada--a report from the Children's Oncology Group.

Complementary and alternative medicine (CAM) is used frequently by pediatric oncology patients. A survey exploring the institutional practices and policies surrounding CAM use in pediatric oncology patients was completed by 17 pediatric hematology/oncology centers in Canada. We found that CAM was offered in only 18% of the institutions, but 94% of the communities. Only 6% of oncology divisions made direct referrals to community CAM providers, and only 20% of the centers had policies regarding use of CAM therapies for their patients. Despite published widespread use of CAM therapies, our study demonstrates that institutional CAM resources and policies on CAM are present in much lower proportions.

Canada↗
PubMed1998

Cancer and inflammatory bowel disease: bias, epidemiology, surveillance, and treatment.

Individuals with chronic ulcerative colitis are at increased risk of developing colorectal carcinoma, particularly if there is long-standing disease or extensive colitis. It is generally accepted that the risk of colorectal cancer does not begin until 8 to 10 years after the time of diagnosis of ulcerative colitis. Thereafter it increases by approximately 0.5% to 1.0% per year. In patients with Crohn's disease, the risk of malignancy is smaller and less well defined. The most significant predictor of the risk of malignancy in patients with inflammatory bowel disease is the presence of dysplasia in colonic biopsies. There is considerable controversy in the literature regarding the efficacy of colonoscopic surveillance programs and the role of prophylactic surgery to prevent colorectal cancer. Surveillance certainly fails to detect carcinoma in some patients who are having regular colonoscopy. Concerns have also been raised as to the cost-benefit of colonoscopic surveillance in patients with colitis. Randomized controlled trials of surveillance programs are highly unlikely in view of the low prevalence of IBD in the population, the long period of observation required, and the probability of contamination of surveillance programs by colonoscopy for assessment of disease activity. Despite the lack of clear guidelines, surveillance colonoscopy and biopsy continues to be widely practiced. Research is proceeding to identify genetic and biochemical markers that may prove clinically useful for predicting cancer risk. At present, however, surveillance programs are likely to continue according to institutional practice. It is important for those participating in such programs to be aware of the limitations of colonoscopy and biopsy as a means of reducing the risk of cancer in inflammatory bowel disease.

Bias↗
PubMed1987

Intraocular lens power calculations. A practical evaluation in normal subjects at the Wilmer Institute.

The practical value of preoperative intraocular lens power calculations in "normal" eyes with less than 4.50 diopters (D) of myopia or hyperopia was evaluated in a consecutive series of 520 eyes that underwent cataract extraction and lens implantation by four experienced surgeons at The Wilmer Ophthalmological Institute. The observed postoperative results with the lenses selected by the surgeons were compared with results calculated for the measurement-predicted emmetropic power lens and for a standard 20-D lens. The need for postoperative spectacle correction of residual refractive errors was comparable for all three choices of lens. Only two eyes (0.4%) would have developed greater than 4.00 D of refractive error with either the "implanted" or "predicted-emmetropic" lenses, as would 11 eyes (2.1%) with the "standard" 20-D lens. The surgeons' deviation from the calculated emmetropic lens did not reduce postoperative refractive error.

Aged↗
PubMed1986

Ethnicity and illness experience: ideological structures and the health care delivery system.

This paper analyses the experiences of Anglo-Canadian and immigrant Chinese families with a chronically ill child by using the idea that the social organization and ideology of health care services generate particular illness experiences. Immigrant families find the ideology dissonant with their customs for managing illness. The disjuncture between practices often leads to non-compliance and ineffective treatment. Health professionals explain non-compliance by the obvious facts of cultural differences, but I argue that it should be understood by institutional practices that exclude families from participating in caretaking. I maintain that patients and families should be included in decisions that affect their lives. Pressures from government to economize by increasing home care services, and the increasing number of immigrants may force practitioners to negotiate culturally acceptable care with them.

Canada↗
PubMed1991

The persistence of Chinese medicine: adjustment and diversity.

Chinese medicine persists in many parts of East and Southeast Asia. This persistence has meant the re-organisation of traditional Chinese medical practice. Institutional developments and adjustments observed among the traditional Chinese medical practitioners, the chung-i, have created diversity. Such diversity among the chung-i is evident by comparing not only the practices which are based in shops and those which are clinic-based but also the newer and older practices.

Acculturation↗
PubMedDate not supplied

Multicultural considerations in the use of advance directives.

PURPOSE/OBJECTIVES: To describe advance directives and the Patient Self-Determination Act (PSDA), to explore the European American sociocultural values underlying advance directives, and to describe the ethical and cultural issues that arise when attempting to encourage and use advance directives in culturally diverse populations. DATA SOURCES: Research articles, case studies, and theoretical articles from clinical and bioethical literature. DATA SYNTHESIS: An overview of advance directives and the PSDA is provided. The European American cultural values underlying advance directives are reviewed and contrasted with sociocultural values of culturally diverse groups to raise the question of cross-cultural applicability of advance directives and European-based bioethics. CONCLUSIONS: The sociocultural values of many culturally diverse groups conflict with the values on which the use of advance directives is based. Thus, working with end-of-life decisions and advance directives for people from culturally diverse groups may be problematic. IMPLICATIONS FOR NURSING PRACTICE: Nurses should be sensitive to sociocultural beliefs that influence decisions affecting end-of-life care, especially the use of advance directives. Practitioners must incorporate this knowledge to increase flexibility of institutional practices and standards of care in the application of advance directives.

Advance Directives↗
PubMed1995

Confidentiality in psychological practice: a decrepit concept?

Although the principle of confidentiality in the relationship between psychologists and client has been vaunted, and is emphasised in the Australian Psychological Society's Code of Professional Conduct (the APS code; 1994), the confidentiality of this relationship is circumscribed by the absence of legal protections, the ethical beliefs of psychologists, institutional practices, and the provisions of the APS code itself. Lack of privilege in judicial proceedings, and statutory obligations to report certain types of behaviour, mandate breaches of confidentiality in some circumstances. Ethical beliefs of psychologists may support disclosure, especially where it is believed that there is danger of serious physical harm to the client or others. Multidisciplinary teams and institutional settings require the exchange of information for optimal delivery of services. Recent amendments to the APS code may require disclosure without the client's consent when a client is believed to be suicidal. Such developments, when considered at all, are typically regarded as exceptions to a general obligation of confidentiality. However, discussion of exceptions presupposes agreement on fundamental principle: the significance of, and rationale for, confidentiality in the psychologist-client relationship. It is argued in this paper that the obligation of confidentiality has been assumed rather than vigorously analysed and empirically explored. A critical examination of this obligation is the most appropriate starting point for the rehabilitation of contemporary principles of confidentiality in the psychologist-client relationship.

Attitude of Health Personnel↗
PubMed1992

The importance of side effects and outcomes in differentiating between prescription drug products.

This study determined the importance of side effects and outcomes (i.e. the control of disease, convenient dosing and cost) in physicians' differentiation of drug products used to treat hypertension, allergic rhinitis, and gastroesophageal reflux. In addition, the study examined whether the importance of particular characteristics attributed to a drug varied with the practice setting. The multiattribute attitude model was used as a framework to examine physicians' perceptions of the importance and the probability of occurrence of specified side effects, results and their prescription intentions. Two groups of physicians were interviewed to identify determinant side effects and results. A questionnaire was used to obtain data by post from a random sample of 2,400 physicians in four types of practices: solo practice, group practice, institution and government (n = 527, 22% response). The findings indicate that the perceived likelihood of occurrence of side effects and results differed with the drug products but did not differ with the type of practice. Practice setting, however, was found to have a significant effect on intention to prescribe. Physicians in each setting differed in their intentions to prescribe certain studied drugs. Finally, physicians in the four settings were found to be similar in their ranking of the importance of particular characteristics of the drug. The control of disease was the most important result in all three scenarios, followed by individual side effects.

Attitude of Health Personnel↗
PubMed2003

The challenge of providing family-centred care during air transport: an example of reflection on action in nursing practice.

This article explores reflection with regard to the nursing practice of a transport nurse in caring for ill newborn patients and their family. It examines the issue of reflective nursing practice, institutional obstacles, and angst in promoting the model of family-centred care, as it applies to newborn infants being transported for tertiary care to a hospital some distance away from the family's home community. Reflective practice is explored as an epistemological link between practice and research, locating one nurse's clinical experience in reflection and subsequent action, through clarification of thought-provoking issues and generation of research questions.

Adaptation, Psychological↗
PubMed2005

Transfusion requirements during cadaveric and living donor pediatric liver transplantation.

Surgical techniques that have been used during liver transplantation (LT) together with patient's coagulation profile and institutional practices are reported to have an effect on transfusion requirements. The aim of this study is to evaluate the transfusion requirement in both cadaveric (CDLT, n = 22) and living donor (LDLT, n = 24) pediatric LT performed in our institution. Balanced general anesthesia was used for all patients. Transfusion requirements were met to maintain a hemoglobin concentration of 8-10 g/dL, platelet level >50 x 10(3)/mL, prothrombin time <20 s and hemodynamic course with observing heart rate, arterial and central venous blood pressures and hourly urine output. Blood loss was replaced by using whole blood. Both groups' perioperative total blood and fresh-frozen plasma (FFP) volumes transfused, fluid requirements and hemodynamic courses, standard coagulation profile and metabolic variables determined in time periods of operations, patients' preoperative characteristics, operative features and postoperative events were compared. The mean transfusion requirements were 37.1 +/- 33.4 and 74.8 +/- 90.8 mL/kg of whole blood (p = 0.059) and 34.5 +/- 24.9 and 51.5 +/- 59.7 mL/kg of FFP for CDLT and LDLT, respectively (p = 0.519). The mean ages and mean body weights of the CDLT patients were higher than LDLT patients (9.7 +/- 5.3 vs. 6.6 +/- 4.4 yr, p = 0.015 and 32.4 +/- 17.7 vs. 21.0 +/- 14.8 kg, p = 0.032, respectively) while the mean operation time (493 +/- 135 vs. 323 +/- 93 min, p = 0.0001) and PELD score (13.1 +/- 11.2 vs. 20.1 +/- 11.8, p = 0.036) were higher for LDLT. In the entire population, multiple regression analysis showed that age, body weight and operation time have a significant combined effect on blood consumption (r2= 0.29, p = 0.003) meanwhile operation time was found to be an effective single variable (p = 0.002). None of the single or combined variables was found to have a significant effect on FFP consumption (r2= 0.17, p = 0.63) and crystalloid use (r2= 0.19, p = 0.11). Hemodynamic courses of both groups were similar. The incidences of metabolic acidosis and hypothermia during the anhepatic periods were higher in the CDLT group (p < 0.05). However, transfusion requirement in the ICU were higher in LDLT group [6.9 +/- 2.2 (n = 6) vs. 18.6 +/- 19 (n = 11) mL/kg, p < 0.05] after LT. As a result of this study in a pediatric patient population, no statistical significance was found in whole blood transfusion and FFP requirements between CDLT and LDLT. Duration of the operation was the primary factor effecting transfusion volume showing the importance of continued small volume losses during uncomplicated LT in this small sized patient population. Transfusion need for pediatric LT should be individualized for each patient based on the intraoperative conditions including surgical and patient features.

Biliary Atresia↗
PubMed1999

A survey on partial left ventriculectomy in the Asia-Pacific region.

BACKGROUND: There has been increasing interest in partial left ventriculectomy as a new therapy for end-stage heart failure. Because the most significant impact of this development is likely to be in regions where heart transplantation is largely unavailable, we conducted a survey among a group of cardiac surgeons based in the Asia-Pacific region to evaluate their overall views on partial left ventriculectomy procedures. METHODS: A questionnaire was sent to surgeons from 65 major institutions in 17 countries and regions in the Asia-Pacific. Questions examined current demographics and opinions regarding potential application and future prospects of this operation. RESULTS: Surveyed surgeons were based in equal proportions in academic, government, and private practice institutions. One third of respondents have already performed partial left ventriculectomy operations, largely in small numbers. In total, 86 procedures were performed with 75% hospital survival rate. Failures were thought to be caused by limited knowledge about patient selection criteria and lack of experience with operative technique and perioperative care. The majority of respondents believe that partial left ventriculectomy is potentially a valuable intervention and intend to perform more cases. Nevertheless, most surgeons identified the need to have larger clinical experience, to perform randomized trials against other therapeutic modalities, and to improve perioperative care. CONCLUSIONS: Although all surgeons recognize that more knowledge is needed before partial left ventriculectomy becomes a standard procedure, it is clear from this survey that the procedure has rapidly gained interest, with more surgeons seeking to learn it.

Cardiac Volume↗
PubMedDate not supplied

Educating for collaborative practice.

OBJECTIVE: To describe a baccalaureate-level course which is designed to help allied health professions students develop an understanding of collaborative practice among interdisciplinary components of a health care system and to report on a survey which assessed the effectiveness of the course for clinical laboratory science graduates. SETTING: University of Kentucky, a large (24,000 students) state-assisted institution PRACTICE DESCRIPTION: Baccalaureate clinical laboratory science program PRACTICE INNOVATION: A college-wide course helps students develop an understanding of the linkages of the major components of a health care system and introduces the techniques necessary to function in an interdisciplinary team. MAIN OUTCOMES MEASURE: Perception of benefit from the course by clinical laboratory science graduates. RESULTS: Graduates report that the course helped them develop a larger perspective of health care delivery beyond that of their own discipline and aided in their understanding of group processes and group problem-solving. CONCLUSIONS: Clinical laboratory science curricula can benefit from the inclusion of a college wide course which introduces a broad perspective of health care delivery and group process concepts.

Allied Health Personnel↗
PubMed2005

Policing the social boundaries of the American Medical Association, 1847-70.

In May 1870 the American Medical Association (AMA) voted to deny the admission of black delegates and their white colleagues to the national meeting in Washington, D.C. Historians of race and medicine have customarily viewed this decision as marking a crucial milestone in the formation of the nexus between racism and the development of the American medical profession in the era after the Civil War (1861-64). This study recasts this narrative by locating the 1870 decision in relation to the antebellum practices of the association and their social consequences for American medicine. It argues that the viability of the AMA as the national voice of the profession was critically dependent on rejecting racial equality. Indeed, at a moment when the question of the abolition of slavery polarized the nation, the AMA was founded in 1847 to create a voluntary professional organization, national in scope, dedicated to raising the standards of medical training and practice. To this end, the AMA elected presidents and selected host cities for annual meetings in the North, South, and West. Seven out of the fourteen meetings and six out of fourteen presidents were from slave and/or border states. These institutional practices together with the representation of blacks as different and enjoying an appropriate status as slaves grounded the national identity of the profession in black subordination. Similarly, the gendered discourses about healing and practices of female exclusion privileged medical authority as male by drawing on and reinforcing patriarchy. In the wake of the war, leaders hoped to restore the national character of the organization by resuming antebellum practices. In response to the new possibilities for blacks in medicine--as represented by the biracial National Medical Society--the AMA took steps to vigorously police the racial boundaries of the national profession. As this study will show, the 1870 decision reflected the logic of the racial politics at the heart of the association's antebellum past and would loom large in its future.

American Civil War↗
PubMed2002

From personal reflection to social positioning: the development of a transformational model of professional education in midwifery.

A transformational model of professional identity formation, anchored and globalized in workplace conversations, is advanced. Whilst the need to theorize the aims and methods of clinical education has been served by the techno-rational platform of 'reflective practice', this platform does not provide an adequate psychological tool to explore the dynamics of social episodes in professional learning and this led us to positioning theory. Positioning theory is one such appropriate tool in which individuals metaphorically locate themselves within discursive action in everyday conversations to do with personal positioning, institutional practices and societal rhetoric. This paper develops the case for researching social episodes in clinical education through professional conversations where midwifery students, in practice settings, are encouraged to account for their moment-by-moment interactions with their preceptors/midwives and university mentors. It is our belief that the reflection elaborated by positioning theory should be considered as the new epistemology for professional education where professional conversations are key to transformative learning processes for persons and institutions.

Humans↗
PubMed2004

Skin markers of occult spinal dysraphism in children: a review of 54 cases.

OBJECTIVES: To verify the diagnostic value of lumbosacral midline cutaneous lesions in asymptomatic children to detect occult spinal dysraphism (OSD) and to propose a practical approach for clinical investigations with respect to the type of cutaneous lesions observed. DESIGN: Retrospective study of 54 children referred to the Department of Pediatric Dermatology between 1990 and 1999 for congenital midline lumbosacral cutaneous lesions. SETTING: The private or institutional practices of participating dermatologists and pediatricians. MAIN OUTCOME MEASURES: Evaluation of the diagnostic value of midline cutaneous lesions for the detec-tion of OSD. Association of skin examination findings with spinal anomalies detected by magnetic resonance imaging or ultrasound. RESULTS: Occult spinal dysraphism was detected in 3 of 36 patients with an isolated congenital midline lesion and 11 of 18 patients with a combination of 2 or more different skin lesions. CONCLUSIONS: A combination of 2 or more congenital midline skin lesions is the strongest marker of OSD. Careful dermatologic examination is needed to detect suggestive markers and request a spinal magnetic resonance image, which is the most sensitive radiologic approach to detect an OSD.

Adolescent↗
PubMed1998

Informed consent in the Childrens Cancer Group: results of preliminary research.

BACKGROUND: Informed consent is critical to the ethical conduct of pediatric cancer clinical research. Research regarding such consent has been limited. METHODS: After conducting a background survey of institutional practice from principal investigators (PIs) at 113 Childrens Cancer Group (CCG) centers, the authors obtained more detailed data regarding informed consent from 23 parents of children recently enrolled in CCG research trials and from 23 clinician-investigators at 5 CCG institutions. RESULTS: Approximately 73% of PIs responded to the background survey, providing context in which to interpret the more detailed information. Parents reported that they found the informed consent process helpful, although somewhat confusing. Satisfaction with informed consent was not related to ethnicity or education level. Parents found discussion with staff more helpful than the consent document, and the majority reported that the amount of information conveyed was appropriate. Although only 3 parents (13%) reported that too much information was given, nearly 50% of the investigators believed too much information usually is provided. All investigators believed that patients benefit from participation in CCG studies; the majority recommend that the child be enrolled on study, and the majority believe the major obstacle to good informed consent is parents' "state of shock." CONCLUSIONS: Parents expressed general satisfaction with the consent process. By contrast, clinician responses indicate dissatisfaction with the informed consent process. Future research must include more centers and larger numbers of parents of children who we enrolled as well as those who declined to participate in CCG studies, examine consent in minority subgroups, and further investigate the role of clinician-investigators and their interaction with parents and children during the informed consent process.

Adult↗