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Clinical supervision

F A K Mazari, J A Khan, N Samuel, G Smith, D Carradice, P C McCollum, I C Chetter
BACKGROUND: The aim was to compare the long-term outcomes of percutaneous transluminal angioplasty (PTA), a supervised exercise programme (SEP) and combined treatment (PTA + SEP) in patients with intermittent claudication owing to femoropopliteal disease. METHODS: Patients recruited to an RCT comparing these treatments were invited for long-term follow-up from 2010 to 2011. Indicators of limb ischaemia were recorded (ankle : brachial pressure index (ABPI) and treadmill walking distances)...
October 20, 2016: British Journal of Surgery
Catherine de Blacam, Sean Tierney, Odhran Shelley
BACKGROUND: Surgical training requires exposure to clinical decision-making and operative experience in a supervised environment. It is recognised that learning ability is compromised when fatigued. The European Working Time Directive requires a decrease in working hours, but compliance reduces trainees' clinical exposure, which has profound implications for plastic surgery training. The aim of this study was to evaluate plastic surgery registrars' experience of an EWTD-compliant rota, and to examine its impact on patient care, education, and logbook activity...
October 20, 2016: Journal of Plastic Surgery and Hand Surgery
Tamara Seitz, Bela R Turk, Henriette Löffler-Stastka
The increasing emigration of graduates of the Medical University of Vienna presents a serious problem. This study examined students' evaluation of clinical rotations, their self-rated performance, and where they felt the most deficits exist. Medical students answered an online questionnaire surveying the following aspects: an evaluation of their internship; supervision; integration in the team and improvement of field-specific knowledge; the qualities of taking a patient's medical history by empathy; patient-centeredness; structure; target orientation; and the ability to integrate field-specific knowledge into anamnesis...
October 19, 2016: Wiener Klinische Wochenschrift
Arnaldina Sampaio, Elisa A Marques, Jorge Mota, Joana Carvalho
This study examined the effect of a Multicomponent Training (MT) intervention on cognitive function, functional fitness and anthropometric variables in institutionalized patients with Alzheimer's disease (AD). Thirty-seven institutionalized elders (84.05 ± 5.58 years) clinically diagnosed with AD (mild and moderate stages) were divided into two groups: Experimental Group (EG, n = 19) and Control Group (CG, n = 18). The EG participated in a six-month supervised MT program (aerobic, muscular resistance, flexibility and postural exercises) of 45-55 minutes/session, twice/week...
October 18, 2016: Dementia
Yue Yin, Lan Gong
PURPOSE: To observe reversibility of meibomian gland (MG) dropout and analyze correlated factors and to compare the treatment efficiency with and without eyelid hygiene in patients with meibomian gland dysfunction (MGD). METHODS: Consecutive 78 eyes of 78 MGD (stage 2-3) patients who finished follow-up examination after 1-month of treatment were recruited in this retrospective study. All patients were treated with artificial lubricant and eyelid hygiene. Related ocular surface evaluation and meibomian gland assessment were examined...
October 14, 2016: Cornea
Jae Hyun Kwon, Chang Hwan Sohn, Jae Ho Lee, Bum Jin Oh
OBJECTIVE: The supply of emergency medicine (EM) specialists has not been able to meet demand in the past decade. This study comparatively analyzed clinical findings to provide fundamental data to inform efficient utilization of a limited number of EM specialists. METHODS: This retrospective study included 54,204 patients who visited the emergency department of a tertiary care medical center from March 1 to December 31, 2012. The experimental specialist-supervised (SS) group included patients supervised by an EM specialist, while the control specialist-on-call (SOC) group included patients attended by a senior resident of EM with an EM specialist on call...
March 2016: Clin Exp Emerg Med
Julie Latimer, Stephen Ling, Ian Flaherty, Marianne Jauncey, Allison M Salmon
BACKGROUND: Fentanyl is a powerful analgesic, the prescription of which has increased markedly in recent years. The emergence of the drug at the Sydney Medically Supervised Injecting Centre (MSIC) warranted a retrospective clinical audit to assess the risk of fentanyl overdose in comparison with other opioids, in the context of a drug consumption room. METHOD: Heroin, fentanyl or other prescription opioids (PO) injections resulting in overdose were audited (September 1, 2012 and August 31, 2015)...
October 14, 2016: International Journal on Drug Policy
Amit R Majithia, Ben Tsuda, Maura Agostini, Keerthana Gnanapradeepan, Robert Rice, Gina Peloso, Kashyap A Patel, Xiaolan Zhang, Marjoleine F Broekema, Nick Patterson, Marc Duby, Ted Sharpe, Eric Kalkhoven, Evan D Rosen, Inês Barroso, Sian Ellard, Sekar Kathiresan, Stephen O'Rahilly, Krishna Chatterjee, Jose C Florez, Tarjei Mikkelsen, David B Savage, David Altshuler
Clinical exome sequencing routinely identifies missense variants in disease-related genes, but functional characterization is rarely undertaken, leading to diagnostic uncertainty. For example, mutations in PPARG cause Mendelian lipodystrophy and increase risk of type 2 diabetes (T2D). Although approximately 1 in 500 people harbor missense variants in PPARG, most are of unknown consequence. To prospectively characterize PPARγ variants, we used highly parallel oligonucleotide synthesis to construct a library encoding all 9,595 possible single-amino acid substitutions...
October 17, 2016: Nature Genetics
Francesco Giallauria, Neil Andrew Smart, Antonio Cittadini, Carlo Vigorito
Exercise training (ET) is strongly recommended in patients with chronic heart failure (CHF). Moderate-intensity aerobic continuous ET is the best established training modality in CHF patients. In the last decade, however, high-intensity interval exercise training (HIIT) has aroused considerable interest in cardiac rehabilitation community. Basically, HIIT consists of repeated bouts of high-intensity exercise alternated with recovery periods. In CHF patients, HIIT exerts larger improvements in exercise capacity compared to moderate-continuous ET...
October 14, 2016: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Marie Christine Iliou, Jean Christophe Blanchard, Aurélia Lamar-Tanguy, Pascal Cristofini, François Ledru
Large subsets of patients admitted in cardiac rehabilitation centers are having a pacemaker, cardiac resynchronization (CRT) or implantable cardiac defibrillator (ICD). Cardiac rehabilitation for patients, mostly with heart failure, with implanted electronic devices as pacemakers or ICD is a unique opportunity not only to optimize the medical treatment, to increase their exercise capacity and improves their clinical condition but also to supervise the correct functioning of the device. CRT reduces clinical symptoms and increases slightly the exercise capacity...
October 14, 2016: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Victoria Shier, Eric Trieu, David A Ganz
BACKGROUND: The United States Preventive Services Task Force recommends exercise to prevent falls in community-dwelling adults aged ≥ 65 years at increased fall risk. However, little is known about how best to implement exercise programs in routine care when a patient's need for exercise is identified within the healthcare system. METHODS: Using a qualitative approach, we reviewed the literature to determine how exercise programs to prevent falls are implemented from the vantage point of a health care setting...
December 2016: Injury Epidemiology
Byron C Wallace, Joël Kuiper, Aakash Sharma, Mingxi Brian Zhu, Iain J Marshall
Systematic reviews underpin Evidence Based Medicine (EBM) by addressing precise clinical questions via comprehensive synthesis of all relevant published evidence. Authors of systematic reviews typically define a Population/Problem, Intervention, Comparator, and Outcome (a PICO criteria) of interest, and then retrieve, appraise and synthesize results from all reports of clinical trials that meet these criteria. Identifying PICO elements in the full-texts of trial reports is thus a critical yet time-consuming step in the systematic review process...
2016: Journal of Machine Learning Research: JMLR
Philip Kemp, Moorene Gilding, Khooseal Seewooruttun, Hannah Walsh
Background With a rise in the number of unqualified staff providing health and social care, and reports raising concerns about the quality of care provided, there is a need to address the learning needs of clinical support workers. This article describes a qualitative evaluation of a service improvement project that involved a work-based learning approach for clinical support workers on mental health inpatient wards. Aim To investigate and identify insights in relation to the content and process of learning using a work-based learning approach for clinical support workers...
September 14, 2016: Nursing Standard
Brett K Beaulieu-Jones, Casey S Greene
Patient interactions with health care providers result in entries to electronic health records (EHRs). EHRs were built for clinical and billing purposes but contain many data points about an individual. Mining these records provides opportunities to extract electronic phenotypes, which can be paired with genetic data to identify genes underlying common human diseases. This task remains challenging: high quality phenotyping is costly and requires physician review; many fields in the records are sparsely filled; and our definitions of diseases are continuing to improve over time...
October 12, 2016: Journal of Biomedical Informatics
Markus K Schuler, Leopold Hentschel, Wadim Kisel, Michael Kramer, Felicitas Lenz, Beate Hornemann, Julia Hoffmann, Stephan Richter, Gerhard Ehninger, Martin Bornhäuser, Frank Kroschinsky
CONTEXT: Physical exercise can alleviate cancer related fatigue. Randomized controlled trials (RCT) in patients with advanced cancer are scarce. OBJECTIVES: We test the impact of a structured, individual sports program on fatigue in patients with advanced cancer. METHODS: 77 patients were invited to participate in this RCT exploring the effects of physical exercises on fatigue 12 and 24 weeks after baseline. Patients were randomized into three groups...
October 12, 2016: Journal of Pain and Symptom Management
Alice E Liddell, Steven Allan, Ken Goss
OBJECTIVES: Compassion-focused therapy (CFT) has shown promising results for a range of clinical presentations. This study explored the therapeutic competencies required to deliver CFT and organized these into a coherent framework. DESIGN: The Delphi method was used to explore and refine competencies for delivering CFT in three rounds of data collection. METHODS: The first round involved interviews with 12 experts in CFT. Data were analysed using template analysis to generate a draft competency framework...
October 15, 2016: Psychology and Psychotherapy
Janet Landeen, Donna Carr, Kirsten Culver, Lynn Martin, Nancy Matthew-Maich, Charlotte Noesgaard, Larissa Beney-Gadsby
Ongoing curricular renewal is a necessary phenomenon in nursing education to align learning with ever-changing professional practice demands. The McMaster Mohawk Conestoga BScN Program in Hamilton, Ontario, Canada recently engaged in a comprehensive curriculum renewal. The purpose of this study was to evaluate the impact of curricular changes on students' deep learning. Faculty perceptions about student learning outcomes during final year clinical placements were gathered through a combination of individual interviews and focus groups using Interpretive Descriptive qualitative research methodology...
October 4, 2016: Nurse Education in Practice
Marc A Auerbach, Marjorie Lee White, Sweta Bhargava, Pavan Zaveri, Elizabeth B Seelbach, Rebekah A Burns, Renuka Mehta, Brett McAninch, Daniel Fein, Todd P Chang, David O Kessler
OBJECTIVES: Few published studies describe graduating pediatric residents' procedural skills or success rates. This information would help guide supervisors' decisions about graduating residents' preparedness, training, and supervision needs. This study aimed to measure success rates for graduating pediatric residents performing infant lumbar puncture (LP) during the final months of their training and to describe their experiences performing and supervising infant LPs during the course of their training...
October 6, 2016: Pediatric Emergency Care
E Tan, F Lin, L Sheck, P Salmon, S Ng
PURPOSE: To derive a decision rule for predicting surgical complexity in periorbital basal cell carcinoma (pBCC). DESIGN: Prospective, cohort study. PARTICIPANTS: Patients referred to an oculoplastic service for excision of pBCC from September 2010 to November 2015 METHODS: This study was conducted at two centres in New Zealand from September 2010 to November 2015. Baseline demographic information, and an initial assessment of operative complexity (a four-point grading scale) were collected...
October 14, 2016: Journal of the European Academy of Dermatology and Venereology: JEADV
S A Buckingham, R S Taylor, K Jolly, A Zawada, S G Dean, A Cowie, R J Norton, H M Dalal
OBJECTIVE: To update the Cochrane review comparing the effects of home-based and supervised centre-based cardiac rehabilitation (CR) on mortality and morbidity, quality of life, and modifiable cardiac risk factors in patients with heart disease. METHODS: Systematic review and meta-analysis. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO and CINAHL were searched up to October 2014, without language restriction. Randomised trials comparing home-based and centre-based CR programmes in adults with myocardial infarction, angina, heart failure or who had undergone coronary revascularisation were included...
2016: Open Heart
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