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Clinical practise

Sarah A Moore, Ruth Da Silva, Madelaine Balaam, Lianne Brkic, Dan Jackson, Dan Jamieson, Thomas Ploetz, Helen Rodgers, Lisa Shaw, Frederike van Wijck, Christopher Price
BACKGROUND: Loss of upper limb function affects up to 85 % of acute stroke patients. Recovery of upper limb function requires regular intensive practise of specific upper limb tasks. To enhance intensity of practice interventions are being developed to encourage patients to undertake self-directed exercise practice. Most interventions do not translate well into everyday activities and stroke patients continue to find it difficult remembering integration of upper limb movements into daily activities...
October 21, 2016: Trials
Laura Chahda, Bernice A Mathisen, Lindsay B Carey
PURPOSE: Given minimal studies describing the role and practice of speech-language pathologists (SLPs) in adult palliative care, the aim of this review was to compile a database of research literature, examine the potential research gaps and to consider material that specifically discussed the need for and/or use of procedures and protocols for SLPs working in palliative care that would support the development of SLP palliative care guidelines. METHOD: A scoping review was conducted utilising Arksey and O'Malley's framework with the goal of exploring any key concepts and approaches utilised by SLPs in adult palliative care, plus any literature and/or recommendations regarding SLP practice in adult palliative care settings...
October 20, 2016: International Journal of Speech-language Pathology
Prerna K Chawla, Zarir F Udwadia, Rajeev Soman, Ashok A Mahashur, Rohit A Amale, Alpa J Dherai, Rohan V Lokhande, Prasad R Naik, Tester F Ashavaid
Therapeutic Drug Monitoring (TDM) is a routinely practised clinical laboratory technique which aids the clinicians with a clear clinical judgement of the drug therapy and optimize the doses if necessary. Rifampicin is the most important and potent component of first line therapy of tuberculosis (TB). Several factors like age, weight, gender, doses and formulations, gastro-intestinal disorders, ethnicity etc alter the absorption and bioavailability of rifampicin thus altering the drug levels. Low plasma levels of rifampicin may play a plausible role in slow response to therapy, treatment failure or relapse or acquired drug resistance...
August 2016: Journal of the Association of Physicians of India
Susanne Hafner, Sabine Haubensak, Tanusree Paul, Oliver Zolk
Background | Differences (polymorphisms) in genes encoding drug targets, drug transport proteins, or drug metabolizing enzymes may be responsible, among other factors, for the observed variation in patients' responses to medications. The field of pharmacogenetics aims to identify patients at higher genetically-determined risk of adverse effects or poor response to medication. This information would allow for modification of dosage or substitution with alternative therapy. However, there is a lack of awareness of pharmacogenetic clinical practise guidelines...
October 2016: Deutsche Medizinische Wochenschrift
N A Koontz, T A Seltman, S F Kralik, K M Mosier, H R Harnsberger
Radiologists have long relied upon the use of metaphoric imaging signs to attribute meaning to disease or anatomy-specific imaging patterns encountered in clinical imaging. Teachers of radiology often employ the use of such signs to help learners rapidly identify the typical appearance of various pathologies. Head and neck (H&N) imaging is no exception, and as a specialty that deals with uncommon pathologies and complex anatomy, learners and practising radiologists alike may benefit from this simplistic, pattern-based approach...
October 3, 2016: Clinical Radiology
Caroline J Falconer, Aitor Rovira, John A King, Paul Gilbert, Angus Antley, Pasco Fearon, Neil Ralph, Mel Slater, Chris R Brewin
BACKGROUND: Self-criticism is a ubiquitous feature of psychopathology and can be combatted by increasing levels of self-compassion. However, some patients are resistant to self-compassion. AIMS: To investigate whether the effects of self-identification with virtual bodies within immersive virtual reality could be exploited to increase self-compassion in patients with depression. METHOD: We developed an 8-minute scenario in which 15 patients practised delivering compassion in one virtual body and then experienced receiving it from themselves in another virtual body...
January 2016: BJPsych Open
E Brooks, M H Gendel, A L Parry, S Humphreys, S R Early
BACKGROUND: Physicians are not immune to cognitive impairment. Because of the risks created by practising doctors with these issues, some have suggested developing objective, population-specific measures of evaluation and screening guidelines to assess dysfunction. However, there is very little published information from which to construct such resources. AIMS: To highlight the presentation characteristics and provide evaluation recommendations specific to the needs of physicians with actual or presumed cognitive impairment...
September 30, 2016: Occupational Medicine
Mandie Scamell, Roa Altaweli, Christine McCourt
BACKGROUND: The expansion of the medicalisation of childbirth has been described in the literature as being a global phenomenon. The vignette described in this paper, selected from an ethnographic study of routine intervention in Saudi Arabian hospitals illustrates how the worldwide spread of the bio-medical model does not take place within a cultural vacuum. AIM: To illuminate the ways in which the medicalisation of birth may be understood and practised in different cultural settings, through a vignette of a specific birth, drawn as a typical case from an ethnographic study that investigated clinical decision-making in the second stage of labour in Saudi Arabia...
September 28, 2016: Women and Birth: Journal of the Australian College of Midwives
Colin P West, Liselotte N Dyrbye, Patricia J Erwin, Tait D Shanafelt
BACKGROUND: Physician burnout has reached epidemic levels, as documented in national studies of both physicians in training and practising physicians. The consequences are negative effects on patient care, professionalism, physicians' own care and safety, and the viability of health-care systems. A more complete understanding than at present of the quality and outcomes of the literature on approaches to prevent and reduce burnout is necessary. METHODS: In this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Scopus, Web of Science, and the Education Resources Information Center from inception to Jan 15, 2016, for studies of interventions to prevent and reduce physician burnout, including single-arm pre-post comparison studies...
September 28, 2016: Lancet
Jayant S Vaidya, Frederik Wenz, Max Bulsara, Jeffrey S Tobias, David J Joseph, Christobel Saunders, Chris Brew-Graves, Ingrid Potyka, Stephen Morris, Hrisheekesh J Vaidya, Norman R Williams, Michael Baum
BACKGROUND: Based on our laboratory work and clinical trials we hypothesised that radiotherapy after lumpectomy for breast cancer could be restricted to the tumour bed. In collaboration with the industry we developed a new radiotherapy device and a new surgical operation for delivering single-dose radiation to the tumour bed - the tissues at highest risk of local recurrence. We named it TARGeted Intraoperative radioTherapy (TARGIT). From 1998 we confirmed its feasibility and safety in pilot studies...
September 2016: Health Technology Assessment: HTA
C M Madronio, B K Armstrong, C G Watts, C Goumas, R L Morton, A Curtin, S W Menzies, G J Mann, J F Thompson, A E Cust
BACKGROUND: Guidelines recommend that health professionals identify and manage individuals at high risk of developing melanoma, but there is limited population-based evidence demonstrating real-world practices. OBJECTIVE: A population-based, observational study was conducted in the state of New South Wales, Australia to determine doctors' knowledge of melanoma patients' risk and to identify factors associated with better identification and clinical management. METHODS: Data were analysed for 1889 patients with invasive, localised melanoma in the Melanoma Patterns of Care study...
September 27, 2016: Cancer Epidemiology
Katharine Reid, David Smallwood, Margo Collins, Ruth Sutherland, Agnes Dodds
BACKGROUND: To ensure the rigour of objective structured clinical examinations (OSCEs) in assessing medical students, medical school educators must educate examiners with a view to standardising examiner assessment behaviour. Delivering OSCE examiner training is a necessary yet challenging part of the OSCE process. A novel approach to implementing training for current and potential OSCE examiners was trialled by delivering large-group education sessions at major teaching hospitals. METHODS: The 'OSCE Roadshow' comprised a short training session delivered in the context of teaching hospital 'Grand Rounds' to current and potential OSCE examiners...
2016: Medical Education Online
Jeong Il Yu, Hee Chul Park, Yong Chan Ahn, Xian-Shu Gao, Jun-Jie Wang, Zhao-Chong Zeng, Yoshinori Ito, Tatsuya Ohno, Yasumasa Nishimura
This online survey of practising radiation oncologists from Korea, China and Japan was conducted to investigate the current practices in radiotherapy (RT) for spine metastasis and to compare these practices across the three countries. The questionnaire included nine general information questions and two clinical scenarios (representing 'typical' and 'good' prognosis spine metastasis), with seven questions for each scenario. An anonymous web-based survey using Google Docs® was undertaken from 2 September 2014 to 9 April 2015...
September 26, 2016: Journal of Radiation Research
C Rajasoorya
Modern healthcare faces the challenges of rising costs, increasing expectations of patients and changing disease patterns. Physicians practise medicine in an era of easy availability and access to a plethora of modern and sometimes expensive diagnostic aids. The powerful utility of clinical skills cannot be underestimated nor lost. The physician has a powerful platform to encourage the rational use of tests, prevent wasteful overutilisation and ensure that tests do not cause more harm than benefit in physical, emotional or financial terms...
September 2016: Singapore Medical Journal
A S M Gilmour, A Welply, J G Cowpe, A D Bullock, R J Jones
Objective To investigate the self-reported confidence and preparedness of final year undergraduate students in undertaking a range of clinical procedures.Methods A questionnaire was distributed to final year dental students at Cardiff University, six months prior to graduation. Respondents rated their confidence in undertaking 39 clinical procedures using a 5-point scale (1 = can undertake on own with confidence, 5 = unable to undertake). Students also responded yes/no to experiencing four difficulties and to three statements about general preparedness...
September 23, 2016: British Dental Journal
P Singh
An allegation calling a dental professional's Fitness to Practise (FtP) into question is probably one of the most stressful events a General Dental Council (GDC) registrant could face during their career. The practise of dentistry is experiencing unprecedented levels of complaints against registrants with orthodontics traditionally being seen as a low risk area. However, as a recently appointed clinical advisor and expert witness to the GDC, I can testify this may no longer be the case. The last twelve months has seen me provide advice on seven cases associated with orthodontics...
September 23, 2016: British Dental Journal
Prem Pais
I read with interest the comment by Mark Wilson, which deals with possible conflict of interest (CoI) affecting publications in academic medical journals. This comment has specifically targeted the New England Journal of Medicine (NEJM) and its editor-in-chief Jeffrey Drazen on the "Vioxx scandal" which broke 15 years ago. Wilson's comment seems to be in response to a blog by Natarajan on CoI in medical publications. In the blog Natarajan writes of commercial CoI biasing publication of clinical trials and cites, among other examples, a publication in the NEJM on trials of voriconazole...
October 2016: Indian Journal of Medical Ethics
Shamzah Araf, Koorosh Korfi, Tahrima Rahim, Andrew Davies, Jude Fitzgibbon
The adoption of high-throughput technologies has led to a transformation in our ability to classify diffuse large B-cell lymphoma (DLBCL) into unique molecular subtypes. In parallel, the expansion of agents targeting key genetic and gene expression signatures has led to an unprecedented opportunity to personalize cancer therapies, paving the way for precision medicine. Areas covered: This review summarizes the key molecular subtypes of DLBCL and outlines the novel technology platforms in development to discriminate clinically relevant subtypes...
October 2016: Expert Review of Molecular Diagnostics
Emma Paternotte, Fedde Scheele, Conny M Seeleman, Lindsay Bank, Albert J J A Scherpbier, Sandra van Dulmen
INTRODUCTION: Intercultural communication (ICC) between doctors and patients is often associated with misunderstandings and dissatisfaction. To develop ICC-specific medical education, it is important to find out which ICC skills medical specialists currently apply in daily clinical consultations. METHODS: Doctor-patient consultations of Dutch doctors with non-Dutch patients were videotaped in a multi-ethnic hospital in the Netherlands. The consultations were analyzed using the validated MAAS-Global assessment list in combination with factors influencing ICC, as described in the literature...
October 2016: Perspectives on Medical Education
Nicola Vousden, Graham Tydeman, Annette Briley, Paul T Seed, Andrew H Shennan
The aim of this study was to assess a new device (Tydeman Tube) designed to facilitate delivery of the impacted foetal head at caesarean section. Standard digital vaginal technique and the Tydeman Tube were each used to elevate the foetal head on a validated full dilatation caesarean simulator. Greater elevation of the foetal head was achieved with the Tydeman Tube than digital technique (mean difference +9.1 mm, p < 0.001). Although greater force was applied to achieve this elevation (mean difference +0...
September 13, 2016: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
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