CHALLENGES IN CLINICAL PRACTICE OF CR MAMMOGRAPHY IN TANZANIA

2018 ◽  
Vol 184 (1) ◽  
pp. 109-115
Author(s):  
Jofrey Jackson ◽  
Wilbroad E Muhogora ◽  
Ismael N Makundi
Keyword(s):  
Clinical Practice ◽  
Staff Training ◽  
Beam Quality ◽  
Improve Patient Care ◽  
Operational Conditions ◽  
Inappropriate Use ◽  
Regulatory Guidance ◽  
Mean Glandular Dose ◽  
Oblique Projections ◽  
Improve Patient

Abstract The aim of this study was to evaluate the clinical practice of CR mammography in Tanzania. The equipment performance and operational conditions were studied; and mean glandular dose (DG) estimated to 75 women undergoing diagnosis at three mammography facilities. All mammograms during this study were reported to be useful for the intended diagnosis. The median DG for craniocaudal and mediolateral oblique projections ranged from 1.27 ± 0.18 mGy to 1.9 ± 0.27 mGy and from 1.3 ± 0.18 mGy to 1.9 ± 0.27 mGy, respectively, and were below the national regulatory guidance of 2.5 mGy. Despite this positive result, unavoidable inappropriate use of beam quality and tube loading settings which could have been through appropriate staff training and performing routine quality control were not uncommon. This work provides an insight of current operational conditions of CR in Tanzania and what strategy should be employed to this service to improve patient care in the country.

scholarly journals Practice-Based Research Networks, Part I: Clinical Laboratories to Generate and Translate Research Findings Into Effective Patient Care

2012 ◽  
Vol 47 (5) ◽  
pp. 549-556 ◽  
Author(s):  
Eric L. Sauers ◽  
Tamara C. Valovich McLeod ◽  
R. Curtis Bay
Keyword(s):  
Clinical Practice ◽  
Patient Care ◽  
Translational Research ◽  
Athletic Training ◽  
Improve Patient Care ◽  
Single Site ◽  
Practice Based Research ◽  
Research Findings ◽  
Human Participants ◽  
Improve Patient

Context To improve patient care, athletic training clinicians and researchers should work together to translate research findings into clinical practice. Problems with patient care observed in clinical practice should be translated into research frameworks, where they can be studied. Practice-based research networks (PBRNs) provide a compelling model for linking clinicians and researchers so they can conduct translational research to improve patient care. Objective To describe (1) the translational research model, (2) practice-based research as a mechanism for translating research findings into clinical practice, (3) the PBRN model and infrastructure, (4) the research potential using the PBRN model, and (5) protection of human participants in PBRN research. Description Translational research is the process of transforming research findings into health behavior that ultimately serves the public and attempts to bridge the gap between research and clinical practice. Practice-based research represents the final step in the translational research continuum and describes research conducted by providers in clinical practices. The PBRNs are characterized by an organizational framework that transcends a single site or study and serves as the clinical research “laboratory” for conducting comparative-effectiveness studies using patient-oriented measures. The PBRN approach to research has many benefits, including enhanced generalizability of results, pooling of resources, rapid patient recruitment, and collaborative opportunities. However, multisite research also brings challenges related to the protection of human participants and institutional review board oversight. Clinical and Research Advantages Athletic training studies frequently include relatively few participants and, consequently, are able to detect only large effects. The incidence of injury at a single site is sufficiently low that gathering enough data to adequately power a treatment study may take many years. Collaborative efforts across diverse clinical practice environments can yield larger patient samples to overcome the limitations inherent in single-site research efforts.

scholarly journals Guidelines in Gastroenterology: Careful Interpretation Is Essential

2021 ◽  
pp. 1-7
Author(s):  
Catarina Correia ◽  
Nuno Almeida ◽  
Pedro Narra Figueiredo
Keyword(s):  
Clinical Practice ◽  
Expert Opinion ◽  
North American ◽  
Clinical Judgment ◽  
Scientific Evidence ◽  
Improve Patient Care ◽  
Level Of Evidence ◽  
Low Level ◽  
High Level ◽  
Improve Patient

<b><i>Introduction:</i></b> Clinical practice guidelines (CPG) contain recommendations that aim to guide physicians in the diagnosis of and therapeutic approach toward patients affected by gastrointestinal (GI) pathologies. These CPG systematically combine scientific evidence and clinical judgment, culminating in recommendations that have been shown to improve patient care. <b><i>Material and Methods:</i></b> European and North American guidelines published in the area of gastroenterology in 2018 and 2019 were considered for inclusion. To standardize the results, only guidelines that used GRADE as an evidence system were included. Thus, in the end, 1,233 recommendations from 29 guidelines published between 2018 and 2019 were analyzed. <b><i>Results:</i></b> Of the 1,233 recommendations collected, 324 (26.3%) had a low level of evidence and 127 (10.3%) had a very low level of evidence, indicating little evidence or expert opinion. Of the 29 publications analyzed, 14 (48.3%) did not present any recommendation with a high level of evidence. Regarding the 1,233 individual recommendations expressed in these 29 publications, only 336 (27.25%) assumed a high level of evidence, with 277 (82.44%) referring to liver pathology. Of the recommendations evaluated, 77 were from North American societies and the remaining 1,156 were European recommendations. In relation to the first group, only 3 (3.9%) had a high level of evidence belonging to the Guidelines for Sedation and Anesthesia in GI Endoscopy. <b><i>Conclusions:</i></b> More than 25% of all recommendations currently accepted to guide patients with gastroenterological disorders are based on low-quality evidence or expert opinion. Thus, these documents should guide our performance, but clinical sense and multidisciplinarity must not be overlooked in dubious cases and with weak scientific evidence. Research should focus on the development of randomized controlled trials and systematic reviews to improve the evidence supporting the guidelines that guide clinical practice.

Leaning upon international directives for optimization: Anemia—Results of the French Lidoanemia-2 Survey.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 180-180
Author(s):  
Vincent Launay-Vacher ◽  
Nicolas Janus ◽  
Lisa Ludwig ◽  
Gilbert Deray ◽  
Florian Scotte
Keyword(s):  
Clinical Practice ◽  
Cancer Patients ◽  
Improve Patient Care ◽  
Web Based ◽  
Anemia Management ◽  
Short Video ◽  
Survey Results ◽  
The Impact ◽  
Improve Patient ◽  
Rbc Transfusion

180 Background: Anemia in cancer patients is common. The LIDOANEMIA-1 survey [Scotté F. MASCC 2015] reported that French clinicians do not follow EORTC guidelines. We aimed at improving EORTC guidelines dissemination among French physicians (FP). This second survey aimed at assessing the impact of our initiative on physicians’ behavior. Methods: Declarative survey conducted in France. The intervention consisted of having physicians watch a short video summarizing EORTC guidelines and their main messages for clinical practice. Evaluation of the impact of the intervention was performed with a 4-question web-based form FP filled in after seeing the video. Results: 319 FP answered the survey. Results are showed in the Table regarding the 4 main items: anemia diagnosis, Hb cut-off for considering RBC transfusion or ESA initiation, and Target Hb level on treatment. Among FP who were not following the guidelines, 67.7, 38.2, 50.8 and 65.2% declared they will follow them after the intervention, respectively for anemia diagnosis, Hb cut-off for considering RBC transfusion or ESA initiation, and Target Hb level on treatment. After the intervention, the expected proportion of FP who will follow EORTC guidelines is 93.2, 69.4, 82.6, and 89.4%, respectively for each item evaluated. Conclusions: Dissemination of guidelines is key to improve patient care. We tested a simple mean of presentation of EORTC guidelines in anemia management in cancer patients which significantly increased the proportion of FP who declare they will follow the guidelines. However, a non-negligible proportion of them does not agree and will not follow them, especially for the Hb cut-off for considering RBC transfusion. [Table: see text]

scholarly journals Biomarker Evaluation and Clinical Development

2020 ◽  
Vol 1 (1) ◽  
pp. 16-22
Author(s):  
Andrew J Vickers ◽  
Melissa Assel
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Decision Analysis ◽  
Patient Care ◽  
Real World ◽  
Improve Patient Care ◽  
Clinical Development ◽  
Biomarker Research ◽  
Biomarker Evaluation ◽  
Improve Patient

Most candidate biomarkers are never adopted into clinical practice. The likelihood that a biomarker with good predictive properties will be incorporated into urologic decision-making and will improve patient care can be enhanced by following established principles of biomarker development. Studies should follow the REMARK guidelines, should have clinically relevant outcomes, and should evaluate the biomarker on the same patients to whom the biomarker would be applied in practice. It is also important to recognize that biomarker research is comparative: the question is not whether a biomarker provides information, but whether it provides better information than is already available. Continuous biomarkers should not be categorized above or below a fixed cutpoint: risk prediction allows for individualization of care. The risk predictions must be calibrated, that is, close to a patient’s true risk, and decision analysis is required to determine whether using the biomarker in clinical practice would change decisions and improve outcomes. Finally, impact studies are needed to evaluate how use of the biomarker in the real world affects outcomes.

Handbook of Communication in Anaesthesia & Critical Care

2010 ◽  
Keyword(s):  
Critical Care ◽  
Clinical Practice ◽  
Communication Skills ◽  
Improve Patient Care ◽  
Care Staff ◽  
Communication Tools ◽  
Everyday Clinical Practice ◽  
Professional Groups ◽  
Clinical Interactions ◽  
Improve Patient

This book provides anesthetists, intensivists and other critical care staff with a comprehensive resource that offers ways of improving communication in everyday clinical practice, and provides practical communication tools that can be used in difficult or unfamiliar circumstances. It demonstrates how communication can be structured to improve patient care and safety with numerous practical examples and vignettes illustrating how the concepts discussed can be integrated into clinical practice, and presents ideas in a way that enhances clinical interactions with patients and colleagues and facilitate the teaching of trainees. Edited by practicing anesthetists with particular expertise in teaching communication, and with contributions from expert clinicians based in North America, Europe and Australasia, this book will stimulate and complement the development of comprehensive resources for communication skills teaching in anesthesia and other related professional groups.

scholarly journals Implementation Science: Lessons Learned From Evaluating Practice Recommendations for the Care of Patients With Spine Injuries

2019 ◽  
Vol 54 (2) ◽  
pp. 192-197
Author(s):  
Alison R. Snyder Valier ◽  
Cailee E. Welch Bacon ◽  
Kristen L. Kucera ◽  
Richelle M. Williams
Keyword(s):  
Clinical Practice ◽  
Patient Care ◽  
Implementation Science ◽  
Patient Outcomes ◽  
Implementation Research ◽  
Improve Patient Care ◽  
Lessons Learned ◽  
Practice Recommendations ◽  
Spine Injuries ◽  
Improve Patient

Health care providers are encouraged to provide care according to practice recommendations because these suggestions should improve patient care and promote optimal patient outcomes. The goals of these practice recommendations are to improve patient care and promote optimal patient outcomes. However, without integration into clinical practice, the value of practice recommendations in supporting patient care is lost. Unfortunately, little is known about the success of integrating practice recommendations into clinical practice, and targeted efforts to promote integration are likely needed. Implementation research is a broad area of study that focuses on how guidelines, programs, or interventions are put into practice and delivered. The Translating Research Into Injury Prevention Practice (TRIPP) framework consists of 6 stages that support implementation science, and the framework has been used to assist in integrating injury-prevention programs into patient care. The structure of the TRIPP framework makes it applicable to other programs that would benefit from implementation science, including practice recommendations. Stages 5 and 6 of the TRIPP framework emphasize the need to explore the implementation context and factors related to uptake of a program by end users. This commentary highlights our efforts to use methods for implementation research to evaluate stage 5 of the TRIPP framework as it relates to acute care for patients with suspected spine injuries and provides 6 lessons learned that may assist in future efforts to better implement practice recommendations in patient care. Targeted efforts to assist clinicians in implementing practice recommendations may promote their use and ultimately enhance the care provided for patients with a variety of health conditions. An essential component of any implementation effort is understanding end users via stages 5 and 6 of the TRIPP framework, and this understanding may maximize knowledge translation and encourage practice change and advancement.

Analytical Methods for the Determination of Sartans in Pharmaceutical Formulations and Biological Fluids: A Review

2020 ◽  
Vol 16 (3) ◽  
pp. 208-222
Author(s):  
Miglena Smerikarova ◽  
Stanislav Bozhanov ◽  
Vania Maslarska
Keyword(s):  
Biological Fluids ◽  
Pharmaceutical Preparations ◽  
Improve Patient Care ◽  
Pharmaceutical Formulations ◽  
Treatment Of Hypertension ◽  
Therapeutic Doses ◽  
Reliable Methods ◽  
Improve Patient

Background: Sartans are mostly used as a part of combination with additional medicines in the therapy of essencial hypertension. Preferred combinations are ARB and thiazide diuretics (Hydrochlorothiazide (HCT) and Chlorthalidone (CHL)) or ARB and calcium antagonists. The number of sartans mostly prescribed by specialists is only seven - Candesartan (CDS), Eprosartan (EPS), Irbesartan (IBS), Losartan (LOS), Olmesartan (OMS), Telmisartan (TMS) and Valsartan (VLS). Methods: The widespread use of sartans in the treatment of hypertension requires reliable methods of analysis. Bulk drugs and pharmaceutical preparations should be analyzed to ensure the quality of the medicinal products reaching patients. On the other hand, the analysis of drugs in biological fluids aims to trace and improve patient care by adjusting the therapeutic doses of drugs. According to our knowledge, a review devoted to the analysis of sartans was published in 2014. Results: Spectral methods are widely used in the analysis of bulk drugs and pharmaceutical dosage forms due to their relatively simple procedures, low reagent and sample consumption, speed, precision and accuracy combined with accessibility and comparatively low cost of common apparatus. Many papers for determination of sartans in bulk drugs and pharmaceutical preparations based on liquid chromatographic techniques were published in the available literature. Among these methods, HPLC takes the leading place but UPLC and HPTLC are also present. Conclusion: The widespread use of sartans in the treatment of hypertension requires reliable methods of analysis. Bulk drugs and pharmaceutical preparations should be analyzed to ensure the quality of the medicinal products reaching patients. On the other hand, the analysis of drugs in biological fluids aims to trace and improve patient care by adjusting the therapeutic doses of drugs. Since 2014, many articles have been published on the sartans analysis and this provoked our interest to summarize the latest applications in the analysis of sartans in pharmaceutical formulations and biological media. Articles published from 2014 to 2018 are covered.

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