Research or clinical care: what’s the difference?

ABSTRACT Background: Personal protective equipment (PPE) is worn by prehospital providers (PHPs) for protection from hazardous exposures. Evidence regarding the ability of PHPs to perform resuscitation procedures has been described in adult but not pediatric models. This study examined the effects of PPE on the ability of PHPs to perform resuscitation procedures on pediatric patients. Methods: This prospective study was conducted at a US simulation center. Paramedics wore normal attire at the baseline session and donned full Level B PPE for the second session. During each session, they performed timed sets of psychomotor tasks simulating clinical care of a critically ill pediatric patient. The difference in time to completion between baseline and PPE sessions per task was examined using Wilcoxon signed-rank tests. Results: A total of 50 paramedics completed both sessions. Median times for task completion at the PPE sessions increased significantly from baseline for several procedures: tracheal intubation (+4.5 s; P = 0.01), automated external defibrillator (AED) placement (+9.5 s; P = 0.01), intraosseous line insertion (+7 s; P < 0.0001), tourniquet (+8.5 s; P < 0.0001), intramuscular injection (+21-23 s, P < 0.0001), and pulse oximetry (+4 s; P < 0.0001). There was no significant increase in completion time for bag-mask ventilation or autoinjector use. Conclusions: PPE did not have a significant impact on PHPs performing critical tasks while caring for a pediatric patient with a highly infectious or chemical exposure. This information may guide PHPs faced with the situation of resuscitating children while wearing Level B PPE.

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Differences in Sexually Transmitted Infections between the Precrisis Period (2000–2007) and the Crisis Period (2008–2014) in Granada, Spain

Journal of Clinical Medicine ◽

10.3390/jcm8020277 ◽

2019 ◽

Vol 8 (2) ◽

pp. 277 ◽

Cited By ~ 4

Author(s):

María Pérez-Morente ◽

María Sánchez-Ocón ◽

Encarnación Martínez-García ◽

Adelina Martín-Salvador ◽

César Hueso-Montoro ◽

...

Keyword(s):

Sexually Transmitted Infections ◽

Clinical Care ◽

Sociodemographic Factors ◽

Risk Indicators ◽

Unprotected Sexual Intercourse ◽

Crisis Period ◽

Sexually Transmitted ◽

Specialized Center ◽

Bivariate Statistical Analysis ◽

The Difference

Objective: To analyze the difference in the prevalence of sexually transmitted infections (STIs) between two time periods (2000–2007 and 2008–2014, with the latter period characterized by the economic crisis), as well as determine differences in sociodemographic factors, clinical care, and risk indicators. Methods: This was a retrospective, observational, and analytical study, reviewing 1437 medical records of subjects attending a specialized center in the province of Granada (Spain) for consultation associated with the presence or suspicion of an STI between 2000–2014. Data were collected on variables relating to the research objective. A descriptive and bivariate statistical analysis was performed by multiple logistic regression. Results: In the analysis comparing the presence of STIs between the crisis and non-crisis periods, the percentage of positive diagnoses reached 56.6% compared to 43.4% negative diagnoses during the non-crisis period, while the percentages were 75.2% and 24.8%, respectively, during the crisis period. This difference was statistically significant (p < 0.001) with an odds ratio (OR) of 2.21 after adjusting for age, sex, days since last unprotected sexual intercourse, and partners in the last year. Conclusions: There are significant differences in the prevalence of STIs between the study periods, which is consistent with the reports of some authors regarding the effect of the financial crisis on these conditions; however, it is worth considering other aspects that might explain the differences.

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A guide for pre-procedural imaging for transcatheter aortic valve replacement patients

Perioperative Medicine ◽

10.1186/s13741-020-00165-1 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Tjörvi E. Perry ◽

Stephen A. George ◽

Belinda Lee ◽

Joyce Wahr ◽

Darrell Randle ◽

...

Keyword(s):

Cardiac Computed Tomography ◽

Clinical Care ◽

Peripheral Vasculature ◽

Team Members ◽

Transcatheter Aortic Valve ◽

Cardiac Assessment ◽

Preprocedural Imaging ◽

The Difference ◽

Clinical Care Team ◽

Review Current

AbstractSafe and accurate pre-procedural assessment of cardiovascular anatomy, physiology, and pathophysiology prior to TAVR procedures can mean the difference between success and catastrophic failure. It is imperative that clinical care team members share a basic understanding of the preprocedural imaging technologies available for optimizing the care of TAVR patients. Herein, we review current imaging technology for assessing the anatomy, physiology, and pathophysiology of the aortic valvular complex, ventricular function, and peripheral vasculature, including echocardiography, cardiac catheterization, cardiac computed tomography, and cardiac magnetic resonance prior to a TAVR procedure. The authorship includes cardiac-trained anesthesiologists, anesthesiologists with expertise in pre-procedural cardiac assessment and optimization, and interventional cardiologists with expertise in cardiovascular imaging prior to TAVRs. Improving the understanding of all team members will undoubtedly translate into safer, more coordinated patient care.

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Why Hasn't Genomic Testing Changed the Landscape in Clinical Oncology?

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2012.32.78 ◽

2012 ◽

pp. e52-e55 ◽

Cited By ~ 5

Author(s):

Daniel F. Hayes ◽

Muin J. Khoury ◽

David Ransohoff

Keyword(s):

Clinical Utility ◽

Computational Models ◽

New Technologies ◽

Clinical Care ◽

Tumor Biomarker ◽

False Discovery Rates ◽

Patients With Cancer ◽

Slow Progress ◽

The Difference ◽

Therapeutic Research

Overview: The “omics” revolution produced great optimism that tumor biomarker tests based on high-order analysis of multiple (sometimes thousands) of factors would result in truly personalized oncologic care. Unfortunately, 10 years into the revolution, the promise of omics-based research has not yet been realized. The factors behind the slow progress in omics-based clinical care are many. First, over the last 15 years, there has been a gradual recognition of the importance of conducting tumor biomarker science with the kind of rigor that has traditionally been used for therapeutic research. However, this recognition has only recently been applied widely, and therefore most tumor biomarkers have insufficiently high levels of evidence to determine clinical utility. Second, omics-based research offers its own particular set of concerns, especially in regard to overfitting computational models and false discovery rates. Researchers and clinicians need to understand the importance of analytic validity, and the difference between clinical/biologic validity and clinical utility. The latter is required to introduce a tumor biomarker test of any kind (single analyte or omics-based), and are ideally generated by carefully planned and properly conducted “prospective retrospective” or truly prospective clinical trials. Only carefully planned studies, which take all three of these into account and in which the investigators are aware and recognize the enormous risk of unintended bias and overfitting inherent in omics-based test development, will ultimately result in translation of the exciting new technologies into better care for patients with cancer.

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The difference between a clinical technician and clinical practitioner is in the scope of practice: the need for a bioscience understanding in paramedicine

AJP Advances in Physiology Education ◽

10.1152/advan.00113.2019 ◽

2019 ◽

Vol 43 (4) ◽

pp. 541-545

Author(s):

Joseph A. Rathner ◽

Christine Kettle

Keyword(s):

Health Care Providers ◽

Allied Health ◽

Clinical Decision Making ◽

Clinical Care ◽

Clinical Decision ◽

Complex Case ◽

Care Providers ◽

Anatomy And Physiology ◽

Coronary Syndrome ◽

The Difference

“Only teach me what I need to know!” This commonly heard refrain is often spoken by allied health students while studying preclinical sciences (physiology, anatomy, pharmacology). Here we use a clinical scenario undertaken by second-year Bachelor of Paramedic Practice students of acute coronary syndrome to demonstrate the difference in clinical decision making when using a clinical reasoning approach to treatment rather than relying exclusively on a practice guidelines approach. We hope to demonstrate that understanding basic bioscience concepts, such as the Frank-Starling mechanism and the anatomy and physiology of the autonomic nervous system, are key to providing good clinical care in response to ambiguous patient symptoms. Students who understand these concepts underlying their patient care guideline will make better clinical decisions and better provide quality of care than students who follow the guideline exclusively. We aim this as a practical demonstration of the value of detailed understanding of human bioscience in allied health education. As health care providers transition from “technician” to “practitioner,” the key distinguishing feature of the role is the ability to practice independently, using “best judgment” rather than clinical guidelines (alone). Evidence suggests that complex case management requires detailed bioscience understanding.

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Early warning scores: unravelling detection and escalation

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-07-2015-0086 ◽

2015 ◽

Vol 28 (8) ◽

pp. 872-875 ◽

Cited By ~ 12

Author(s):

Gary B Smith ◽

David R Prytherch ◽

Paul Meredith ◽

Paul E Schmidt

Keyword(s):

Early Warning ◽

Personal Experience ◽

Design Methodology ◽

Nurse Educators ◽

Clinical Care ◽

Early Warning Score ◽

Content Type ◽

Patient Deterioration ◽

The Difference ◽

Practical Implications

Purpose – The purpose of this paper is to increase understanding of how patient deterioration is detected and how clinical care escalates when early warning score (EWS) systems are used. Design/methodology/approach – The authors critically review a recent National Early Warning Score paper published in IJHCQA using personal experience and EWS-related publications, and debate the difference between detection and escalation. Findings – Incorrect EWS choice or poorly understood EWS escalation may result in unnecessary workloads forward and responding staff. Practical implications – EWS system implementers may need to revisit their guidance materials; medical and nurse educators may need to expand the curriculum to improve EWS system understanding and use. Originality/value – The paper raises the EWS debate and alerts EWS users that scrutiny is required.

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Effectiveness prediction of Evogliptin treatment in type 2 diabetes mellitus in russian-korean population

Diabetes Mellitus ◽

10.14341/dm9547 ◽

2018 ◽

Vol 21 (5) ◽

pp. 333-343

Author(s):

Anna A. Mosikian ◽

Alina Y. Babenko ◽

Yulia A. Sevastyanova ◽

Roman V. Drai ◽

Evgenij V. Shlyakhto

Keyword(s):

Hba1c Level ◽

Statistical Power ◽

Clinical Care ◽

Statin Treatment ◽

Linear Regression Models ◽

South Korean ◽

Effectiveness Prediction ◽

The Difference ◽

Phosphorous Concentration

Background: Individualized treatment has already become a part of a routine clinical care. Many data on the effectiveness prediction of commercially available DPP-4 inhibitors had been published, but not on the effectiveness prediction of evogliptin. Aim: To reveal the clinical characteristics and metabolic predictors of better hypoglycemic response to evogliptin. Matherials and methods: We have conducted a retrospective study, based on the data of a randomized clinical trial comparing effectiveness and safety of evogliptin and sitagliptin in Russian and Korean subpopulations. We provide univariate linear regression models for separate subpopulations and a multivariate stepwise regression model for the combined subpopulation. HbA1c change after 24 weeks of evogliptin treatment was a primary endpoint and a dependent variable in the analysis. Results: The decrease of HbA1c after 24 weeks of treatment with evogliptin in Russian subpopulation negatively correlates with triglycerides/HDL level (p = 0,046). In South Korean subpopulation it correlates positively with HbA1c level at baseline (p 0,0001). In order to increase the statistical power of the analysis the data of both populations were combined. According to the combined data, the decrease of HbA1c after 24 weeks of treatment with evogliptin positively correlates with HbA1c level at baseline (p0.0001) and log(HOMA-B) (p=0.0042), and it negatively correlates with log(triglycerides/HDL) (p=0.0057), blood phosphorous concentration (p=0.014) and statin treatment (p=0.044). No correlation of HbA1c change at week 24 was observed with body mass index, diabetes duration and blood C-peptide concentration. Patients able to achieve HbA1c7,0 % had higher HOMA-B (53.22 36.95 и 39.67 24.74, respectively, р=0.033) and were tend to have higher HDL concentration (1.36 0.28 и 1.26 0.26 mmol/l, respectively, р=0.076) and lower triglycerides to HDL ratio (0.87 0.70 и 1.48 0.95, respectively, р=0.079). Conclusion: A patient, who benefits more when treated with evogliptin, has higher HOMA-B, lower triglycerides to HDL ratio and phosphorous concentration in the 1-2 quartiles of the normal range. Triglycerides to HDL ratio is, probably, a specific effectiveness predictor for Russian, but not for Korean subpopulation. These data prove the difference in effectiveness prediction for different drugs of DPP-4 inhibitors group and reveal the need of further investigation.

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Accuracy of Acoustic Measures of Voice via Telepractice Videoconferencing Platforms

Journal of Speech Language and Hearing Research ◽

10.1044/2021_jslhr-20-00625 ◽

2021 ◽

pp. 1-14

Author(s):

Hasini R. Weerathunge ◽

Roxanne K. Segina ◽

Lauren Tracy ◽

Cara E. Stepp

Keyword(s):

Repeated Measures ◽

Ambient Noise ◽

Clinical Care ◽

Linear Regression Analysis ◽

Transmission Condition ◽

Valuable Insight ◽

Acoustic Measures ◽

The Difference ◽

Acoustic Measure ◽

Insight Into

Purpose Telepractice improves patient access to clinical care for voice disorders. Acoustic assessment has the potential to provide critical, objective information during telepractice, yet its validity via telepractice is currently unknown. The current study investigated the accuracy of acoustic measures of voice in a variety of telepractice platforms. Method Twenty-nine voice samples from individuals with dysphonia were transmitted over six video conferencing platforms (Zoom with and without enhancements, Cisco WebEx, Microsoft Teams, Doxy.me, and VSee Messenger). Standard time-, spectral-, and cepstral-based acoustic measures were calculated. The effect of transmission condition on each acoustic measure was assessed using repeated-measures analyses of variance. For those acoustic measures for which transmission condition was a significant factor, linear regression analysis was performed on the difference between the original recording and each telepractice platform, with the overall severity of dysphonia, Internet speed, and ambient noise from the transmitter as predictors. Results Transmission condition was a statistically significant factor for all acoustic measures except for mean fundamental frequency ( f o ). Ambient noise from the transmitter was a significant predictor of differences between platforms and the original recordings for all acoustic measures except f o measures. All telepractice platforms affected acoustic measures in a statistically significantly manner, although the effects of platforms varied by measure. Conclusions Overall, measures of f o were the least impacted by telepractice transmission. Microsoft Teams had the least and Zoom (with enhancements) had the most pronounced effects on acoustic measures. These results provide valuable insight into the relative validity of acoustic measures of voice when collected via telepractice. Supplemental Material https://doi.org/10.23641/asha.14794812

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Microsampling for monitoring gentamicin in neonates.

10.1101/2021.03.27.21254449 ◽

2021 ◽

Author(s):

Suzanne L Parker ◽

Adam D Irwin ◽

Francine Hosking ◽

Deanne August ◽

Brittany Schoenmaker ◽

...

Keyword(s):

Clinical Care ◽

Plasma Concentrations ◽

Therapeutic Drug ◽

Proof Of Concept ◽

First Line ◽

Timely Manner ◽

Local Hospital ◽

Pathology Laboratory ◽

Gentamicin Concentration ◽

The Difference

Gentamicin is recommended as first-line treatment of neonatal sepsis. The use of gentamicin is associated with toxicity which complicates neonatal dosing and necessitates therapeutic drug monitoring (TDM). In a proof-of-concept investigation, we sought to compare (1) gentamicin concentrations obtained using volumetric absorptive microsampling (VAMS) to standard TDM plasma samples, and (2) the time taken to report results obtained using VAMS compared to standard TDM by the local hospital chemical pathology service. The difference between gentamicin concentrations obtained from plasma collected for routine clinical care and calculated plasma concentrations, based on samples collected in whole blood using VAMS, was -18.0% and -0.4% for two patients. The research laboratory reported results within the time taken for the routine chemical pathology laboratory to report results. This proof-of-concept study demonstrates that the use of microsampling for TDM by pathology services can fulfil the requirements of providing an accurate gentamicin concentration in a timely manner.

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Variations in Pediatric Rheumatology Workforce and Care Processes Across Canada

The Journal of Rheumatology ◽

10.3899/jrheum.201611 ◽

2021 ◽

pp. jrheum.201611

Author(s):

Jennifer J.Y. Lee ◽

Ronald M. Laxer ◽

Brian M. Feldman ◽

Claire E.H. Barber ◽

Michelle Batthish ◽

...

Keyword(s):

Pediatric Rheumatology ◽

Census Data ◽

Clinical Care ◽

Median Number ◽

Multidisciplinary Teams ◽

Full Time ◽

Allied Health Professionals ◽

Care Processes ◽

Outcome Monitoring ◽

The Difference

Objective To examine Canadian pediatric rheumatology workforce and care processes. Methods Pediatric rheumatologists and allied health professionals (AHPs) participated. A designee from each academic centre provided workforce information including number of providers, total and breakdown of full-time equivalents (FTE), and triage processes. We calculated the clinical care FTE (cFTE) available per 75,000 (recommended benchmark) and 300,000 (adjusted) children using 2019 census data. The national workforce deficit was calculated as the difference between current and expected cFTEs. Remaining respondents were asked about ambulatory practices. Results The response rate of survey A (workforce information) and survey B (ambulatory practice information) was 100% and 54%, respectively. The majority of rheumatologists (91%) practiced in academic centres. The median number of rheumatologists per centre was 3 (IQR:3) and median cFTE was 1.8 (IQR:1.5). The median cFTE per 75,000 was 0.2 (IQR:0.3) with a national deficit of 80 cFTEs. With the adjusted benchmark, there was no national deficit but a regional maldistribution of rheumatologists. All centres engaged in multidisciplinary practices with a median of 4 different AHPs, although the median FTE for AHPs was ≤1. Most centres (87%) utilized a centralized triage process. Of 9 (60%) centres that used an electronic triage process, 6 were able to calculate wait times. Most clinicians integrated quality improvement practices, such as pre-visit planning (68%), post-visit planning (68%), and periodic health outcome monitoring (36-59%). Conclusion This study confirms a national deficit at the current recommended benchmark. Most rheumatologists work in multidisciplinary teams, but AHP support may be inadequate.

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