scholarly journals Communicating Guideline Recommendations Using Graphic Narrative Versus Text-Based Broadcast Screensavers: Design and Implementation Study (Preprint)

2021 ◽  
Author(s):  
Lauren Sinnenberg ◽  
Craig A Umscheid ◽  
Frances S Shofer ◽  
Damien Leri ◽  
Zachary F Meisel
Keyword(s):  
Clinical Practice ◽  
High Volume ◽  
Suppressive Therapy ◽  
Guideline Recommendation ◽  
Graphic Narrative ◽  
Design And Implementation ◽  
Resident Physicians ◽  
Graphic Narratives ◽  
The One ◽  
The Impact

BACKGROUND The use of graphic narratives, defined as stories that use images for narration, is growing in health communication. OBJECTIVE The aim of this study was to describe the design and implementation of a graphic narrative screensaver (GNS) to communicate a guideline recommendation (ie, avoiding low-value acid suppressive therapy [AST] use in hospital inpatients) and examine the comparative effectiveness of the GNS versus a text-based screensaver (TBS) on clinical practice (ie, low-value AST prescriptions) and clinician recall. METHODS During a 2-year period, the GNS and the TBS were displayed on inpatient clinical workstations. The numbers of new AST prescriptions were examined in the four quarters before, the three quarters during, and the one quarter after screensavers were implemented. Additionally, an electronic survey was sent to resident physicians 1 year after the intervention to assess screensaver recall. RESULTS Designing an aesthetically engaging graphic that could be rapidly understood was critical in the development of the GNS. The odds of receiving an AST prescription on medicine and medicine subspecialty services after the screensavers were implemented were lower for all four quarters (ie, GNS and TBS broadcast together, only TBS broadcast, only GNS broadcast, and no AST screensavers broadcast) compared to the quarter prior to implementation (odds ratio [OR] 0.85, 95% CI 0.78-0.92; OR 0.89, 95% CI 0.82-0.97; OR 0.87, 95% CI 0.80-0.95; and OR 0.81, 95% CI 0.75-0.89, respectively; <i>P</i>&lt;.001 for all comparisons). There were no statistically significant decreases for other high-volume services, such as the surgical services. These declines appear to have begun prior to screensaver implementation. When surveyed about the screensaver content 1 year later, resident physicians recalled both the GNS and TBS (43/70, 61%, vs 54/70, 77%; <i>P</i>=.07) and those who recalled the screensaver were more likely to recall the main message of the GNS compared to the TBS (30/43, 70%, vs 1/54, 2%; <i>P</i>&lt;.001). CONCLUSIONS It is feasible to use a graphic narrative embedded in a broadcast screensaver to communicate a guideline recommendation, but further study is needed to determine the impact of graphic narratives on clinical practice.

Optimizing Anticancer Therapy in Metastatic Non-Castrate Prostate Cancer: American Society of Clinical Oncology Clinical Practice Guideline

2018 ◽  
Vol 36 (15) ◽  
pp. 1521-1539 ◽  
Author(s):  
Michael J. Morris ◽  
R. Bryan Rumble ◽  
Ethan Basch ◽  
Sebastien J. Hotte ◽  
Andrew Loblaw ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Metastatic Prostate Cancer ◽  
De Novo ◽  
High Volume ◽  
Abiraterone Acetate ◽  
Newly Diagnosed ◽  
The Impact

Purpose This clinical practice guideline addresses abiraterone or docetaxel with androgen-deprivation therapy (ADT) for metastatic prostate cancer that has not been treated (or has been minimally treated) with testosterone-lowering agents. Methods Standard therapy for newly diagnosed metastatic prostate cancer has been ADT alone. Three studies have compared ADT alone with ADT and docetaxel, and two studies have compared ADT alone with ADT and abiraterone. Results Three prospective randomized studies (GETUG-AFU 15, STAMPEDE, and CHAARTED) examined overall survival (OS) with adding docetaxel to ADT. STAMPEDE and CHAARTED favored docetaxel (hazard ratio [HR], 0.78; 95% CI, 0.66 to 0.93; n = 2,962 and HR, 0.73; 95% CI, 0.59 to 0.89; n = 790, respectively). GETUG-AFU 15 was negative. LATITUDE and STAMPEDE examined the impact on OS of adding abiraterone (with prednisone or prednisolone) to ADT. LATITUDE and STAMPEDE favored abiraterone (HR, 0.62; 95% CI, 0.51 to 0.76; n = 1,199 and HR, 0.63; 95% CI, 0.52 to 0.76; n = 1,917, respectively). Recommendations ADT plus docetaxel or abiraterone in newly diagnosed metastatic non-castrate prostate cancer offers a survival benefit as compared with ADT alone. The strongest evidence of benefit with docetaxel is in men with de novo high-volume (CHAARTED criteria) metastatic disease. Similar survival benefits are seen using abiraterone acetate in high-risk patients (LATITUDE criteria) and in the metastatic population in STAMPEDE. ADT plus abiraterone and ADT plus docetaxel have not been compared, and it is not known if some men benefit more from one regimen as opposed to the other. Fitness for chemotherapy, patient comorbidities, toxicity profiles, quality of life, drug availability, and cost should be considered in this decision. Additional information is available at www.asco.org/genitourinary-cancer-guidelines .

On Psychic Determinism

2017 ◽  
Vol 65 (3) ◽  
pp. 423-446 ◽  
Author(s):  
Robin Gordon Brown
Keyword(s):  
Clinical Practice ◽  
The Other ◽  
Clinical Theory ◽  
Psychoanalytic Literature ◽  
The One ◽  
The Impact ◽  
Philosophical Doctrine

A confusion persists in the psychoanalytic literature regarding the concept of psychic determinism. Two authors are cited in whose works the concept is identified as foundational to psychoanalysis, in the one case as a “fundamental hypothesis” (Charles Brenner) and in the other as an “underlying presupposition” or assumption (Linda A.W. Brakel). Both claims are based on a conflation of the concept Freud had in mind with a philosophical doctrine going by the same name but meaning something quite different. The philosophical doctrine has no place in psychoanalysis at all, and Freud’s concept does not play a foundational role there. In a second section a restricted concept of psychic determinism is critically examined. A third section deals with the impact of that restricted concept on clinical theory and contemporary controversies about clinical practice. Finally, some possible reasons for this confusion are suggested.

Translating Principles of Speech Science to Clinical Practice: Current and Future Trends in Craniofacial Disorders

2008 ◽  
Vol 18 (1) ◽  
pp. 31-40 ◽  
Author(s):  
David J. Zajac
Keyword(s):  
Clinical Practice ◽  
Speech Intelligibility ◽  
Current Practice ◽  
Computer Assisted ◽  
Behavioral Management ◽  
Single Word ◽  
Future Directions ◽  
Speech Science ◽  
The Impact ◽  
Opinion Article

Abstract The purpose of this opinion article is to review the impact of the principles and technology of speech science on clinical practice in the area of craniofacial disorders. Current practice relative to (a) speech aerodynamic assessment, (b) computer-assisted single-word speech intelligibility testing, and (c) behavioral management of hypernasal resonance are reviewed. Future directions and/or refinement of each area are also identified. It is suggested that both challenging and rewarding times are in store for clinical researchers in craniofacial disorders.

Static and Dynamic Studies of Gasoline in View of its Octane Number and its Toxic Effect

2013 ◽  
Vol 12 (7) ◽  
pp. 451-459
Author(s):  
Ashraf Yehia El-Naggar ◽  
Mohamed A. Ebiad
Keyword(s):  
Toxic Effect ◽  
Aromatic Hydrocarbons ◽  
Octane Number ◽  
Liquid Fuel ◽  
Positive Impact ◽  
Hydrocarbon Composition ◽  
Different Temperatures ◽  
Different Seasons ◽  
The One ◽  
The Impact

Gasoline come primarily from petroleum cuts, it is the preferred liquid fuel in our lives. Two gasoline samples of octane numbers 91 and 95 from Saudi Arabia petrol stations were studied. This study was achieved at three different temperatures 20oC, 30oC and 50oC representing the change in temperatures of the different seasons of the year. Both the evaporated gases of light aromatic hydrocarbons (BTEX) of gasoline samples inside the tank were subjected to analyze qualitatively and quantitatively via capillary gas chromatography. The detailed hydrocarbon composition and the octane number of the studied gasoline samples were determined using detailed hydrocarbon analyzer. The idea of research is indicating the impact of light aromatic compounds in gasoline on the toxic effect of human and environment on the one hand, and on octane number of gasoline on the other hand. Although the value of octane number will be reduced but this will have a positive impact on the environment as a way to produce clean fuel.

The Development of Agritourism in the Podkarpackie Voivodeship in the Light of International and National Conditions

2017 ◽  
Vol 13 ◽  
pp. 244-261
Author(s):  
Mariola Tracz ◽  
Małgorzata Bajgier-Kowalska ◽  
Radosław Uliszak
Keyword(s):  
Development Strategy ◽  
Current State ◽  
Central Statistical ◽  
Central Statistical Office ◽  
Tourism Resources ◽  
The One ◽  
The Impact ◽  
District Offices ◽  
Socio Economic Factors

Podkarpackie Voivodeship is one of the regions of Poland in which the number of agritourism entities is very high. Therefore tourism plays a significant role in its development strategy. The aim of the paper is to identify the current state of agritourism and the changes that have occurred in the region in the years 2000–2016. Specific objectives are to determine the distribution of agritourism farms and their offer, together with a comprehensive analysis of the environmental and socio-economic factors, as well as the impact of the Slovak-Ukrainian border. The report was developed on the statistical materials from the Polish Central Statistical Office, Podkarpackie Agricultural Advisory Centre in Boguchwała and data collected from municipalities and district offices that is published on their websites, as well as through interviews with 100 owners of agritourism farms in the Podkarpackie Voivodeship. The research has shown, on the one hand, the decline in the number of farms in the region and, on the other hand, the increase in the diversity of the tourist offer of these entities. Distribution of agritourism farms is closely linked to the attractiveness of natural environment and quality of secondary tourism resources. Traditional agritourism has not yet fully used its countryside, as well as cross-border advantages of its location.

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