scholarly journals Observed Interprofessional Collaboration (OIPC) During Interdisciplinary Team Meetings: Development and Validation of a Tool in a Rehabilitation Setting

2014 ◽  
Vol 4 (1) ◽  
Author(s):  
Emmanuelle Careau ◽  
Claude Vincent ◽  
Bonnie R. Swaine
Keyword(s):  
Interrater Reliability ◽  
Interprofessional Collaboration ◽  
Interdisciplinary Team ◽  
Clinical Settings ◽  
Team Meetings ◽  
The Past ◽  
Video Recordings ◽  
Development And Validation ◽  
Made In

Background: Despite all the efforts made in the past few years, interprofessional collaboration (IPC) in clinical settings is not always optimal. In addition, there are only a few instruments that healthcare managers and practitioners can use to evaluate the quality of IPC practice. Therefore, we developed an observationbased tool to evaluate IPC interactional factors occurring during interdisciplinary team meetings, and we examined the initial validation of the tool in a rehabilitation setting.Methods and Findings: The items were developed and pre-tested iteratively by construct experts (N = 7) and non-experts (N = 4). Interrater reliability was determined between two observers, following the analysis of 30 video recordings of meetings in two rehabilitation centres involving a total of 152 participants. An observation grid (OIPC) consisting of 20 items that can be answered on a threepoint scale and demonstrating acceptable interrater reliability was developed.Conclusions: The OIPC is a tool aimed at evaluating IPC interactional factors during interdisciplinary meetings based on team performance rather than individual behaviours. It can be useful for healthcare managers and practitioners who want to evaluate the quality of IPC practices.

The Role of Histones and Heparin in Sepsis: A Review

2021 ◽  
pp. 088506662199232
Author(s):  
Xiaojuan Zhang ◽  
Xin Li
Keyword(s):  
Septic Shock ◽  
Multiple Organ ◽  
Clinical Settings ◽  
The Past ◽  
Life Saving ◽  
Extracellular Histones ◽  
Sepsis And Septic Shock ◽  
Development And Management ◽  
Made In

Septic shock with multiple organ failure is a devastating situation in clinical settings. Through the past decades, much progress has been made in the management of sepsis and its underlying pathogenesis, but a highly effective therapeutic has not been developed. Recently, macromolecules such as histones have been targeted in the treatment of sepsis. Histones primarily function as chromosomal organizers to pack DNA and regulate its transcription through epigenetic mechanisms. However, a growing body of research has shown that histone family members can also exert cellular toxicity once they relocate from the nucleus into the extracellular space. Heparin, a commonly used anti-coagulant, has been shown to possess life-saving capabilities for septic patients, but the potential interplay between heparin and extracellular histones has not been investigated. In this review, we summarize the pathogenic roles of extracellular histones and the therapeutic roles of heparin in the development and management of sepsis and septic shock.

scholarly journals Late Effects and Survivorship Issues in Patients with Neuroblastoma

Children ◽  
2018 ◽  
Vol 5 (8) ◽  
pp. 107 ◽  
Author(s):  
Danielle Friedman ◽  
Tara Henderson
Keyword(s):  
Late Effects ◽  
Survival Rates ◽  
Premature Mortality ◽  
The Past ◽  
Excess Morbidity ◽  
Related Risk ◽  
Impaired Quality ◽  
Made In

Over the past two decades, marked progress has been made in understanding the biology of neuroblastoma; this has led to refined risk stratification and treatment modifications with resultant increasing 5-year survival rates for children with neuroblastoma. Survivors, however, remain at risk for a wide variety of potential treatment-related complications, or “late effects”, which may lead to excess morbidity and premature mortality in this cohort. This review summarizes the existing survivorship literature on long-term health outcomes for survivors of neuroblastoma, focusing specifically on potential injury to the endocrine, sensory, cardiovascular, pulmonary, and renal systems, as well as survivors’ treatment-related risk for subsequent neoplasms and impaired quality of life. Additional work is needed to assess the potential late effects of newer multimodality therapies with the aim of optimizing long-term medical and psychosocial outcomes for all survivors of neuroblastoma.

An Integrative Approach to the Assessment and Treatment of Inflammatory Conditions

2017 ◽  
Author(s):  
Mark Liponis ◽  
Bettina Martin
Keyword(s):  
Integrative Approach ◽  
The Past ◽  
Inflammatory Conditions ◽  
Improved Outcomes ◽  
Targeted Treatments ◽  
Great Progress ◽  
Assessment And Treatment ◽  
The Many ◽  
Made In

The past two decades have seen great progress in recognizing the importance of inflammation in medicine. Increased focus on inflammation in both prevention and treatment has improved outcomes and quality of life in chronic diseases. Science has improved our understanding of inflammation’s many causes and effects on health, and many advances have been made in the availability of targeted therapeutic options for treating inflammation. This chapter gives an overview of recognizing the many causes of inflammation, its many targeted treatments strategies, and the questions that still surround it. It discusses several integrative approaches to reducing inflammation, including exercise, diet, and different strategies for managing sleep, mood, and stress, such as meditation and massage.

Design of clinical trials in rheumatology

2016 ◽  
Author(s):  
Vibeke Strand ◽  
Jeremy Sokolove ◽  
Alvina D. Chu
Keyword(s):  
Lupus Erythematosus ◽  
Trial Design ◽  
Phase 1 ◽  
Proof Of Concept ◽  
Phase 3 ◽  
Treatment Allocation ◽  
Randomized Controlled ◽  
The Past ◽  
Development And Validation ◽  
Made In

Development of new therapies for rheumatic diseases requires a series of randomized controlled trials (RCTs) progressing from phase 1, ’first-in-human’ to generate initial safety, pharmacokinetic (PK) and pharmacodynamic (PD) data; to phase 2, proof of concept for efficacy with safety and PK/PD data; and phase 3, designed to demonstrate definitive efficacy and safety to support regulatory approval. Important aspects of RCT designs include sample size estimations, treatment allocation, rescue, blinding, and statistical analyses of prespecified endpoints to preserve trial integrity. Over the past 15 years, significant progress has been made in the design of RCTs in rheumatoid arthritis (RA). Similarly, development and validation of composite outcome measures in psoriatic arthritis, ankylosing spondylitis, gout, and osteoarthritis have furthered trial design and treatment approvals. RCTs in systemic lupus erythematosus and other multisystem, heterogeneous diseases pose more challenges. Trial design will continue to evolve as promising therapies are introduced into the clinic.

Design of clinical trials in rheumatology

2013 ◽  
Author(s):  
Vibeke Strand ◽  
Jeremy Sokolove ◽  
Alvina D. Chu
Keyword(s):  
Lupus Erythematosus ◽  
Trial Design ◽  
Phase 1 ◽  
Proof Of Concept ◽  
Phase 3 ◽  
Treatment Allocation ◽  
Randomized Controlled ◽  
The Past ◽  
Development And Validation ◽  
Made In

Development of new therapies for rheumatic diseases requires a series of randomized controlled trials (RCTs) progressing from phase 1, 'first-in-human' to generate initial safety, pharmacokinetic (PK) and pharmacodynamic (PD) data; to phase 2, proof of concept for efficacy with safety and PK/PD data; and phase 3, designed to demonstrate definitive efficacy and safety to support regulatory approval. Important aspects of RCT designs include sample size estimations, treatment allocation, rescue, blinding, and statistical analyses of prespecified endpoints to preserve trial integrity. Over the past 15 years, significant progress has been made in the design of RCTs in rheumatoid arthritis (RA). Similarly, development and validation of composite outcome measures in psoriatic arthritis, ankylosing spondylitis, gout, and osteoarthritis have furthered trial design and treatment approvals. RCTs in systemic lupus erythematosus and other multisystem, heterogeneous diseases pose more challenges. Trial design will continue to evolve as promising therapies are introduced into the clinic.

scholarly journals Exploring the Competencies of Japanese Expert Nurse Practitioners: A Thematic Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1674
Author(s):  
Mari Igarashi ◽  
Ryuichi Ohta ◽  
Yasuo Kurita ◽  
Akinori Nakata ◽  
Tsutomu Yamazaki ◽  
...  
Keyword(s):  
Medical Care ◽  
Nurse Practitioners ◽  
Thematic Analysis ◽  
Interprofessional Collaboration ◽  
Quality Of Healthcare ◽  
Medical Professionals ◽  
Clinical Settings ◽  
Structured Interviews ◽  
Personal Qualities

Nurse practitioners (NPs) provide medical care equivalent to that of physicians and facilitate access to healthcare. Although Japan’s first NP graduated in 2010, how Japanese expert NPs work effectively in clinical contexts is yet to be investigated. We aimed to identify the competencies that make expert NPs in Japan effective. Twelve Japanese expert NPs were purposely selected. The average age of the participants was 44.8 years, average NP experience was 7.5 years, and eight participants were women. Semi-structured interviews were conducted online from March to May 2021. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Thematic analysis revealed five themes: working in physicians’ contexts, interprofessional collaboration, involvement in nurses’ work, contribution to healthcare, and personal qualities for effective working. Japanese expert NPs can function effectively in clinical settings by flexibly and humbly collaborating with other medical professionals who have autonomous positions. They can improve the quality of healthcare by proposing practical solutions to problems faced by patients and medical organizations. These explored competencies can be applied to other aging and more complex societal contexts, and in updating the required competencies of Japanese NPs.

Review of the Electrolarynx: The Past and Present

2019 ◽  
Vol 4 (1) ◽  
pp. 118-129 ◽  
Author(s):  
Steven R. Cox
Keyword(s):  
Quality Of Life ◽  
The Past ◽  
Speech Rehabilitation ◽  
Related Quality ◽  
Potential Impact ◽  
Perceptual Characteristics ◽  
Made In ◽  
Voice And Speech

Purpose The purpose of this article is to provide a review of the neck-type electrolarynx, describe acoustic and perceptual characteristics of electrolaryngeal speech, and highlight the potential impact of electrolaryngeal speech on voice-related quality of life postlaryngectomy, concluding by describing efforts to improve electrolaryngeal speech rehabilitation. Although several alaryngeal communication options exist, the electrolarynx is the most readily available means of producing voice and speech postlaryngectomy. This is due to the small and handheld nature of an electrolaryngeal device, which is commonly placed against the neck during use. Research suggests that approximately half of laryngectomees use an electrolarynx up to 2 years postlaryngectomy. Conclusion Given the importance of the electrolarynx postlaryngectomy, decisions should be made in conjunction with the laryngectomee. It is important to ask: Why not an electrolarynx?

Measuring the Quality of Union Budgets: Need to Go beyond the Deficit Measures

2017 ◽  
Vol 63 (2) ◽  
pp. 187-195
Author(s):  
Karamjeet Kaur
Keyword(s):  
Composite Index ◽  
Infrastructure Development ◽  
Fiscal Consolidation ◽  
The Past ◽  
Essential Services ◽  
Difference Of Opinion ◽  
The Government ◽  
Run Up ◽  
Made In

In the run-up to Union Budget 2016–2017, a major difference of opinion emerged within the Union Government over adherence to fiscal consolidation vis-à-vis maintaining adequate expenditure allocation for essential services, such as health, education and infrastructure development ( Business Standard, 2016). As the budget document was unveiled, it was clear from the deficit targets met (and sought to be met in the future) that the government did not deviate from its commitments towards fiscal consolidation. These deficit targets, however, provide limited understanding of the overall ‘quality’ of expenditure and receipts of the government. In order to comprehend the overall picture and quantify this qualitative aspect, there is a need to go beyond the conventional measures of deficit. This article discusses the concept, meaning and usage of the various measures of deficits in order to, first, highlight their limitations in understanding the overall quality of budgets and, second, make a case for creation of a ‘composite index’ to reflect the broad quality and composition of budgets. A modest attempt has also been made in this article to evaluate the Union Budgets of the recent years on the basis of one such index developed by Bhide and Panda (2002). Results provide concrete evidence of a discernible improvement in the quality of budgets in the past few years.

scholarly journals Conditional Reasoning: A Review and Suggestions for Future Test Development and Validation

2019 ◽  
Vol 23 (1) ◽  
pp. 65-95 ◽  
Author(s):  
James M. LeBreton ◽  
Elizabeth M. Grimaldi ◽  
Jeremy L. Schoen
Keyword(s):  
Final Section ◽  
Test Development ◽  
Conditional Reasoning ◽  
The Past ◽  
Conference Presentations ◽  
Development And Validation ◽  
Future Test ◽  
Made In

Lawrence R. James spent the last 20 years of his 35-year career developing and validating a new theory of personality that he called conditional reasoning. This theory was focused on mapping and measuring core aspects of the implicit (i.e., unconscious) personality. In this article, we (a) review James’s seminal contributions to the theory and measurement of conditional reasoning, (b) discuss subsequent contributions made in the area of conditional reasoning, and (c) provide a brief “look under the hood” at James’s approach to test development and validation. This final section of our paper is designed to familiarize other researchers with the protocols that James and his colleagues have used over the past 20 years. Many of these protocols have gone unmentioned or only briefly acknowledged (e.g., in conference presentations or informal meetings); indeed, many of these validation protocols were “implicit” in the thinking of James and his approach to the study of personality. Having benefited from working closely with James, we were privy to many of these implicit assumptions and protocols that privately guided James’s early work on conditional reasoning.

scholarly journals Allergic and Mixed Rhinitis: Diagnosis and Natural Evolution

2019 ◽  
Vol 8 (11) ◽  
pp. 2019 ◽  
Author(s):  
Justin C. Greiwe ◽  
Jonathan A. Bernstein
Keyword(s):  
Clinical History ◽  
Natural Evolution ◽  
Nonallergic Rhinitis ◽  
Validated Questionnaires ◽  
The Past ◽  
Nasal Provocation ◽  
Mixed Rhinitis ◽  
Made In ◽  
Pathophysiologic Mechanisms

Chronic rhinitis (CR) is divided into two main categories: allergic rhinitis (AR) and nonallergic rhinitis (NAR). These conditions are more recognizable to an experienced clinician, as they can be more clearly demarcated diagnostically. However, an additional 30% to 50% of patients with CR might have an overlap of NAR and AR, referred to as mixed rhinitis (MR). Progress in elucidating the pathophysiologic mechanisms behind MR and NAR has been made in the past several years, and there are now several guidelines published to assist the clinician in accurately diagnosing AR, NAR, and MR. Clinical history and subjective symptoms can provide clues for differentiating AR from MR and NAR, but allergy testing is recommended to confirm these conditions. Progress in accurately diagnosing patients with CR will be made as studies incorporate subjective (i.e., validated questionnaires such as the irritant index questionnaire (IIQ), medication responsiveness, and quality-of-life tools) and objective (i.e., nasal cytologic testing, nasal provocation, and biomarkers) methods characterizing rhinitis subtypes.

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