scholarly journals Impact of the Telephone Assistive Device (TAD) on stuttering severity while speaking on the telephone

2009 ◽  
Vol 56 (1) ◽  
Author(s):  
Nola Chambers
Keyword(s):  
Auditory Feedback ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Individual Variability ◽  
Assistive Device ◽  
Related Factors ◽  
Quasi Experimental ◽  
Repeated Use ◽  
Telephone Calls ◽  
Clinically Significant

There is extensive experimental evidence that altered auditory feedback (AAF) can have a clinically significant effect on the severity of speech symptoms in people who stutter. However, there is less evidence regarding whether these experimental effects can be observed in naturalistic everyday settings particularly when using the telephone. This study aimed to investigate the effectiveness of the Telephone Assistive Device® (TAD), which is designed to provide AAF on the telephone to people who stutter, on reducing stuttering severity. Nine adults participated in a quasi-experimental study. Stuttering severity was measured first without and then with the device in participants’ naturalistic settings while making and receiving telephone calls (immediate benefit). Participants were then allowed a week of repeated use of the device following which all measurements were repeated (delayed benefit). Overall, results revealed significant immediate benefits from the TAD in all call conditions. Delayed benefits in received and total calls were also significant. There was sub­stantial individual variability in response to the TAD but none of the demographic or speech-related factors measured in the study were found to significantly impact the benefit (immediate or delayed) derived from the TAD. Results have implications for clinical decision making for adults who stutter.

4971Blood viscosity and its relevance to the diagnosis and management of pulmonary hypertension: a new elephant in the cathlab

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kempny ◽  
K Dimopoulos ◽  
A E Fraisse ◽  
G P Diller ◽  
L C Price ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Catheterization ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Pulmonary Vasculature ◽  
Pulmonary Vascular Disease ◽  
Significant Difference ◽  
The Difference ◽  
Clinically Significant ◽  
The Relationship

Abstract Background Pulmonary vascular resistance (PVR) is an essential parameter assessed during cardiac catheterization. It is used to confirm pulmonary vascular disease, to assess response to targeted pulmonary hypertension (PH) therapy and to determine the possibility of surgery, such as closure of intra-cardiac shunt or transplantation. While PVR is believed to mainly reflect the properties of the pulmonary vasculature, it is also related to blood viscosity (BV). Objectives We aimed to assess the relationship between measured (mPVR) and viscosity-corrected PVR (cPVR) and its impact on clinical decision-making. Methods We assessed consecutive PH patients undergoing cardiac catheterization. BV was assessed using the Hutton method. Results We included 465 patients (56.6% female, median age 63y). The difference between mPVR and cPVR was highest in patients with abnormal Hb levels (anemic patients: 5.6 [3.4–8.0] vs 7.8Wood Units (WU) [5.1–11.9], P<0.001; patients with raised Hb: 10.8 [6.9–15.4] vs. 7.6WU [4.6–10.8], P<0.001, respectively). Overall, 33.3% patients had a clinically significant (>2.0WU) difference between mPVR and cPVR, and this was more pronounced in those with anemia (52.9%) or raised Hb (77.6%). In patients in the upper quartile for this difference, mPVR and cPVR differed by 4.0WU [3.4–5.2]. Adjustment of PVR required Conclusions We report, herewith, a clinically significant difference between mPVR and cPVR in a third of contemporary patients assessed for PH. This difference is most pronounced in patients with anemia, in whom mPVR significantly underestimates PVR, whereas in most patients with raised Hb, mPVR overestimates it. Our data suggest that routine adjustment for BV is necessary.

Abstract 16873: Association of Preoperative Cell-Free DNA Levels and Outcome Following Pediatric Cardiopulmonary Bypass

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Justinn Tanem ◽  
John Scott ◽  
George M Hoffman ◽  
Robert A Niebler ◽  
Aoy TOMITA-MITCHELL ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Primary Outcome ◽  
Clinical Decision Making ◽  
Treatment Strategies ◽  
Clinical Decision ◽  
Related Factors ◽  
Cell Free Dna ◽  
Free Dna

Introduction: Preoperative risk stratification in congenital cardiac surgery includes patient and procedure related factors, which may be used in clinical decision making as well program performance evaluation. Despite these tools, unidentified factors contribute to wide variation in outcomes both within and between centers. Identification of latent physiologic risk factors may strengthen predictive models. Hypothesis: Total cell-free DNA (TCF) functions as a biomarker for cellular injury as well as a pro-inflammatory cytokine. We hypothesized that elevated preoperative TCF would be associated with poor outcome following pediatric cardiac surgery requiring cardiopulmonary bypass (CPB). Methods: Prospective observational study of children age < 18 yr and wt > 3 kg undergoing planned CPB surgery. The Children’s Wisconsin Institutional Review Board approved the protocol . A serum TCF sample was obtained after induction of anesthesia prior to surgical incision. The primary outcome measure was a composite of postoperative cardiac arrest, ECMO, or death (CAED). Association of outcome to TCF was assessed by logistic regression with a cutpoint chosen by ROC curve exploration. Odds ratios with 95% CI were calculated. Results: Data were available in 117 patients, median age 0.9 years (range 0-17.4), median weight 7.8kg (range 3.2-98). The primary outcome (CAED) was met in 6/117 (5.1%). Table 1 summarizes characteristics of patients with and without CAED. Risk of CAED was 2% with TCF<20 ng/ml, and 27% with TCF>20 ng/ml (OR=18.2, CI 2.2- 212, p<0.01). Elevated TCF was associated to fewer hospital free days (GLM p<0.01). Data in table reported as median [IQR]. Conclusions: Preoperative TCF has an important association with postoperative cardiac arrest, ECMO, and death. Alternative or intensified treatment strategies could be considered in patients with elevated preoperative TCF.

scholarly journals Toward data-based clinical decision making for adults with challenging behavior using the Behavior Problems Inventory-Short Form (BPI-S)

2018 ◽  
Vol 23 (2) ◽  
pp. 103-110 ◽  
Author(s):  
Darren L. Bowring ◽  
Vasiliki Totsika ◽  
Richard P. Hastings ◽  
Sandy Toogood
Keyword(s):  
Behavior Problems ◽  
Behavior Change ◽  
Challenging Behavior ◽  
Clinical Decision Making ◽  
Short Form ◽  
Challenging Behaviors ◽  
Clinical Decision ◽  
Service Evaluation ◽  
Content Type ◽  
Clinically Significant

Purpose The Behavior Problems Inventory-Short Form (BPI-S) is a shorter version of the Behavior Problems Inventory-01. In this paper, BPI-S population norms are reported from a total administrative population of adults with intellectual disability (ID). To facilitate the use of the BPI-S in clinical services to assess behavior change, the purpose of this paper is to describe how to use BPI-S clinically significant and reliable change (RC) scores. Design/methodology/approach Data were gathered on 265 adults with ID known to services. Proxy informants completed the BPI-S on challenging behaviors over the previous six months. Clinically significant cut-off values and RC scores were calculated using the Jacobson and Truax’s (1991) method. Findings BPI-S clinical reference data are presented to provide benchmarks for individual and group comparisons regarding challenging behavior. Examples demonstrate how to use clinical norms to determine change. Practical implications Behavior change is a major goal of researchers and practitioners. Data from the present study can make the BPI-S a valuable tool for determining change in challenging behavior following service input or intervention. Originality/value Whilst well used in research, the BPI-S may be less extensively used in practice. This present study provides data to enable researchers and practitioners to use the BPI-S more widely in assessing clinical outcomes, such as intervention research and service evaluation.

scholarly journals Precision Approaches in the Management of Colorectal Cancer: Current Evidence and Latest Advancements towards Individualizing the Treatment

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3481
Author(s):  
Rebecca A. Shuford ◽  
Ashley L. Cairns ◽  
Omeed Moaven
Keyword(s):  
Colorectal Cancer ◽  
Growth Factor ◽  
Metastatic Colorectal Cancer ◽  
Mismatch Repair ◽  
Clinical Decision Making ◽  
Growth Factor Receptor ◽  
Clinical Decision ◽  
Current Evidence ◽  
Therapeutic Modalities ◽  
Clinically Significant

The genetic and molecular underpinnings of metastatic colorectal cancer have been studied for decades, and the applicability of these findings in clinical decision making continues to evolve. Advancements in translating molecular studies have provided a basis for tailoring chemotherapeutic regimens in metastatic colorectal cancer (mCRC) treatment, which have informed multiple practice guidelines. Various genetic and molecular pathways have been identified as clinically significant in the pathogenesis of metastatic colorectal cancer. These include rat sarcoma (RAS), epithelial growth factor receptor (EGFR), vascular endothelial growth factor VEGF, microsatellite instability, mismatch repair, and v-raf murine sarcoma viral oncogene homolog b1 (BRAF) with established clinical implications. RAS mutations and deficiencies in the mismatch repair pathway guide decisions regarding the administration of anti-EGFR-based therapies and immunotherapy, respectively. Furthermore, there are several emerging pathways and therapeutic modalities that have not entered mainstream use in mCRC treatment and are ripe for further investigation. The well-established data in the arena of targeted therapies provide evidence-based support for the use or avoidance of various therapeutic regimens in mCRC treatment, while the emerging pathways and platforms offer a glimpse into the future of transforming a precision approach into a personalized treatment.

Switching and Combining Antipsychotics

CNS Spectrums ◽  
2010 ◽  
Vol 15 (S6) ◽  
pp. 8-11 ◽  
Author(s):  
Christoph U. Correll
Keyword(s):  
Decision Making ◽  
Individual Differences ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Individual Variability ◽  
The Body ◽  
Striatal Dopamine ◽  
Caloric Content ◽  
Pharmacokinetic Profiles ◽  
Positron Emission

Pharmacologic knowledge can inform clinical decision-making, particularly the dosing and switching decisions made with antipsychotics. Of relevance are the pharmacokinetic (what does the body do to the drug) and the pharmacodynamic (what does the drug do to the body) properties of antipsychotics.The goal of antipsychotic dosing is to achieve sufficient dopa-mine blockade in areas where dopamine excess can lead to psychosis, mania, or aggression. Using positron emission topography, one investigation showed that response rates were considerably higher in patients who achieved >65% striatal dopamine blockade. Conversely, striatal dopamine blockade >80% predicted the emergence of extrapyramidal symptoms (EPS) or akathisia.There is, however, considerable intra-individual variability in achieving the desired 60% to 80% striatal dopamine blockade. Such variability is likely due to inter-individual differences in the absorption, distribution, metabolism and elimination of medications. At the same time, antipsychotics themselves differ in their general pharmacokinetic profiles. For example, ziprasidone absorption is ~50% less when ingested on an empty stomach than when taken with a meal; the degree of absorption depends on the caloric content, while the fat content is not relevant.

scholarly journals Diagnósticos de enfermagem de pacientes em tratamento radioterápico

2018 ◽  
Vol 12 (11) ◽  
pp. 3060
Author(s):  
Camila Marcon ◽  
Gabriela Vicari ◽  
Patricia Poltroni ◽  
Aline Maffissoni ◽  
Kauana Dall' Agnese Caregnatto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiation Therapy ◽  
Skin Color ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Related Factors ◽  
Cross Sectional ◽  
Color Changes ◽  
Factores De Riesgo ◽  
Nursing Diagnoses

RESUMOObjetivo: identificar a incidência dos diagnósticos de enfermagem, bem como características definidoras, fatores relacionados e fatores de risco, com base na taxonomia NANDA-I de pacientes em tratamento radioterápico. Método: trata-se de estudo quantitativo, transversal, exploratório-descritivo, realizado com 60 pacientes em um ambulatório. Resultados: identificou-se 23 Diagnósticos de Enfermagem, sendo os mais incidentes: risco de integridade da pele prejudicada (35%), mobilidade física prejudicada (15%) e eliminação urinária prejudicada (7%). As características definidoras evidenciadas foram amplitude limitada de movimentos (15,3%), incontinência e dificuldade para deglutir (7,2%). Dentre os fatores relacionados, estão dor (18,3%), desconforto (10,7%) e radiação (6%) e os fatores de risco radiação (56%), mudanças na pigmentação da pele/mudanças no turgor da pele (26,3%) e estado nutricional desequilibrado (6,3%). Conclusão: os resultados do estudo contribuem para atender às necessidades de saúde dos pacientes em tratamento radioterápico e na tomada de decisão clínica pelo enfermeiro. Descritores: Enfermagem; Oncologia; Radioterapia; Processos de Enfermagem; Diagnóstico de Enfermagem; Pesquisa em Enfermagem.ABSTRACT Objective: to identify the incidence of nursing diagnoses, as well as defining characteristics, related factors and risk factors, based on the NANDA-I taxonomy of patients undergoing radiation therapy. Method: quantitative, cross-sectional, exploratory and descriptive study, performed with 60 patients in an outpatient clinic. Results: 23 Nursing Diagnoses were identified, of which the most prevalent were risk for impaired skin integrity (35%), impaired physical mobility (15%) and impaired urinary elimination (7%). The defining characteristics were limited transfer ability (15.3%), incontinence and impaired swallowing (7.2%). The related factors were pain (18.3%), discomfort (10.7%) and radiation (6%), and the risk factors are radiation (56%), skin color changes/alteration in skin turgor (26.3%) and imbalanced nutritional state (6.3%). Conclusion: The results of the present may study contribute to meet the health needs of patients undergoing radiation therapy and clinical decision making by the nurse. Descriptors: Nursing; Oncology; Radiotherapy; Nursing Process; Nursing Diagnosis; Nursing Research.RESUMEN Objetivo: identificar la incidencia de los diagnósticos de enfermería, así como características definidoras, factores relacionados y factores de riesgo, con base en la taxonomía NANDA-I de pacientes en tratamiento radioterápico. Método: estudio cuantitativo, transversal, exploratorio-descriptivo, realizado con 60 pacientes en un ambulatorio. Resultados: se identificaron 23 Diagnósticos de Enfermería, siendo los más incidentes: riesgo de integridad de la piel perjudicada (35%), movilidad física perjudicada (15%) y eliminación urinaria perjudicada (7%). Las características definidoras evidenciadas fueron amplitud limitada de movimientos (15,3%), incontinencia y dificultad para deglutir (7,2%). Dentro de los factores relacionados, están el dolor (18,3%), el malestar (10,7%) y la radiación (6%) y los factores de riesgo radiación (56%), cambios en la pigmentación de la piel/cambios en la turgencia de la piel (26,3%) y estado nutricional desequilibrado (6,3%). Conclusión: los resultados del estudio contribuyen para atender a las necesidades de salud de los pacientes en tratamiento radioterápico y en la tomada de decisión clínica por el enfermero. Descriptores: Enfermería; Oncología Médica; Radioterapia; Proceso de Enfermería; Diagnóstico de Enfermería; Investigación en Enfermería.

scholarly journals Comparative Sensitivity of Transthoracic and Transesophageal Echocardiography in Diagnosis of Infective Endocarditis Among Veterans With Staphylococcus aureus Bacteremia

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Poorani Sekar ◽  
James R. Johnson ◽  
Joseph R. Thurn ◽  
Dimitri M. Drekonja ◽  
Vicki A. Morrison ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Transesophageal Echocardiography ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Valve Surgery ◽  
Related Factors ◽  
Staphylococcus Aureus Bacteremia ◽  
Patient Refusal

Abstract Background Echocardiography is fundamental for diagnosing infective endocarditis (IE) in patients with Staphylococcus aureus bacteremia (SAB), but whether all such patients require transesophageal echocardiography (TEE) is controversial. Methods We identified SAB cases between February 2008 and April 2012. We compared sensitivity and specificity of transthoracic echocardiography (TTE) and TEE for evidence of IE, and we determined impacts of IE risk factors and TTE image quality on comparative sensitivities of TTE and TEE and their impact on clinical decision making. Results Of 215 evaluable SAB cases, 193 (90%) had TTE and 130 (60%) had TEE. In 119 cases with both tests, IE was diagnosed in 29 (24%), for whom endocardial involvement was evident in 25 (86%) by TEE, vs only 6 (21%) by TTE (P &lt; .001). Transesophageal echocardiography was more sensitive than TTE regardless of risk factors. Even among the 66 cases with adequate or better quality TTE images, sensitivity was only 4 of 17 (24%) for TTE, vs 16 of 17 (94%) for TEE (P &lt; .001). Among 130 patients with TEE, the TEE results, alone or with TTE results, influenced treatment duration in 56 (43%) cases and led to valve surgery in at least 4 (6%). It is notable that, despite vigorous efforts to obtain both tests routinely, TEE was not done in 86 cases (40%) for various reasons, including pathophysiological contraindications (14%), patient refusal or other patient-related factors (16%), and provider declination or system issues (10%). Conclusions Patients with SAB should undergo TEE when possible to detect evidence for IE, especially if the results might affect management.

scholarly journals Computerized nursing process in the Intensive Care Unit: ergonomics and usability

2016 ◽  
Vol 50 (6) ◽  
pp. 998-1004 ◽  
Author(s):  
Sônia Regina Wagner de Almeida ◽  
◽  
Grace Teresinha Marcon Dal Sasso ◽  
Daniela Couto Carvalho Barra ◽  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nursing Practice ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Nursing Process ◽  
Evaluation Instrument ◽  
Before And After ◽  
Quasi Experimental ◽  
Usability Criteria

Abstract OBJECTIVE Analyzing the ergonomics and usability criteria of the Computerized Nursing Process based on the International Classification for Nursing Practice in the Intensive Care Unit according to International Organization for Standardization(ISO). METHOD A quantitative, quasi-experimental, before-and-after study with a sample of 16 participants performed in an Intensive Care Unit. Data collection was performed through the application of five simulated clinical cases and an evaluation instrument. Data analysis was performed by descriptive and inferential statistics. RESULTS The organization, content and technical criteria were considered "excellent", and the interface criteria were considered "very good", obtaining means of 4.54, 4.60, 4.64 and 4.39, respectively. The analyzed standards obtained means above 4.0, being considered "very good" by the participants. CONCLUSION The Computerized Nursing Processmet ergonomic and usability standards according to the standards set by ISO. This technology supports nurses' clinical decision-making by providing complete and up-to-date content for Nursing practice in the Intensive Care Unit.

scholarly journals Perceptions and experiences of wrist surgeons on the management of triangular fibrocartilage complex tears: a qualitative study

2019 ◽  
Vol 44 (6) ◽  
pp. 572-581
Author(s):  
Vanessa I. Robba ◽  
Alexia Karantana ◽  
Andrew P. G. Fowler ◽  
Claire Diver
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Triangular Fibrocartilage Complex ◽  
Classification Systems ◽  
Structured Interviews ◽  
Level Of Evidence ◽  
Related Factors ◽  
Data Saturation ◽  
Triangular Fibrocartilage

There is lack of consensus on the management of triangular fibrocartilage injuries. The aim of this study was to investigate wrist surgeons’ experiences and perceptions regarding treatment of triangular fibrocartilage complex injuries and to explore the rationale behind clinical decision-making. A purposive sample of consultant wrist surgeons ( n = 10) was recruited through ‘snow-balling’ until data saturation was reached. Semi-structured interviews were conducted, digitally recorded and transcribed verbatim. Two researchers independently analysed data using an iterative/thematic approach. Findings suggest that surgeons rely more on their own training and experience, and patient-related factors such as individual expectations, to inform their decision-making, rather than on published material. Current classification systems are largely considered to be unhelpful. Level of evidence: V

scholarly journals Using daily monitoring of psychiatric symptoms to evaluate hospital length of stay

BJPsych Open ◽  
2016 ◽  
Vol 2 (6) ◽  
pp. 341-345 ◽  
Author(s):  
Andrew C. Page ◽  
Nadia K. Cunningham ◽  
Geoffrey R. Hooke
Keyword(s):  
Hospital Stay ◽  
Clinical Decision Making ◽  
Psychiatric Symptoms ◽  
Clinical Decision ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Significant Treatment ◽  
Daily Monitoring ◽  
Additional Information ◽  
Clinically Significant

BackgroundRoutine symptom monitoring and feedback improves out-patient outcomes, but the feasibility of its use to inform decisions about discharge from in-patient care has not been explored.AimsTo examine the potential value to clinical decision-making of monitoring symptoms during psychiatric in-patient hospitalisation.MethodA total of 1102 in-patients in a private psychiatric hospital, primarily with affective and neurotic disorders, rated daily distress levels throughout their hospital stay. The trajectories of patients who had, and had not, met a criterion of clinically significant improvement were examined.ResultsTwo-thirds of patients (n=604) met the clinically significant improvement criterion at discharge, and three-quarters (n=867) met the criterion earlier during their hospital stay. After meeting the criterion, the majority (73.2%) showed stable symptoms across the remainder of their hospital stay, and both classes showed substantially lower symptoms than at admission.ConclusionsMonitoring of progress towards this criterion provides additional information regarding significant treatment response that could inform clinical decisions around discharge readiness.

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