The John Bowlby Memorial Lecture 2003 The body in clinical practice

Touch ◽  
2018 ◽  
pp. 35-47
Author(s):  
Susie Orbach
Author(s):  
Titilayo Dorothy Odetola ◽  
Olusola Oluwasola ◽  
Christoph Pimmer ◽  
Oluwafemi Dipeolu ◽  
Samson Oluwayemi Akande ◽  
...  

The “disconnect” between the body of knowledge acquired in classroom settings and the application of this knowledge in clinical practice is one of the main reasons for professional fear, anxiety and feelings of incompetence among freshly graduated nurses. While the phenomenon of the theory-to-practice gap has been researched quite extensively in high-income country settings much less is known about nursing students’ experiences in a developing country context. To rectify this shortcoming, the qualitative study investigated the experiences of nursing students in their attempt to apply what they learn in classrooms in clinical learning contexts in seven sites in Nigeria. Thematic content analysis was used to analyse data gained from eight focus group discussions (n = 80) with the students. The findings reveal a multifaceted theory-practice gap which plays out along four tensions: (1) procedural, i.e. the difference between practices from education institutions and the ones enacted in clinical wards – and contradictions that emerge even within one clinical setting; (2) political, i.e. conflicts that arise between students and clinical staff, especially personnel with a lower qualification profile than the degree that students pursue; (3) material, i.e. the disconnect between contemporary instruments and equipment available in schools and the lack thereof in clinical settings; and (4) temporal, i.e. restricted opportunities for supervised practice owing to time constraints in clinical settings in which education tends to be undervalued. Many of these aspects are linked to and aggravated by infrastructural limitations, which are typical for the setting of a developing country. Nursing students need to be prepared regarding how to deal with the identified procedural, political, material and temporal tensions before and while being immersed in clinical practice, and, in so doing, they need to be supported by educationally better qualified clinical staff.


2019 ◽  
Vol 31 (3) ◽  
pp. 251-256

Cirrhosis of liver is one of the common medical problem in daily clinical practice and one of the leading causes of morbidity and mortality. Zinc is an essential trace elements for human and plays in many biological roles in the body. Among them, zinc deficiency is thought to be involved in metabolism of ammonia and causes hyperammonia that worsen hepatic encephalopathy. This study aimed to find out the severity of cirrhosis of liver was by Child Turcotte Pugh score and to investigate the associations between serum zinc level and severity of cirrhosis. A hospital-based cross-sectional descriptive study was performed on 78 patients with different underlying causes of cirrhosis of liver at the Medical Units of Yangon General Hospital and Yangon Specialty Hospital. Among the study population, Child grade A was found to be 28.21%, Child grade B was 30.77% and Child grade C was 41.03%. Regarding result of serum zinc level, 62.8% were low level, 28.2% were within normal level and 8.9% were high level. Mean value of serum zinc level in grade A was 0.68 mg/l, grade B was 0.54 mg/l and grade C was 0.48 mg/l (p=0.00). It was found out that there was a high prevalence of zinc deficiency in severe cirrhotic patients. The zinc level was significantly lowest among patients with Child-Pugh C as compare to those with Child-Pugh B and C. Severity of zinc deficiency should be requested for supplementation therapy in cirrhotic patients as to prevent complications such as hepatic encephalopathy, hepatocellular carcinoma and liver failure. Screening for zinc deficiency may need in these patients with more advanced cirrhosis because it seems to be a marker of advanced liver disease and it can be deducted that awareness of serum zinc level among cirrhotic patients is very important in clinical practice.


2021 ◽  
Vol 10 (2) ◽  
pp. 228
Author(s):  
Tomonari Kinoshita ◽  
Taichiro Goto

Despite complete resection, cancer recurrence frequently occurs in clinical practice. This indicates that cancer cells had already metastasized from their organ of origin at the time of resection or had circulated throughout the body via the lymphatic and vascular systems. To obtain this potential for metastasis, cancer cells must undergo essential and intrinsic processes that are supported by the tumor microenvironment. Cancer-associated inflammation may be engaged in cancer development, progression, and metastasis. Despite numerous reports detailing the interplays between cancer and its microenvironment via the inflammatory network, the status of cancer-associated inflammation remains difficult to recognize in clinical settings. In the current paper, we reviewed clinical reports on the relevance between inflammation and cancer recurrence after surgical resection, focusing on inflammatory indicators and cancer recurrence predictors according to cancer type and clinical indicators.


Author(s):  
Elena Sergeevna Ilyina ◽  
Natal’a Valer’evna Filippova ◽  
Yulia Borisovna Barylnik

Pharmacogenetics is a relatively new scientific discipline, which is currently the main tool in personalized medicine. The aim of research in this area is to identify significant genetic markers for the introduction of their accounting in routine clinical practice. Generalization of data on the patient’s phenotype should be the key to predicting the pharmacokinetics and pharmacodynamics of the drug in the body. A personalized approach based on pharmacogenetic research data in psychiatry is extremely relevant due to the high social and budgetary costs of treating mental disorders around the world. Currently, there are data on the pharmacogenetics of most modern antidepressants, however, conducting such studies in patients with depressive disorders in most cases is impossible for implementation in routine clinical practice due to the impossibility of conducting the test in the laboratory of medical organizations and the lack of specialists competent in the clinical interpretation of the results of pharmacogenetic testing.


2020 ◽  
Vol 14 ◽  
pp. 117954682095341 ◽  
Author(s):  
Todd C Villines ◽  
Mark J Cziraky ◽  
Alpesh N Amin

Real-world evidence (RWE) provides a potential rich source of additional information to the body of data available from randomized clinical trials (RCTs), but there is a need to understand the strengths and limitations of RWE before it can be applied to clinical practice. To gain insight into current thinking in clinical decision making and utility of different data sources, a representative sampling of US cardiologists selected from the current, active Fellows of the American College of Cardiology (ACC) were surveyed to evaluate their perceptions of findings from RCTs and RWE studies and their application in clinical practice. The survey was conducted online via the ACC web portal between 12 July and 11 August 2017. Of the 548 active ACC Fellows invited as panel members, 173 completed the survey (32% response), most of whom were board certified in general cardiology (n = 119, 69%) or interventional cardiology (n = 40, 23%). The survey results indicated a wide range of familiarity with and utilization of RWE amongst cardiologists. Most cardiologists were familiar with RWE and considered RWE in clinical practice at least some of the time. However, a significant minority of survey respondents had rarely or never applied RWE learnings in their clinical practice, and many did not feel confident in the results of RWE other than registry data. These survey findings suggest that additional education on how to assess and interpret RWE could help physicians to integrate data and learnings from RCTs and RWE to best guide clinical decision making.


2015 ◽  
Vol 12 (1) ◽  
pp. 54-59
Author(s):  
L V Luss

In the pathogenesis of various diseases histamine performs an important role relating to one of the most important mediators involved in the regulation of vital functions in the body. Histamine plays a key role in the development of allergic diseases and pseudoallergic reactions. Therefore, in clinical practice, of particular interest are drugs that block the effects of histamine - antihistamines. The lecture highlights mechanisms of action of histamine and indications for antihistamines. Particular attention is given to parenteral forms of antihistamines and benefits of a new form of antihistamines for parenteral use without sedation - fenkarol one of quinuclidine derivatives. Features and advantages of antihistamines - quinuclidine derivatives, first developed in Laboratory of academician M.D. Mashkovsky are presented.


Author(s):  
A.G. Zamalutdinova ◽  
L.Yu. Kulagina ◽  
\A.Z. Nigmedzyanova ◽  
E.V. Kanner ◽  
M.L. Maksimov

The use of drugs during pregnancy and breastfeeding remains one of the least studied, but important issues in pharmacology today. When choosing medicinal products during pregnancy, one of the crucial principles is to ensure the safety of the embryo and fetus. Among the generally accepted rules aimed at eliminating fetal risk, a decrease in the dosage of the drug to the lower limit of the therapeutic range is usually named. However, one should take into account the changes that occur in the body of a pregnant woman: the body weight and the volume of circulating blood rise, the excretion of drugs is accelerated (the clearance increases), which, on the contrary, requires an increase in the dosages of individual drugs to maintain therapeutic efficacy. Antibacterial drugs (ABD) are the most difficult group of drugs to use, since they require taking into account not only the mechanism of action of drugs, but also the basics of clinical microbiology. ABD occupy a special place in clinical practice, as they are one of the most frequently prescribed classes of drugs.


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