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Thorough Assessment (thorough + assessment)
Selected AbstractsCollaborative curriculum development: Clinicians' views on the neurology content of a new occupational therapy courseAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 1 2000Annie McCluskey Academics are often accused of being out of touch with clinical practice. This can result in graduates who are poorly prepared to work in local health-care systems. To avoid this scenario, occupational therapy clinicians in New South Wales were invited by mail to list 10 topics related to neurology, which they felt should be included in a new undergraduate curriculum. Fifty-two clinicians responded. A modified nominal group technique was then used with 10 expert clinicians, to further explore the written responses. Content analysis revealed four areas which clinicians felt needed attention in the new curriculum. These areas or themes have been named: (i) Integrated Foundation Studies; (ii) The Art of a Thorough Assessment; (iii) Treatment Approaches in Neurology; and (iv) Building Confidence. Clinicians felt that neuroscience material needed to be better integrated with professional subjects; that observational skills and activity analysis should receive more class time, and that three different approaches to motor training should be taught. More practical student experience was also recommended, on and off campus, to help increase confidence when conducting initial assessments and upper limb retraining. Information from this study will be of interest to clinicians in neurology and to occupational therapy educators across Australia. [source] The importance of exposure estimation in the assessment of skin sensitization riskCONTACT DERMATITIS, Issue 5 2000Michael K. Robinson The development of new ingredients and products for the consumer market requires a thorough assessment of their potential for skin sensitization and the possible clinical manifestation of allergic contact dermatitis. The process by which low molecular weight chemicals induce and elicit skin sensitization reactions is complex and dependent on many factors relevant to the ability of the chemical to penetrate the skin, react with protein, and trigger the cell-mediated immune response. These major factors include inherent potency, chemical dose, duration and frequency of exposure, vehicle or product matrix, and occlusion. The fact that a chemical is a contact allergen does not mean that it cannot be formulated into a consumer product at levels well tolerated by most individuals. Many common ingredients (e.g., fragrances, preservatives) are known skin allergens. However, all allergens show dose-response and threshold characteristics. Therefore, one should be able to incorporate these chemicals into products at levels that produce acceptably low incidences of skin sensitization under foreseeable conditions of exposure. The critical exposure determinant for evaluating skin sensitization risk is dose per unit area of skin exposed. Use of this parameter allows for comparative assessments from different types of skin sensitization tests (including cross-species comparisons), and, at least for known potent allergens, there is remarkable similarity in threshold dose/unit area determinations across species. The dose/unit area calculation enables a judgment of the sensitization risk for different product types. This is illustrated using the chemical preservative methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) as a case study. [source] Resistant readers 8 months later: energizing the student's learning milieu by targeted counsellingDYSLEXIA, Issue 2 2006Anne Brit Andreassen Abstract Several studies have reported that an alarming large subgroup of poor readers seems to be treatment resistant. This group obviously needs attention beyond standard special education instructions. In Norway, the National Centre for Reading Education and Research has been assigned the task of assisting the school psychological services nationwide in severe cases of reading disabilities. The aim of the present study of a clinical sample of students with severe dyslexia, due to phonological deficits, was to evaluate effects of counselling 8 months after a 2-day assessment at the centre. Sixty-five students, with a mean age of 12.3 years, participated. A thorough assessment of each student's strengths and problems was conducted at the centre. Additional information was obtained from the school psychological services, the teachers, and the parents. Diagnostic reports and proposals for remediation were forwarded to the school psychological services. Students', parents', and teachers' evaluation of the students' reading abilities 8 months after the assessment was retrieved for 75% of cases. Of these, 80% reported clear progress in the students' reading abilities. The progress could not be related to age, cognitive level, place of residence, or previous special education received, but instead to improved motivation. Copyright © 2006 John Wiley & Sons, Ltd. [source] Justifying the expense of the cancer Clinical Nurse SpecialistEUROPEAN JOURNAL OF CANCER CARE, Issue 1 2010C.A. POLLARD ba POLLARD C.A., GARCEA G., PATTENDEN C.J., CURRAN R., NEAL C.P., BERRY D.P. & DENNISON A.R. (2009) European Journal of Cancer Care19, 72,79 Justifying the expense of the cancer Clinical Nurse Specialist In order to maximise patient care, assessment of the adequacy of the service provision by the Clinical Nurse Specialist (CNS) must be regularly undertaken. This study attempted to determine whether CNSs were providing an adequate service via retrospective and prospective audit. The results of a comprehensive audit of the work of the CNS within a tertiary referral Hepatobiliary Unit are presented. The audit involved postal and telephone questionnaires as well as prospective collection of data. The majority of responses from patients were positive, with many finding the CNS a useful and well-utilised contact. Overall, the CNSs performed well in each of their designated tasks; however, areas were still identified which could be further improved. Audit is essential in providing feedback to the CNS and to identify areas which require improvement. The CNS has evolved to meet a clinical gap in patient care, and as a result, the role of a CNS is frequently nebulous or poorly defined. This renders evaluation of the CNS problematic and fraught with difficulties. However, a thorough assessment can still be made using carefully constructed audit looking at each task of the CNS. [source] Efficacy of integrated interventions combining psychiatric care and nursing home care for nursing home residents: a review of the literatureINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2010Janine Collet Abstract Background Nursing home residents needing both psychiatric care and nursing home care for either somatic illness or dementia combined with psychiatric disorders or severe behavioural problems are referred to as Double Care Demanding patients, or DCD patients. Integrated models of care seem to be necessary in order to improve the well-being of these residents. Objectives Two research questions were addressed. First, which integrated interventions combining both psychiatric care and nursing home care in DCD nursing home residents are described in the research literature? And second, which outcomes of integrated interventions combining both psychiatric care and nursing home care in DCD nursing home residents are reported in the literature? Method A critical review of studies was done that involved integrated interventions combining both psychiatric care and nursing home care on psychiatric disorders and severe behavioural problems in nursing home patients. A systematic literature search was performed in a number of international databases. Results Eight intervention trials, including four RCTs (2b level of evidence), were identified as relevant studies for the purpose of this review. Seven studies, three of which were RCTs, showed beneficial effects of a comprehensive, integrated multidisciplinary approach combining medical, psychiatric and nursing interventions on severe behavioural problems in DCD nursing home patients. Conclusions Important elements of a successful treatment strategy for DCD nursing home patients include a thorough assessment of psychiatric, medical and environmental causes as well as programmes for teaching behavioural management skills to nurses. DCD nursing home patients were found to benefit from short-term mental hospital admission. This review underlines the need for more rigorously designed studies to assess the effects of a comprehensive, integrated multidisciplinary approach towards DCD nursing home residents. Copyright © 2009 John Wiley & Sons, Ltd. [source] The effectiveness of antipsychotic medication in the management of behaviour problems in adults with intellectual disabilitiesJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 10 2007S. Deb Abstract Background Psychopharmacological intervention in the management of behaviour problems in adults with intellectual disabilities (ID) has become a common treatment strategy. This has become a cause for concern, given that the evidence for its effectiveness is uncertain and most drugs are not licensed for this use. Methods A comprehensive systematic review of empirical research on the effectiveness of antipsychotic medication was conducted. Electronic and manual searches of literature were conducted. Stringent scientific methodology determined those primary trials that were worthy of inclusion. Results This review revealed one randomized controlled trial (RCT), one controlled, four uncontrolled prospective and three retrospective case series studies in adults. Additionally, two studies in both adults and children , one crossover RCT and one prospective controlled trial , were found. Conclusion Presently, there is RCT-based evidence for risperidone to be effective in both adults and children; however, this treatment carries a certain amount of risk associated with adverse effects. There is also evidence to support the use of other antipsychotics, primarily atypicals, but the evidence is based on noncontrolled case studies. There is currently not enough evidence available to recommend specific medication for specific behaviour problems. Before prescribing medication, clinicians should carry out a thorough assessment of behaviour, including its causes and consequences, and draw up a formulation providing the rationale for the prescribed intervention after considering all medication- and nonmedication-based management options. [source] Postinfectious gastroparesis related to autonomic failure: a case reportNEUROGASTROENTEROLOGY & MOTILITY, Issue 2 2006A. Lobrano Abstract, Background and aim:, Severe dysautonomia may be secondary to viral infections, resulting in impaired autoimmune, cardiovascular, urinary and digestive dysfunction. Herein, we present a case of a 31-year-old white female patient who had severe gastroparesis related to autonomic failure following an episode of acute gastroenteritis. This seems to be the first report providing thorough assessment of the enteric and autonomic nervous system by analysis of full-thickness small intestinal biopsies, cardiovagal testing and autopsy. Hospital course:, This patient affected by a severe gastroparesis was treated with antiemetics, prokinetics, analgesics and gastric electrical stimulation to control symptoms. Nutritional support was made using jejunal feeding tube and, in the final stage of disease, with total parenteral nutrition. Autonomic studies revealed minimal heart rate variability and a disordered Valsalva manoeuvre although the enteric nervous system and the smooth muscle layer showed a normal appearance. Hospital courses were complicated by episodes of bacteraemia and fungemia. Serum antiphospholipid antibodies were noted but despite anticoagulation, she developed a pulmonary embolism and shortly thereafter the patient died. Autopsy revealed acute haemorrhagic Candida pneumonia with left main pulmonary artery thrombus. Sympathetic chain analysis revealed decreased myelinated axons with vacuolar degeneration and patchy inflammation consistent with Guillain-Barre syndrome. The evaluation of the enteric nervous system in the stomach and small bowel revealed no evidence of enteric neuropathy or myopathy. Conclusion:, A Guillain-Barre-like disease with gastroparesis following acute gastroenteritis is supported by physiological and autonomic studies with histological findings. [source] Human Factors Programs within Contra Costa CountyPROCESS SAFETY PROGRESS, Issue 3 2009Michael Dossey Abstract Starting in 1999, regulated industrial facilities in Contra Costa County, California were required to develop Human Factors Programs as part of the Industrial Safety Ordinance (ISO). Human Factors Programs within the County are designed to be a thorough assessment of the interactions between equipment, work processes, procedures, practices, work environment, people, and management systems as they relate to health and safety. Committees were established at each facility to oversee the development, training, and execution of the site-specific programs. Primary areas of focus in the ongoing implementation of an effective Human Factors Program are periodic assessments and resolution of Latent Conditions, and performance of Management of Organizational Change Assessments before staffing changes. This article describes the steps that facilities in Contra Costa County have taken to develop comprehensive site specific Human Factors Programs. © 2009 American Institute of Chemical Engineers Process Saf Prog, 2009 [source] Vitiligo associated with other autoimmune diseases: polyglandular autoimmune syndrome types 3B + C and 4CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 5 2006P. Amerio Summary Vitiligo is a common skin disease characterized by depigmented maculae resulting from a reduction of the number and function of melanocytes. Many studies suggest that vitiligo might be an autoimmune disease. Vitiligo has been frequently described in association with other autoimmune diseases. Among the diseases described in association with vitiligo are the so-called autoimmune polyglandular syndromes (APS). Vitiligo can be present in all types of APS but the most frequent association appears to be in APS-3. APS-3 was defined as the association between autoimmune thyroiditis and another autoimmune disease. Here we report one patient with thyroiditis, vitiligo and autoimmune gastritis (APS-3B +,C), one patient with chronic autoimmune thyroiditis, vitiligo and alopecia (APS-3C), and one case of a young patient with type 1 diabetes mellitus and vitiligo (APS-4), according to the newest classification. We stress the importance of a thorough assessment for autoimmune diseases in selected patients with vitiligo. [source] Hoarse voice in adults: an evidence-based approach to the 12 minute consultationCLINICAL OTOLARYNGOLOGY, Issue 1 2009I. Syed Background:, The hoarse voice is a common presentation in the adult ENT clinic. It is estimated that otolaryngology/voice clinics receive over 50 000 patients with dysphonia each year. Good vocal function is estimated to be required for around 1/3 of the labour force to fulfil their job requirements. The assessment and management of the patient with a hoarse voice is potentially a complex and protracted process as the aetiology is often multi-factorial. This article provides a guide for the clinician in the general ENT clinic to make a concise, thorough assessment of the hoarse patient and engage in an evidence based approach to investigation and management. Method:, Literature search performed on 4 October 2008 using EMBASE, MEDLINE, Cochrane databases using subject headings hoarse voice or dysphonia in combination with diagnosis, management, investigation, treatment, intervention and surgery. Results:, General vocal hygiene is beneficial for non organic dysphonia but the evidence base for individual components is poor. There is a good evidence base for the use of voice therapy as first line treatment of organic dysphonia such as vocal fold nodules and polyps. There is little evidence for surgical intervention as first line therapy for most common benign vocal fold lesions. Surgery is, however, the treatment of choice for hoarseness due to papillomatosis. Both CO2 laser and microdissection are equally acceptable modalities for surgical resection of common benign vocal fold lesions. Laryngopharyngeal reflux is commonly cited as a cause of hoarseness but the evidence base for treatment with gastric acid suppression is poor. Despite the widespread use of proton pump inhibitors for treating laryngopharyngeal reflux, there is high quality evidence to suggest that they are no more effective than placebo. Conclusion:, A concise and thorough approach to assessment in the general ENT clinic will provide the diagnosis and facilitate the management of the hoarse voice in the majority of cases. Voice therapy is an important tool that should be utilised in the general ENT clinic and should not be restricted to the specialist voice clinic. If there is no improvement after initial measures, the larynx appears normal and/or the patient has failed initial speech & language therapy, referral to a specialist voice clinic may be helpful. More research is still required particularly with regard to laryngopharyngeal reflux which is often cited as an important cause of hoarseness but is still poorly understood. [source] Giant cell arteritis on 18F-FDG PET/CTCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 5 2009Thomas F. Heston Summary Purpose:, We present a case of incidentally noted giant cell arteritis in a patient undergoing 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT imaging. The patient was originally referred to PET/CT for staging of his renal transitional cell carcinoma. Methods:, The patient was injected intravenously with 370 MBq of 18F-FDG. After a 60 min uptake period, PET/CT imaging was performed from the skull base to the mid thighs. Results:, A small para-aortic node in the region of the surgical bed showed increased tracer uptake of concern for malignancy. In addition, there were several non-calcified pulmonary nodules present, also concerning for malignancy. Incidentally noted was diffusely increased tracer uptake throughout the aorta and a thickened aortic wall on CT images. Diffuse tracer uptake was also present in the proximal branches of the aorta, including the carotid, iliac, femoral, and subclavian arteries. The patient had biopsy proven giant cell arteritis. Conclusion:, Increased 18F-FDG uptake by the aorta on PET/CT imaging is an abnormal finding that prompts a more thorough assessment for malignancy, and also can indentify important co-morbidities in cancer patients. Evaluation of aortic uptake should be a routine practice in the interpretation of 18F-FDG PET/CT scans. [source] | ||||||||||