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Clinical Issues (clinical + issues)
Selected AbstractsSocial Networks and the Elderly: Conceptual and Clinical Issues, and a Family ConsultationFAMILY PROCESS, Issue 3 2000Carlos E. Sluzki M.D. After a general introduction to the construct "social networks," this article discusses the progressive transformation of the personal social network,family, friends and acquaintances, work and leisure relationships, et cetera,as individuals reach an advanced age. This is followed by a summary and discussion of a clinical consultation, with an emphasis on the reciprocal influence between individual and social network. [source] Therapeutic Equivalence , Clinical Issues and Statistical Methodology in Noninferiority TrialsBIOMETRICAL JOURNAL, Issue 1 2005Axel Munk This special issue on therapeutic equivalence contains a selection of 8 papers presented at the conference ,Therapeutic Equivalence , Clinical Issues and Statistical Methodology in Noninferiority Trials' held in Düsseldorf, December 12,13, 2003. The aim of this conference was to gather experts from academics, industry and regulatory agencies in the field of therapeutic equivalence, in particular of noninferiority trials. Originally initiated as a small workshop, it soon turned out that there is obviously strong need to discuss these challenging issues at a broader auditorium. Indeed, the feedback to this conference was overwhelming, finally more than 300 researchers participated. Hence the idea emerged to collect the results and discussions in a single journal issue. It took more than a year to finish it, and various activities in this rapidly developing area have been going on and were incorporated. We are very grateful to the Editors E. Brunner and M. Schumacher of the Biometrical Journal for their encouragement and support to publish this special issue on the occasion of this conference. Further, the technical assistance and expertise of G. Skipka and K. Thangavelu is gratefully acknowledged. We are also indebted to Peter Bauer and Stephen Senn for their discussions of the subsequent articles by Bristol, Freitag, Hauschke, Slacik-Erben, Hensen and Kaufmann, Hung, Wang and O'Neill, Lange and Freitag, Tsong and Zhang, Wellek, and last but not least we would like to thank Joachim Röhmel for his contribution to this special issue. Joachim Röhmel contributed significantly during the last three decades to various branches of biostatistical research, and in particular to the design and analysis of equivalence trials. The aim of this special issue is therefore twofold, it is also devoted to the occasion of Joachim Röhmel's retirement from BfArM in 2004. In the following we would briefly like to express our deep appreciation of his scientific work. (© 2005 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Clinical issues in using buprenorphine in the treatment of opiate dependenceDRUG AND ALCOHOL REVIEW, Issue 3 2000Dr A. Chadderton MB Abstract This paper looks at the current role of buprenorphine in the treatment of opiate dependence. It suggests that buprenorphine is a useful alternative to methadone and that in at least some cases it may be the preferred option. Buprenorphineis a partial agonist and a partial antagonist with a ceiling of opiate activity probably approximately equal to 30mg methadone. It achieves this at a dose of 10-12mg, although there is considerable individual variation. Because of its ceiling effect it has a good safety profile compared to full agonists such as methadone although some overdose deaths, particularly in conjunction with benzodiazepine abuse, have been reported in France. Induction of buprenorphine may take slightly longer than for methadone and there is a higher dropout rate compared to methadone in the first 2 weeks. This is probably due to the antagonist action of buprenorphine causing more withdrawal symptoms in comparison to methadone. Also, the ceiling effect for buprenorphine means that some clients do not experience sufficient opiate activity to satisfy them. Buprenorphine has a long half-life and dissociates slowly from opiate receptors. Most clients can be dosed second-daily but some find this unacceptable due to mood swings and/or withdrawal symptomson the second day. For these clients daily dosing is required. Transferring from buprenorphine to methadone is straightforward and well tolerated by clients. Transferring from methadone to buprenorphine, however, is more difficult because of the partial antagonist action of buprenorphine. Clients experience withdrawal symptoms that can take up to 2 weeks to settle. Most clients find these symptoms unacceptable when transferring from doses of over 30mg of methadone. The optimum method for transferring from methadone to buprenorphine is still to be determined. Withdrawal from buprenorphine appears to be relatively easier than from methadone. This is presumably due to buprenorphine's partial agonist effect at mureceptors. It is expected that during 2000 buprenorphine will be approved for use in Australia for the treatment of opiate dependence. It may well becomea first-line choice for opiate replacement in heroin dependence. It is also likely to be useful in assisting detoxification fromboth methadone and heroin. [source] Modifiable Risk Factors for Migraine Progression (or for Chronic Daily Headaches),Clinical LessonsHEADACHE, Issue 2006Marcelo E. Bigal MD Herein we summarize clinical issues gleaned from a full peer-reviewed article on modifiable risk factors for migraine. Since migraine is progressive in some but not in most individuals, identifying patients at risk for progression is crucial. Key interventions include: (1) Decrease headache frequency with behavioral and pharmacologic interventions; (2) Monitor the body mass index and encourage maintenance of normal weight; (3) Avoid medication overuse; (4) Avoid caffeine overuse; (5) Investigate and treat sleep problems and snoring; (6) Screen and treat depression and other psychiatric comorbidities. These recommendations have not been demonstrated to improve outcomes in longitudinal studies. [source] Puzzling practice: A strategy for working with clinical practice issuesINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 2 2008Kenneth Walsh RPN RN BNurs PhD In this paper we aim to share the evolution of innovative ways to explore, ,unpack' and reframe clinical issues that exist in everyday practice. The elements of these processes, which we call ,puzzling practice', and the techniques associated with them, were delineated over a two year period by the four authors using action theory based processes. The authors have evolved several different frameworks for ,puzzling practice' which we draw on and use in our practice development work and in our research practice. This paper pays attention to a particular form of puzzling practice that we have found to be useful in assisting individual clinicians and teams to explore and find workable solutions to practice issues. The paper uses a semi-fictitious example of ,Puzzling Practice' gleaned from our experience as practice development facilitators. In this example ,puzzling practice' uses seven different elements; naming the issue; puzzling the issue; testing the puzzle exploring the heart of out practice; formulating the puzzle question; visualizing the future; and generating new strategies for action. Each of the elements is illustrated by the story and the key foundations and ideas behind each element is explored. [source] Behavioral treatment of substance abuse in schizophreniaJOURNAL OF CLINICAL PSYCHOLOGY, Issue 8 2009Wendy N. Tenhula Abstract Co-occurring substance use disorders are highly prevalent among individuals with schizophrenia and other serious and persistent mental illnesses (SPMI) and are associated with clinically significant consequences. A multifaceted behavioral treatment called Behavioral Treatment for Substance Abuse in Serious and Persistent Mental Illness (BTSAS) can reduce substance abuse in persons with SPMI. The key treatment strategies in BTSAS include a urinalysis contingency, short-term goal setting, training in drug refusal skills, psychoeducation about the impact of drug use, and relapse prevention training. A case example illustrating the application of BTSAS is presented and relevant clinical issues are discussed. © 2009 Wiley Periodicals, Inc. J Clin Psychol: In Session 65: 1,11, 2009. [source] Working systemically with family violence: risk, responsibility and collaborationJOURNAL OF FAMILY THERAPY, Issue 4 2001Arlene Vetere In this article we describe a project which aims to ensure prevention and continued protection from violence for family members. We outline our theoretical approach to assessment and working with violence in family relationships and the associated ethical problems. We identify three recurrent themes: risk, collaboration, and responsibility. We focus on our work with couples, where the man is violent towards the woman. Within this discussion we identify other important clinical issues. [source] Eating disorders in adults with intellectual disabilityJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 6 2000S. Gravestock Abstract There is an increasing focus on the nutrition of people with intellectual disability (ID), but less interest in the range of eating disorders (EDs) that they may exhibit and the bio-psycho-social impact of these conditions. Despite diagnostic and methodological difficulties, psychopathology and ED research studies suggest that 3,42% of institutionalized adults with ID and 1,19% of adults with ID in the community have diagnosable EDs. Weight surveys indicate that 2,35% of adults with ID are obese and 5,43% are significantly underweight, but the contribution of diagnosable EDs is unknown. Such data and case reports suggest that EDs are associated with considerable physical, behavioural, psychiatric and social comorbidity. Review papers have focused on the aetiology and treatment of pica, rumination, regurgitation, psychogenic vomiting and food faddiness/refusal. Emerging clinical issues are the development of appropriate diagnostic criteria, multimodal assessment and clinically effective treatment approaches. Key service issues include staff training to improve awareness, addressing comorbidity and access issues, and maintaining support for adults with ID and EDs, and their carers. Research should confirm the multifaceted aetiology and comorbidity of EDs. Then multicomponent assessment and treatment models for EDs can be developed and evaluated. [source] THERAPY WITH LESBIAN AND GAY PARENTS AND THEIR CHILDRENJOURNAL OF MARITAL AND FAMILY THERAPY, Issue 4 2000Jane Ariel This article explores some of the social and clinical issues facing the many different kinds of gay and lesbian families that are becoming increasingly visible in the United States. Research findings are discussed that dispel popularly held myths and sterotypes concerning these families, gays and lesbians as parents, and their children. Clinical vignettes are presented to illustrate issues often encountered in the consulting room, some unique to gay and lesbian families and some common to all families. [source] Teaching sexual history taking to health care professionals in primary careMEDICAL EDUCATION, Issue 6 2001John R Skelton Objectives Although it is accepted that history taking is central to correct diagnosis, little work has been undertaken on the development of sexual history taking, particularly in a primary care context where sexual health may not occur to the patient. Embarrassment is recognized as one major problem. This paper reports on a series of teaching interventions designed to help primary health care professionals (doctors and nurses) to identify and deal effectively with sexual health issues in the consultation. Methods 141 participants took part in nine different courses, with 114 returning evaluations. All courses involved tutorial teaching on clinical and ethicolegal issues and role play with trained professional role-players; some involved video-based dramatizations to particularize principles in context. During role play sessions, which were followed by detailed, contextualized feedback, clinical issues, attitudinal issues (e.g. articulating a sense of personal embarrassment, and the risk of stereotyping), and ethicolegal issues were all discussed, as were examples of words and phrases which participants were invited to try out. Outcomes The overall quality of the courses was rated by participants, on average, at 89·95 (maximum 100), and the relevance of the topic at 91·40. Free text comments centred on the power of the training as a consciousness raiser, on the need to alter communication strategies, the need to change existing clinical practice and the value of role play as a methodology. Interactive courses on sexual health are highly acceptable to participants. [source] Professional identity as a resource for talk: exploring the mentor,student relationshipNURSING INQUIRY, Issue 4 2008Pam Shakespeare This paper discusses a study examining how mentors in nurse education make professional judgments about the clinical competence of their pre-registration nursing students. Interviews were undertaken with nine UK students and 15 mentors, using critical incidents in practice settings as a focus. The study was undertaken for the English National Practice-Based Professional Learning Centre for Excellence in Teaching and Learning. This paper reports on the conversation analytic thread of the work. The mentor role with pre-registration nursing students is not only supportive but involves formal assessment. Central to the relationship is communication. In professional education, communication is seen as a skill to be applied and assessed in practice settings but is also the medium mentors and mentees use to talk about the relationship. Analysis of excerpts of conversation in the interviews shows that episodes of communication are used as topics of conversation to establish professional identity. It also reveals that judgments about the extent of professional capacity of both students and mentors are grounded in everyday behaviours (for example, enthusiasm, indifference and confidence) as well as professional competence. In addition to focusing on clinical issues, mentors can and do use mundane communication as a resource for judgments about competence. [source] Through the Iron Curtain: analytical space in post-Soviet RussiaTHE JOURNAL OF ANALYTICAL PSYCHOLOGY, Issue 2 2006Angela Connolly Abstract: This paper discusses the experience of working as an analyst in post-totalitarian Russia in order to explore some of the general theoretical and clinical issues involved in working in a different cultural and linguistic context, and the particular problems encountered in the Russian cultural context. It describes how the Soviet regime worked actively to create a new totally collective mentality through the destruction of individual differences and the collectivization of private space, and the effects this produced in the individual and collective psyche. It examines the difficulties encountered when working with Russian analysands in creating and maintaining the setting, in preserving boundaries, in creating analytical space, and in working with certain particular transference-countertransference dynamics. It focuses on the contrast between my own Western experience of space and the spatial experience of the analysands, and describes the process of helping them use analytical space to interiorize and create a new experience of psychic space. The paper uses dreams to illustrate some of these dynamics, and the particular psychic problems associated with the traumas created by totalitarian regimes. [source] Biopsy of the oral mucosa and use of histopathology servicesAUSTRALIAN DENTAL JOURNAL, Issue 2010RM Logan Abstract Patients often present with intraoral pathology in the general dental practice setting. Therefore, it is important that dental practitioners are aware of how to deal with pathology when this occurs and have an understanding of investigative techniques that might assist in making a diagnosis. Biopsy and subsequent histological examination of the lesion is an important diagnostic tool. Even if dentists refer the patient to another practitioner for the biopsy, the referring practitioner still needs to be familiar with the procedure and results obtained so that the patient can be appropriately managed. This paper reviews clinical issues that may impact on biopsy procedures and the potential pitfalls and problems that may affect the histological assessment of tissue and therefore affect diagnosis. The medico-legal responsibilities of practitioners are also addressed. [source] Systemic antibiotics in periodontal therapyAUSTRALIAN DENTAL JOURNAL, Issue 2009LJA Heitz-Mayfield Abstract Periodontitis is a biofilm infection with a mixed microbial aetiology. Periodontitis is generally treated by non-surgical mechanical debridement and regular periodontal maintenance care. Periodontal surgery may be indicated for some patients to improve access to the root surface for mechanical debridement. A range of systemic antibiotics for treatment of periodontitis has been documented, with some studies showing superior clinical outcomes following adjunctive antibiotics while others do not. This has resulted in controversy as to the role of systemic antibiotics in the treatment of periodontal diseases. Recent systematic reviews have provided an evidence-based assessment of the possible benefits of adjunctive antibiotics in periodontal therapy. This review aims to provide an update on clinical issues of when and how to prescribe systemic antibiotics in periodontal therapy. [source] Dynamic Chemical Instabilities in Living Cells May Provide a Novel Route in Drug DevelopmentCHEMBIOCHEM, Issue 10 2004Howard R. Petty Dr. Chemical waves, such as the NAD(P)H (green) and Ca2+(white-orange) waves of neutrophils, are emergent properties of living cells that represent the collective behavior of proteins that constitute intracellular subsystems. Studies of these waves suggest novel approaches in drug development and fresh insights into several clinical issues. [source] Multiple Encounter Simulation for High-acuity Multipatient Environment TrainingACADEMIC EMERGENCY MEDICINE, Issue 12 2007Leo Kobayashi MD Patient safety interventions for multitasking, multipatient, error-prone work settings such as the emergency department (ED) must improve assorted clinical abilities, specific cognitive strategies, and teamwork functions of the staff to be effective. Multiple encounter simulation scenarios explore and convey this specialized mental work-set through use of multiple high-fidelity medical simulation (SIM) manikins in realistic surroundings. Multipatient scenarios reflect the work situations being targeted yet have the benefit of scripted control and instructor guidance to advance specific educational objectives. The use of two or more SIM patients promotes the exploration not only of multiple distinct clinical issues but also of interdependent processes pervasive in EDs. Cascading shortages of time, personnel, equipment, and supplies are re-created, thereby replicating process limitations at various levels, in a safe environment in which compensatory actions and adaptive behaviors can be learned. Distinguishing features of multipatient exercises include 1) broadened educational scope and expanded indications for SIM application, 2) enhanced scenario complexity, 3) controlled exposure to high workload environments, 4) expanded communication requirements, and 5) increased potential for reflective learning. Widespread and effective training in well-replicated, carefully coordinated representations of complex multipatient work environments may strengthen educational interventions for personnel working in high acuity and work-overloaded settings such as the ED. The use of concurrent patient encounter SIM exercises to elicit calculated stressors and to foster compensatory staff behaviors is an educational advance toward this objective. The authors present SIM methodology using concurrent patient encounters to replicate these environments. [source] Development of an imaginal provocation test to evaluate treatment for anger problems in people with intellectual disabilitiesCLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 4 2004John L. Taylor Anger and associated aggressive behaviour are significant clinical issues for many people with intellectual disabilities (IDs) that can lead to serious constraints to their liberty, which, in turn, adversely affects their quality of life. There is some evidence to support cognitive,behavioural anger treatment in this client group; however, anger assessment protocols for people with IDs should be diversified. In this regard, a method for anger assessment using imaginal provocation scenes was extended for use with this client population and the context in which treatment takes place. Two studies of the Imaginal Provocation Test (IPT) were conducted: the first with 48 patients examined its internal reliability and concurrent validity with anger psychometric scales; the second investigated whether it was sensitive to change associated with anger treatment in a small outcome study involving men with IDs and histories of offending. The IPT was found to successfully induce anger, be internally reliable, have strong concurrent validity and detect statistically significant changes in anger following anger treatment (N = 9), compared with a routine care waiting-list control group (N = 8). The IPT also had value in highlighting clinical improvements for anger treatment condition participants compared with the control group.,Copyright © 2004 John Wiley & Sons, Ltd. [source] Narrative Methods and Children: Theoretical Explanations and Practice IssuesJOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 1 2008Lorna Bennett RN TOPIC:,The Narrative approach is an innovative way of working with children and adolescents experiencing mental health problems. This approach can be effectively integrated with the expressive arts and other nonverbal ways of accessing the life world of children. In addition, the approach promotes respect for and collaboration with the child in working towards healing and growth. PURPOSE:,In this paper core features of the narrative approach are described; the theoretical and philosophical and evidence base for this approach as well as its congruence with the special nature and needs of children will be explored. Finally, the benefits and challenges of this approach in relation to a specific clinical situation will be highlighted. SOURCES USED:,Published literature and the author's clinical experiences. CONCLUSION:,Narrative methods are ideally suited for addressing needs of children experiencing mental health problems and can enhance therapeutic effectiveness. Some of the challenges associated with its use include: finding creative ways to apply specific narrative concepts and methods with diverse clinical issues/problems; learning to collaborate with children and respect them as experts in their own lives; and shifting the nursing focus from a problem-focused orientation to a strength-oriented and child-centered approach. [source] | ||||||||||||||||