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Clinical Time (clinical + time)
Selected AbstractsThe Status of Bedside Ultrasonography Training in Emergency Medicine Residency ProgramsACADEMIC EMERGENCY MEDICINE, Issue 1 2003Francis L. Counselman MD Abstract Bedside ultrasonography (BU) is rapidly being incorporated into emergency medicine (EM) training programs and clinical practice. In the past decade, several organizations in EM have issued position statements on the use of this technology. Program training content is currently driven by the recently published "Model of the Clinical Practice of Emergency Medicine," which includes BU as a necessary skill. Objective: The authors sought to determine the current status of BU training in EM residency programs. Methods: A survey was mailed in early 2001 to all 122 Accreditation Council for Graduate Medical Education (ACGME)-accredited EM residency programs. The survey instrument asked whether BU was currently being taught, how much didactic and hands-on training time was incorporated into the curriculum, and what specialty representation was present in the faculty instructors. In addition, questions concerning the type of tests performed, the number considered necessary for competency, the role of BU in clinical decision making, and the type of quality assurance program were included in the survey. Results: A total of 96 out of 122 surveys were completed (response rate of 79%). Ninety-one EM programs (95% of respondents) reported they teach BU, either clinically and/or didactically, as part of their formal residency curriculum. Eighty-one (89%) respondents reported their residency program or primary hospital emergency department (ED) had a dedicated ultrasound machine. BU was performed most commonly for the following: the FAST scan (focused abdominal sonography for trauma, 79/87%); cardiac examination (for tamponade, pulseless electrical activity, etc., 65/71%); transabdominal (for intrauterine pregnancy, ectopic pregnancy, etc., 58/64%); and transvaginal (for intrauterine pregnancy, ectopic pregnancy, etc., 45/49%). One to ten hours of lecture on BU was provided in 43%, and one to ten hours of hands-on clinical instruction was provided in 48% of the EM programs. Emergency physicians were identified as the faculty most commonly involved in teaching BU to EM residents (86/95%). Sixty-one (69%) programs reported that EM faculty and/or residents made clinical decisions and patient dispositions based on the ED BU interpretation alone. Fourteen (19%) programs reported that no formal quality assurance program was in place. Conclusions: The majority of ACGME-accredited EM residency programs currently incorporate BU training as part of their curriculum. The majority of BU instruction is done by EM faculty. The most commonly performed BU study is the FAST scan. The didactic component and clinical time devoted to BU instruction are variable between programs. Further standardization of training requirements between programs may promote increasing standardization of BU in future EM practice. [source] Clinical randomized controlled trial of chemomechanical caries removal (CarisolvÔ)INTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 3 2006M. A. LOZANO-CHOURIO Summary., Objectives., The purpose of this study was to compare the chemomechanical caries-removal system (CarisolvÔ) with high-speed excavation in cavitated occlusal caries of primary molars. Design and setting., The study was a randomized controlled, clinical trial in which the two techniques were compared in each subject. Participants were chosen from public schools, in Maracaibo County, Zulia State, Venezuela. Sample and methods. The sample consisted of 80 primary molars selected from 40 children (mean age 7·7 ± 0·7 years). Each patient had at least two contralateral primary molars with cavitated occlusal caries and approximately equal-size access to lesions. The outcome variables were: clinically complete caries removal, size of the opening of the cavity, volume of carious tissue removed, pain during caries removal, anaesthesia requested by the patient, caries-removal time, and behaviour and preference of patients. Results., All treated molars were clinically caries free whichever caries-removal procedure was used. When Carisolv, was used the final cavity entrance sizes were smaller (P < 0·001) and the estimated volume of tissue removed was less (P < 0·001). The time taken for caries removal was three times longer (7·51 ± 1·83 min, P < 0·001). Some pain was reported by seven (17·5%) participants when Carisolv was used, compared with 16 (40%) when high-speed excavation was used (P < 0·05). Using the Carisolv method there was a higher proportion of patients with positive behaviour (P < 0·01), and 71·0% (P < 0·05) preferred this treatment. Conclusion., Carisolv is an effective clinical alternative treatment for the removal of occlusal dentinal caries in cavitated primary molars; it is more conservative of dental tissue and appeared to be more comfortable for most patients, although the clinical time spent is longer than when using high-speed excavation. [source] Breast cancer in young families: a qualitative interview study of fathers and their role and communication with their children following the diagnosis of maternal breast cancerPSYCHO-ONCOLOGY, Issue 1 2009Gillian Forrest Abstract Objective: To explore father,child communication following the diagnosis of maternal breast cancer, examine disparities in their understandings of the impact of the illness, and identify gaps in their need for support and information. Methods: The design is the qualitative interview study with thematic analysis. The interviews were home-based with fathers and children in Oxfordshire, UK. The participants were 26 fathers whose partners had early breast cancer and 31 of their children aged between 6 and 18 years. Results: Fathers described graphically their reaction to news of their partner's breast cancer and their attempts to provide support for their partners and maintain normal family life for their children. Fathers were keen to reassure and protect children but often said that they lacked sufficient information about breast cancer,especially side effects of treatments. Fathers sometimes did not recognise the extent of their children's distress and some interpreted their children's reactions as ,bad behaviour' or ,rudeness'. Children were often acutely aware of the father's emotional state, and expressed a wish to protect him. Some fathers would have liked an opportunity to talk to a clinician directly about the children but did not want to claim clinical time for themselves or their children. Conclusion: This study suggests that clinicians could improve their care of breast cancer patients by being more family-centred. Fathers routinely need more information and preparation about the likely impact of the illness and its treatment (especially side effects) on the mother, and how children of different ages may react to the emotional strain. Clinicians need to be prepared to offer to talk to teenagers. Copyright © 2008 John Wiley & Sons, Ltd. [source] Surgical workforce in New Zealand: characteristics, activities and limitationsANZ JOURNAL OF SURGERY, Issue 4 2009Antony Raymont Planning the future surgical workforce is a vitally important activity in which the Royal Australasian College of Surgeons is actively engaged. This paper reports on a survey, undertaken in late 2005, of all vocationally registered New Zealand surgeons. It describes their age and gender distribution, their workload, the distribution of their work hours and limitations on their activities. It is hoped that this will contribute to planning of surgical services for the future. Of surgeons surveyed, 452 (73%) responded. Their mean age was 51 years and 7% were female. Recruitment has been stable at approximately 20 per year since 1990. New Zealand surgeons worked, on average, 48 h per week and could accommodate additional work. Seventy-seven per cent of surgeons took after-hours calls and reported a 55% chance of returning to the hospital each week (30% in the main population centres and 70% in other districts). Overall, surgeons spent 50% of their clinical time in private practice. Most surgeons experienced significant resource constraints in providing surgical care. The current workload of surgeons in New Zealand is acceptable but after-hours duties, especially in secondary hospitals, may be unattractive. Surgical services are currently limited by institutional resources. If there is a substantial increase in the need for surgery in the future, surgical recruitment, which has been stable, should be increased. [source] Survivorship care after breast cancer: Follow-up practices of Australian health professionals and attitudes to a survivorship care planASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 2 2010Meagan E BRENNAN Abstract Objective: The increasing number of breast cancer survivors and the complexity of follow-up care make the provision of high-quality survivorship care a challenge. This study explored the follow-up practices of health professionals and their attitudes to alternative models such as shared care and the use of a survivorship care plan. Methods: Specialist oncologists (surgeons, medical and radiation oncologists) breast physicians and breast-care nurses completed an online survey. Results: A total of 217 practitioners completed the survey, which was estimated to include 42.8% of oncologists treating breast cancer in Australia. One-third of responding specialists reported spending more than 25% of their clinical time providing follow-up care. They reported many positive aspects to follow-up consultations and viewed follow-up care as an important part of their clinical role but expressed concern about the sustainability of follow-up care in their practices. The follow-up intervals and recommendations were in line with national guidelines. The specialists were supportive of sharing follow-up care with primary-care physicians, breast physicians and breast-care nurses. Most professionals felt that a survivorship care plan would improve care and said they would use a proforma. Conclusion: The oncologists felt that follow-up care was an important part of their role and they were supportive of the concepts of shared care programs and a survivorship care plan. Input from consumers is required to evaluate the acceptability of these alternative models and to assess ways of implementing these changes to work towards a more comprehensive and sustainable method of delivering survivorship care. [source] Clinical nurse specialist care managers' time commitments in a disease-management program for bipolar disorderBIPOLAR DISORDERS, Issue 6 2004Henry A Glick Objectives:, As part of a cost-effectiveness analysis for Department of Veterans Affairs Cooperative Studies Program #430, ,Reducing the Efficacy-Effectiveness Gap in Bipolar Disorder,' we conducted a time and motion study to quantify the time psychiatric clinical nurse specialist (CNS) care managers spent providing care for patients. Methods:, Clinical nurse specialist care managers completed activity logs in which they recorded time spent implementing the Bipolar Disorders Program (BDP) during a 1-week period in spring, summer, fall and winter over a 1-year period when caseloads were at steady state. Mean service time was estimated by use of univariate analysis of means and by multivariable regression analysis. Results:, On average CNS care managers spent 40% of their clinical time in activities that typically are reimbursed (e.g. clinic visits) and spent the remaining 60% of their time in activities that are typically unreimbursed. Total clinic time increased as the number of visits per day increased; however, this increase got smaller with each additional visit per day. Conclusions:, As with other chronic illness management programs, CNS care managers expend a substantial portion of their clinical effort for the BDP in activities that are typically unreimbursed. Their activities have a fixed component per day as well as a component that systematically varies with the number of visits per day. These findings should be considered when costing out and disseminating psychiatric and other medical chronic illness management programs. [source] | ||||||||||