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PubMed2001

[Effective clinical information system closely connected with clinical laboratory data for infectious diseases].

Nowadays, information on clinical laboratory tests for infectious disease is almost supported by information on such as clinical, identical and susceptible microbiological tests. However, information support necessary for clinical diagnosis and therapy with clinically valuable data remains unsatisfactory. To offer more useful microbiological information to support clinics from clinical laboratory division, exchange of clinical information between clinical divisions, integrated systems of clinical information in the district and establishment of domestic and international information network et al are required. Establishment of these advanced total information network systems for clinical microbiological tests for infectious diseases may exceedingly contribute to earlier diagnosis, control and prevention of various infectious diseases.

Clinical Laboratory Information Systems↗

PubMed1990

Clinical and non-clinical binges.

A study was conducted to determine if, and in what respects, clinical binges (reported by bulimic subjects) are different from non-clinical binges (reported by a non-clinical population). Furthermore, the study tested whether the DSM-III-R criteria and other variables that are retrospectively claimed to be defining characteristics indeed differentiate binges from non-binge eating episodes. Clinical binges appeared to differ from non-clinical binges as to amount of calories ingested and duration. With respect to subjective experience, clinical and non-clinical binges did not differ. The DSM-III-R criteria for binge eating discriminate clinical and non-clinical binges quite well from non-binges. With the addition of other seemingly important variables, binges are not discriminated better from non-binges than with the DSM-III-R variables alone. It is argued that the difference between pathological binge eating and non-clinical binge eating is mainly a matter of severity.

Adult↗

PubMed1994

Clinical-molecular correlation in 104 mild X-linked muscular dystrophy patients: characterization of sub-clinical phenotypes.

A multidisciplinary study was conducted in order to assess dystrophin expression in a large series of mild X-linked muscular dystrophy patients, with well-defined clinical phenotype. Patients (104) were divided in 4 clinical groups, according to clinical severity: asymptomatic (sub-clinical), benign, moderate and severe, Cardiopathy was also assessed, and dilated cardiomyopathy was found in 47% of sub-clinical and benign cases. Myoglobinuria, cramps and myalgia were also associated with a sub-clinical or benign clinical status. Dystrophin immunohistochemical pattern of labelling and dystrophin amount decreased gradually across clinical groups. Our study showed a significative correlation between: (1) dystrophin amount and immunohistochemical score (p < 0.05); (2) dystrophin amount and clinical score (p < 0.05). Therefore, the combined use of these different techniques for prognosis of mild X-linked muscular dystrophy patients is useful. Our study assesses the prevalence of the various disease courses in a large cohort of mild X-linked muscular dystrophy patients. From our series, up to 30% of patients may be either asymptomatic or have sub-clinical changes.

Adolescent↗

PubMed2005

In clinical practice, masked hypertension is as common as isolated clinic hypertension: predominance of younger men.

BACKGROUND: The prevalence and implications of masked hypertension are under investigation. The aim of this study was to investigate the clinical characteristics associated with masked hypertension in subjects referred for ambulatory blood pressure (BP) monitoring. METHODS: We analyzed 1494 BP monitoring sessions. A subject was considered to have isolated clinic hypertension if clinic BP was > or =140/90 mmHg and awake BP was <135/85 mmHg. Masked hypertension was diagnosed when clinic BP was <140/90 mmHg and awake BP was > or =135/85 mmHg. RESULTS: Of 1494 individuals, 16% had normal BP, 11% had isolated clinic hypertension, 61% had hypertension, and 11% had masked hypertension. Subjects with masked hypertension were younger and more likely to be male than subjects with isolated clinic hypertension, and their awake heart rate was significantly higher. A negative correlation was found between the awake-clinic systolic BP difference and clinic systolic BP (r = -0.7, P < .0001). The reproducibility of the masking phenomenon was comparable to that of other variables. CONCLUSIONS: In a group of consecutive subjects referred for ambulatory BP monitoring, masked hypertension was found to be as common as isolated clinic hypertension. Masking was correlated with male sex, young age, and higher awake heart rate, thus suggesting a causal relationship with greater daytime physical activity. The linear association of the masking and the white-coat effects to clinic BP suggests that regression toward the mean may partially explain these phenomena.

Adult↗

PubMed1999

Clinical audit and the contribution of the laboratory to clinical outcome.

Medical and clinical audit are tools introduced in an attempt to assess clinical performance. Clinical audit implementation in practice should follow that of the audit and the learning cycles. Ideally, audit should assess the outcome of clinical care. However, many audit projects concentrate on the process of care, which is more amenable to review. One of the cornerstones of audit is the setting up of agreed standards of care. This takes the form of clinical practice guidelines derived, preferably from the outcome of randomised double-blind controlled trials as the basis of evidence-based medicine. The assessment of the contribution of the clinical laboratory to patient outcome could be seen as a further extension of clinical audit in the practice of laboratory medicine. Areas where this contribution may be assessed include validity and usefulness of diagnostic tests, the assessment of analytical goals in relation to patient outcome, variation in inter-laboratory performance and its effect on decision limits and whether any measurement or set of measurements contribute to improved outcome. The practice of clinical audit and the application of evidence-based medicine are seen as powerful educational tools, though there is much work to be done to assess their contribution to clinical outcome. Randomised clinical trials could form the basis for the assessment of the value and contribution of the laboratory to the outcome.

Evidence-Based Medicine↗

PubMed2000

Cancer worries, risk perceptions and associations with interest in DNA testing and clinic satisfaction in a familial colorectal cancer clinic.

Multi-disciplinary familial cancer clinics are becoming an integral part of cancer services. It is, therefore, important to assess how attendance at these clinics impacts on cancer-related concerns, risk perceptions and behavioural intentions, and how the clinic services are being received by those using them. This study has assessed a familial colorectal cancer clinic with respect to cancer-related worries and risk perceptions and their impact on interest in DNA testing and overall satisfaction with the clinic. Pre- and post-clinic questionnaires were completed by 127 patients and relatives attending the clinic. After attending the clinic, the proportion of people 'very' or 'extremely' worried about developing bowel cancer reduced from 49 (pre-clinic) to 34% (p = 0.002). Worry about bowel cancer was positively associated with younger age, higher education level and higher perceived risk of developing cancer. A reduction in level of risk perception correlated with a lower likelihood of feeling 'very worried' about developing bowel cancer. Of those intending to go ahead with DNA testing, 58% were 'very worried' about bowel cancer compared with 15% of those not intending to proceed with testing, suggesting that worry was a motivation for interest in DNA testing. One-third of participants indicated another session of genetic counselling would be helpful. Within this group, a higher proportion was very worried about bowel cancer (43%) than for those who did not want another session (17%). Attendance at this familial colorectal cancer clinic alleviated worry for many individuals, partly due to improved information about risk of colorectal cancer.

Adult↗

PubMedDate not supplied

[Outpatient rehabilitation of alcohol dependent patients in a day clinic: initial results of a comparative follow-up study of day clinic and inpatient treatment].

This article describes the development of an outpatient concept for the day-clinic withdrawal treatment of alcohol dependent persons in a Hamburg institution for addiction aid. It reports the initial, selected results of a comparative follow-up study of patients discharged during the years 1998-2000, who either receive ambulatory treatment in the day clinic (n = 270) or inpatient treatment in the institution's special clinic (n = 462). Assessable questionnaires are available from 131 outpatients of the day-clinic treatment and 173 patients of the inpatient treatment form. The response rate - with reference to the group of those who were reachable - was 57.2 % for patients of the day clinic and 53.2 % for patients of the special clinic. The results of the study arrive at the conclusion that both treatment forms can be seen as thoroughly comparable with regard to primary outcome measurements (for example reduction of psychological stress, abstinence rates, reintegration into occupational life). Rehabilitants treated in the inpatient setting more frequently report that they had already contacted centres for further treatment and self-help groups during the rehabilitation phase, which however doesn't lead to a change of participation behaviour following the rehabilitation phase. This serves to confirm the assumption that an additional offer of a day-clinic service in the area of addiction rehabilitation provides a further, effective treatment concept that sensibly supplements the otherwise inpatient-oriented treatment landscape. The results indicate the quality of the work performed in the day clinic studied (as well as in the inpatient clinic) and should encourage the funding agencies and employees of other day clinic institutions in the field of addiction rehabilitation to participate in evaluation and quality assurance measures, thus continuing to bridge the gap between the (theoretical) state of knowledge concerning outpatient rehabilitation and the degree to which it can be successfully realized.

Adult↗

PubMed2006

Practice-based clinical research and ethical decision making--Part I: deciding whether to incorporate practice-based research into your clinical practice.

Calls for increasing clinical research in routine care settings aim to improve the empirical and ethical foundations of evidence-based practice. In the treatment and prevention of stroke many troubling management questions remain uninvestigated by the clinical research enterprise. Many practicing physicians perceive available data as having limited applicability to their average patients. Recent efforts by the National Institute of Neurological Disorders and Stroke seek to establish clinical research networks that will expand the role of private practice physicians in the conduct of research on stroke and other neurological diseases, akin to practice-based research networks supported by the Agency for Healthcare Research and Quality and other National Institutes of Health institutes. Adding clinical research to one's practice of medicine has practical and ethical implications. Furthermore, because of the growth and expansion of clinical research, all practicing physicians should have a fundamental understanding of clinical research and the differences between clinical care and clinical research, even if they are not directly involved in the conduct of clinical research, to appropriately advise their patients. In this and the following article, we offer two practical frameworks to aid physicians contemplating adding clinical research to their everyday practice of medicine.

Decision Making↗

PubMed1986

[Fetal monitoring sub partu in West Germany. II. Effect of clinic size and clinic type on monitoring practice].

Data from 690 clinics concerning obstetric management and intensive monitoring of the fetus sub partu were classified according to the type of hospital (e. g., municipal clinic, district hospital...) and the size of the hospital based on the number of births per year. On the basis of the annual number of births four groups (I-IV) were formed, each with 172 clinics. While the average number of surgical deliveries (cesarean, forceps, vacuum) is not related to the hospital (Table 3), it is related to the type of hospital (Table 6): the average number of cesarean deliveries is highest in university clinics (n = 24; 14.9%), and on average more forceps (6.5%) than vacuum extractions (5.7%) are performed. In all other hospitals vacuum extraction is clearly preferred (7-8%). The quotient Q of the annual number of births per CTG unit is not constant, but increases with the size of the clinic: In large hospitals (Group IV) significantly more births are monitored with a CTG unit (maximum 607, average 215), so that there is a numerical "monitoring deficit" as compared to smaller departments. The monitoring capability is numerically highest in the university clinics (Q = 147) and lowest in the academic teaching hospitals (Q = 192). The larger the clinic, the more frequently fetal blood is analyzed: the figure in large clinics is 40%. Small clinics are less familiar with this method (approx. 16%). The larger the clinic, the more often intrauterine catheters are used to measure labor; the figure rises from 7% to 29%.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Rate↗

PubMed2004

Molecular characterization of clinical Saccharomyces cerevisiae isolates and their association with non-clinical strains.

We assessed the molecular characterization of 96 clinical isolates of S. cerevisiae from a Spanish medical institution and we compared them with 6 non-clinical strains isolated from wine, beer and bread and 1 S. boulardii strain collected from a commercial preparation. The strains were subjected to HinfI mtDNA restriction analysis and PCR amplification of delta sequences. Although both techniques are appropriate for routine clinical analysis, that based on PCR turned out to be the most discriminating. This study, apart from providing tools for clinical application, deals with the relationships between clinical and non-clinical strains. The two baker's yeasts analysed shared mtDNA and PCR patterns with a group of 31 clinical isolates. An exogenous entry of a strain was also reflected in the case of 19 clinical isolates and the therapeutic strain S. boulardii. Both baker's yeasts and S. boulardii were identified respectively among 32.3% and 19.8% of the clinical isolates and there seemed to be a connection between their ability to colonize humans and their ability to cause vaginal infection. The rest of food isolates were not grouped with clinical strains.

DNA, Fungal↗

PubMed2001

How discriminatory is the objective structured clinical examination (OSCE) in the assessment of clinical competence of medical students?

A prospective collection and analysis of examination marks for three consecutive academic years was undertaken to determine the correlation between the objective structured clinical examination (OSCE) and various other components of medical students' examination, and also to examine how discriminatory the OSCE examination is in the assessment of clinical competence. Out of 388 students, 96.3% passed the examination at the first attempt. Of those who passed, 15.5% had merit while 1.0% had a distinction. When the OSCE component was excluded from the analysis, 11.6% and 2.8% had merits and distinctions, respectively, but when the clinical examination was excluded, there were 17.8% and 6.2% merits and distinctions, respectively. Correlations between the various components of the examination were significant except for that between the clinical examination and the project. Although the OSCE and clinical components of examinations for clinical students are complementary, the OSCE component awards more merit and distinction categories. Although there were statistically significant correlations between the various components of the examination, only 11% of the variability in clinical examination scores could be explained by the performance in OSCE suggesting that the different components are testing different aspects of the student's clinical competence. Completely replacing clinicals with an OSCE may not necessarily be the best way of assessing medical students' clinical competence.

Journal Article↗

PubMed2002

Development of the Knee Standardized Clinical Interview: a research tool for studying the primary care clinical epidemiology of knee problems in older adults.

OBJECTIVE: To develop a standardized clinical interview, incorporating the perspectives of general practitioners (GPs) and rheumatologists, for primary care clinical epidemiological studies of adults aged 50 yr and over with knee problems. METHODS: Two parallel, consensus development studies using a modified nominal group technique involving GPs (n=5) and consultant rheumatologists (n=4) from North Staffordshire with reference panels of GPs (n=28) and rheumatologists (n=11) from selected centres in Great Britain, respectively. A single standardized clinical interview was formed using the clinical history questions identified in the consensus development studies and its feasibility was tested in a small sample of patients. RESULTS: In the GP consensus development study, 115 clinical history questions were identified, of which 71 were of agreed importance following postal rating, face-to-face discussion and re-rating. In the rheumatologist study, 158 questions were identified, of which 47 were of agreed importance. There was considerable overlap in the clinical history questions independently developed by the two studies. A single standardized clinical interview containing 74 questions was formed. It contained questions on the history, onset and recent course of the complaint; nature, location and severity of current knee symptoms; impact of knee problem; past history of knee problems; family history; comorbidity; previous/current investigations and treatment; ideas, concerns and expectations. In preliminary testing it took 20-45 min to conduct and was comprehensible to patients. CONCLUSIONS: A research tool-the Knee Standardized Clinical Interview (KNE-SCI)-has been formed from consensus development studies involving GPs and rheumatologists. In preliminary testing, it is comprehensible to patients, and forms a coherent clinical interview for research data collection. However, further evaluation is required to determine its accuracy and reliability and its usefulness for clinical epidemiological research.

Aged↗

PubMed2002

The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder?

OBJECTIVE: To assess whether published studies support basing the diagnosis of compartment syndrome of the lower leg on clinical findings. DATA SOURCES: A MEDLINE search of the English literature from 1966 to 2001 was performed using "compartment syndromes" as the subject. A manual search of the bibliographies of retrieved articles and of major orthopaedic texts was also performed. STUDY SELECTION AND EXTRACTION: Of 1,932 titles identified, 433 abstracts of potential relevance were reviewed, and 104 articles from relevant abstracts were examined in their entirety. Four studies met all eligibility criteria. Criteria for inclusion included the following: (a) target population, traumatic or iatrogenic tibia injuries; (b) diagnostic test, presence of data needed to calculate both the sensitivity and specificity of clinical findings; (c) outcome, the presence or absence of compartment syndrome; and (d) methodologic criteria, prospective study design. DATA SYNTHESIS: The likelihood ratio form of Bayes' theorem was used to assess the discriminatory ability of the clinical findings as tests for the compartment syndrome. CONCLUSIONS: There are limited data from which to define the usefulness of clinical findings for the diagnosis of compartment syndrome. Data from eligible studies suggest that the sensitivity of clinical findings for diagnosing compartment syndrome is low (13% to 19%). The positive predictive value of the clinical findings was 11% to 15%, and the specificity and negative predictive value were each 97% to 98%. These findings suggest that the clinical features of compartment syndrome of the lower leg are more useful by their absence in excluding the diagnosis than they are when present in confirming the diagnosis. Likelihood ratio calculations found that the probability of compartment syndrome with one clinical finding was approximately 25%, and the probability was 93% with 3 clinical findings present. However, these findings are based on limited information; because of the paucity of data available, the predictive value of the clinical findings for the diagnosis of compartment syndrome has yet to be defined.

Compartment Syndromes↗

PubMed2006

Clinical selection of melanocytic lesions for dermoscopy decreases the identification of suspicious lesions in comparison with dermoscopy without clinical preselection.

BACKGROUND: In most cases dermoscopy is performed only on lesions selected by clinical inspection which present worrying clinical features or appear to deviate from the patient's average type of naevus. Thus, possible early malignant melanomas (MMs) or MM precursors, lacking typical clinical characteristics, may elude the dermoscopic examination. OBJECTIVES: To perform a comparison between two different approaches to the patient's examination, one based on a clinical preselection of lesions to be examined by dermoscopy, and the other consisting of the dermoscopic scrutiny of all melanocytic lesions with a diameter>or=2 mm (total dermoscopy). METHODS: Sixty-three consecutive patients with MM, undergoing periodic dermoscopic examinations of their naevi, were enrolled in the study. The patients first underwent an assessment of the entire skin with the unaided eye for the identification of lesions for dermoscopy. Subsequently, the patients underwent dermoscopic examination of all melanocytic lesions. Images of naevi identified by clinical examination or by total dermoscopy as having dermoscopic aspects characteristic of a suspicious lesion, i.e. necessitating either surgical excision or follow-up examinations, were separately recorded, classified and described employing the ABCD rule of dermoscopy and the seven-point checklist. RESULTS: Five hundred and fifty-one lesions were chosen by clinical inspection for subsequent dermoscopic examination; among these, 117 were considered for excision or follow-up. Ninety-two further lesions were identified for excision or follow-up by employing only total dermoscopy. Dermoscopy scores of lesions selected by clinical inspection plus dermoscopy were similar to those identified by dermoscopy alone. In the former group, 13 lesions showed either an ABCD or a seven-point score corresponding to a suspicious lesion, whereas eight such lesions were identified only by total dermoscopy. Thus, by clinical selection plus dermoscopy we were able to identify only 62% of dermoscopically suspicious lesions. CONCLUSIONS: Clinical selection of melanocytic lesions for dermoscopic examination is associated with the 'loss' of a conspicuous number of lesions which deserve surgical excision or follow-up examinations. Total dermoscopy, enabling the detection of suspicious lesions, together with storage, retrieval and sequential comparison of their images, could enhance MM diagnosis by follow-up, in comparison with clinical preselection for dermoscopy.

Adult↗

PubMed2006

Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings.

BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a prothrombotic adverse drug reaction caused by heparin. As thrombocytopenia is common in hospitalized patients receiving heparin, it would be useful to have a clinical scoring system that could differentiate patients with HIT from those with other reasons for thrombocytopenia. AIM: To compare prospectively the diagnostic utility of a clinical score for HIT in two different clinical settings. METHODS: The pretest clinical scoring system, the '4 T's', was used to classify 100 consecutive patients referred for possible HIT in one hospital (Hamilton General Hospital, HGH) into high, intermediate, and low probability groups. This system was also used to classify likewise 236 patients by clinicians in Germany referring blood for diagnostic testing for HIT in Greifswald (GW). The clinical scores were correlated with the results of laboratory testing for HIT antibodies using the serologic criteria for HIT with high diagnostic specificity. RESULTS: In both centers, patients with low scores were unlikely to test positive for HIT antibodies [HGH: 1/64 (1.6%), GW: 0/55 (0%)]. Patients with intermediate [HGH: 8/28 (28.6%), GW: 11/139 (7.9%)] or high scores [HGH: 8/8 (100%), GW: 9/42 (21.4%)] were more likely to test positive for clinically significant HIT antibodies. The positive predictive value of an intermediate or high clinical score for clinically significant HIT antibodies was higher at one center (HGH). CONCLUSIONS: A low pretest clinical score for HIT seems to be suitable for ruling out HIT in most situations (high-negative predictive value). The implications of an intermediate or high score vary in different clinical settings.

Adult↗

PubMed1997

Provision for sexual health care of adolescents in genitourinary medicine clinics in the United Kingdom. The British Cooperative Clinical Group.

OBJECTIVES: To investigate the provision for sexual health care of adolescents in genitourinary medicine clinics in the United Kingdom. METHODS: A questionnaire was sent to all 170 consultants in charge of genitourinary medicine clinics in the United Kingdom. RESULTS: Completed questionnaires were received from 119 consultants in charge of clinics. Eleven per cent of attenders during April-June 1995 were aged under 20 years. Attenders aged under 16 years and from 16-19 years old were found to have significantly higher rated of gonorrhoea than those aged over 19. The same applied to male attenders with chlamydia. Female attenders aged 16-19 had significantly higher rates of anogenital warts than those aged over 19. Thirty six per cent of female cases of gonorrhoea occurred under the age of 20 years. In most clinics (74%) it was policy for a new clinic attender aged under 16 years to see a health adviser. Most clinics (79%) provided emergency contraception, but few (14%) had a full contraception service. Most clinics participated in STD/HIV/sexual health education in the local community, especially in schools (74%) and colleges (70%). Seventy five per cent of health authorities had medical services designated for young people, but only 18% had such services which offered screening for STDs. Only 4% of genitourinary medicine clinics held sessions which were designated for young people (upper age limit 21 years or less). CONCLUSIONS: Genitourinary medicine clinics in the United Kingdom provide a range of services, including extensive education in the community, to promote sexual health among adolescents. A critical evaluation of the quality of health education activity by genitourinary medicine clinics would be of interest.

Adolescent↗

PubMed2005

Quality of life in Parkinson's disease: movement disorders clinic vs general medical clinic--a comparative study.

OBJECTIVES: to determine the effect of attending a movement disorders (MD) clinic on quality of life (QOL) outcomes for patients with Parkinson's disease (PD). METHODS: Postal questionnaire study of forty-two patients with Parkinson's disease attending either a movement disorders clinic or more conventional general medical clinic were selected consecutively to complete the Parkinson's Disease Quality of Life Questionnaire (PDQL). All patients were diagnosed by a consultant physician with an interest in Parkinson's disease (S.B.R.) and had attended either the movement disorders clinic or the general medical clinic on at least three occasions. Questionnaires were completed independently of the examiners and returned by post. RESULTS: Mean PDQL score was 124.1 [5.16] in the movement disorders clinic and 95.9 [5.86] in the general medical clinic. Analysis of covariance revealed that those subjects attending the MD clinic reported a significantly higher QOL than those subjects in general medical care (F(1,39)= 161.98, P < 0.001). CONCLUSION: These data indicate that the quality of life of respondents attending the movement disorders clinic is significantly higher than those attending the general medical clinic.

Aged↗

PubMed2000

The effects of clinical decision making on nurse practitioners' clinical productivity.

The degree of clinical decision making and clinical productivity among nurse practitioners (NPs) is of great interest to policy makers and planners involved in providing appropriate outpatient primary care services. The authors performed a statewide mailed survey of all NPs practicing either full-time or part-time in Wisconsin (response rate of 72.1%) to address the following research questions: Do the demographic characteristics, practice attributes, and primary practice settings of NPs impact their level of clinical decision making (e.g., the autonomy to order laboratory and radiological tests or to refer a patient to a physician specialist other than their collaborating physician)? Do NPs' levels of clinical decision making correlate with their outpatient clinical productivity, adjusting for demographic characteristics, practice attributes, and primary practice settings? The multiple linear regression results indicated that having more years in practice as an NP, practicing in the family specialty area (vs. a combined other category, which included pediatrics, acute care, geriatrics, neonatal, and school), treating patients according to clinical guidelines, practicing in settings with a fewer number of physicians, and practicing in a multispecialty group practice versus a single-specialty group practice were associated with greater levels of clinical decision making. However, NPs who primarily practiced in a hospital/facility-based practice, as compared with a single-specialty group practice, had lower levels of clinical decision making. After adjusting for demographic characteristics, practice attributes, and primary practice settings, NPs with greater clinical decision-making authority had greater outpatient clinical productivity. The conclusions discuss the policy implications of the findings.

Decision Making↗