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PubMedDate not supplied

Capturing a vision for nursing: undergraduate nursing students in alternative clinical settings.

An urgent need to secure additional community health placements provided initial motivation to use alternate clinical settings. Subsequent student requests for placement in these settings, rather than the traditional community settings, drew attention to the sites' unique and far-reaching benefits. Presenting the findings of a qualitative study, the authors discuss the perspectives of students, instructors, and RNs regarding their experiences in these alternative clinical settings and provide recommendations for the use of alternative settings in nursing education.

British Columbia↗

PubMed2003

Handheld technologies in a clinical setting: state of the technology and resources.

Handheld or palm-based computing technology, commonly known as personal digital assistants (PDAs), are having a tremendous impact in many personal, educational, and business settings. The potential is particularly compelling for healthcare, specifically in the clinical setting. By exploring the development of the technology, applications, and products, as well as issues regarding its use, a better understanding of this technology can be gained. The rapid acceptance and ongoing swift development of handheld computing technology is leading to an evolution in the way clinical data and information move to and from the bedside and into the patient record. This article focuses on three main areas related to PDAs: the development of the palm technology, its potential in clinical settings, and available specific resources.

Computers, Handheld↗

PubMed2006

Bacterial biofilms within the clinical setting: what healthcare professionals should know.

Bacterial biofilm formation is the prevailing microbial lifestyle in natural and manmade environments and occurs on all surface types. Biofilm formation develops in several phases and is influenced by various parameters, both environmental and inherent to the attaching cell. Biofilms also serve as protective niches for particular pathogens when outside a host. Although it is accepted that biofilms are ubiquitous in nature, the significance of biofilms in clinical settings, especially with regard to their role in medical-related infections, is often underestimated. It has been found that several aspects of human pathogenesis within a clinical context are directly related to biofilm development. Various types of surfaces in clinical settings are prone to biofilm development and an increased risk of disease may be a direct consequence of their formation. This review describes the process of biofilm formation, highlights the importance of bacterial associations with surfaces in clinical settings and describes various methods for biofilm visualization and control.

Bacteria↗

PubMed1988

Quantitative EEG: II. Frequency analysis and topographic mapping in clinical settings.

The results of many studies using quantitative EEG techniques in clinical settings have been published. Those reports are reviewed here, with emphasis on those that used EEG frequency analysis and topographic mapping. In cerebrovascular disease, these methods can confirm the existence of lesions that are too mild to show up on routine EEG or too mild or too early to show up on computed tomography. The results correlate well with cerebral blood flow studies. These EEG tests can be done continuously in an intensive care unit or operating room. However, exact localization ability is inferior to that seen using traditional neuroimaging tests. In epilepsy, quantitative EEG techniques have found subtle degrees of background EEG changes near epileptic foci. Other methods can quantify epileptic spikes in useful ways and can indicate which region is driving other regions during seizures. Quantification is also useful for measuring drug effects when drugs (such as thiopental) are given deliberately to provoke acute EEG changes. Other measurements of drug effects may become useful in the future. In patients with mass lesions and metabolic encephalopathies, quantitative EEG changes do occur, and some of these correlate with the clinical state. However, in the latter settings, the clinical advantages for patient care are not yet clear, especially in comparison to available neuro-imaging studies and other routine medical tests. For dementia, quantitative EEG techniques are being developed. Some of these tests are accurate in moderately or severely demented patients, but there is still poor accuracy for early or borderline cases. For dyslexia, schizophrenia, and depression, there is a considerable volume of research reports but still no consensus about how to use quantitative EEG tests for care of individual patients. These tests require substantial user expertise in EEG. At present, these tests should be viewed as adjunctive to traditional EEG testing: such routine EEG testing should serve as the foundation for any clinical use of quantitative EEG tools.

Brain↗

PubMed2005

How medical residents perceive the quality of supervision provided by attending doctors in the clinical setting.

INTRODUCTION: The supervision of medical residents is a key responsibility of attending doctors in the clinical setting. Most attending doctors, however, are unfamiliar with the principles of effective supervision. Although inconsistent, supervision has been shown to be both important and effective for the professional development of medical residents. OBJECTIVE: To examine how medical residents perceive the supervisory roles of attending doctors, in terms of what they perceive as poor supervision and what they characterise as good supervisory practice. METHOD: We carried out a questionnaire survey of 38 medical residents at the Department of Paediatrics at the teaching hospital of the University of Amsterdam, the Netherlands. Attending doctors directly involved with the supervision of medical residents participated in the study. The clinical settings where supervision occurred included the neonatal and paediatric intensive care units and the general paediatric wards. RESULTS: Medical residents rated the quality of supervision they received in all departments positively. A majority of the attending doctors were rated highly in 'overall supervision'. Creating pleasant learning environments and being stimulated to learn and function independently were aspects of supervision characterised positively. Coaching in clinical skills and procedures, effective communication skills and clinical decision making using principles of cost-appropriate care were aspects of supervision found to be deficient. DISCUSSION: This study shows that medical residents enjoy supervision from collaborative, understanding and patient attending doctors. Medical residents prefer to be treated as adult learners and enjoy feedback that is constructive, measured and adapted to their professional needs.

Attitude of Health Personnel↗

PubMed2002

Utilization of BRCA1/2 genetic testing in the clinical setting: report from a single institution.

BACKGROUND: Clinical testing for BRCA1/2 has been available since 1996. Interest in testing in the research and hypothetical situations has been consistently high, but there have been limited reports on its clinical utilization. METHODS: This is a retrospective study of BRCA1/2 test utilization by high-risk patients who were seen at the Johns Hopkins Breast and Ovarian Surveillance Service. RESULTS: Between February 1996 and December 1999, 258 families who had at least a 10% chance of carrying a BRCA1/2 mutation were offered genetic testing. Of these, 26 families seen between February 1996 and October 1996 had access to free testing. Overall, 68 of 258 (26%) underwent genetic testing. Educational level, number of children or daughters, breast carcinoma screening behavior, smoking and drinking behavior, perceived risk of breast carcinoma, and family history was not associated with test utilization. Eligibility for free testing, prior history of breast or ovarian carcinoma, Ashkenazi Jewish versus non-Ashkenazi Jewish heritage, genetic risk category, and age category were associated with test utilization, and in multivariate analysis, the first three remained statistically significant factors associated with genetic testing. Only 26% of the 50 patients who did not have access to free testing sought insurance reimbursement, of which greater than 50% (7 of 13) had a prior diagnosis of breast or ovarian carcinoma. CONCLUSIONS: The actual utilization of BRCA1/2 genetic testing in a clinical setting is lower than in the research and hypothetical settings. Potential obstacles include cost, fear of insurance discrimination, and need to involve an affected family member in the testing process.

Adult↗

PubMed2003

Counseling in the clinical setting to prevent unintended pregnancy: an evidence-based research agenda.

Unintended pregnancies account for about half of all pregnancies in the United States and, in 1995, numbered nearly 3 million pregnancies. They pose appreciable medical, emotional, social and financial costs on women, their families and society. The US is not attaining national goals to decrease unintended pregnancies, and little is known about effective means for reducing unintended pregnancy rates in adults or adolescents.To examine the evidence about the effectiveness, benefits and harms of counseling in a clinical setting to prevent unintended pregnancy in adults and adolescents and to use the evidence to propose a research agenda.We identified English-language articles from comprehensive searches of the MEDLINE, CINAHL, PsychLit and other databases from 1985 through May 2000; the main clinical search terms included pregnancy (mistimed, unintended, unplanned, unwanted), family planning, contraceptive behavior, counseling, sex counseling, and knowledge, attitudes and behavior. We also used published systematic reviews, hand searching of relevant articles, the second Guide to Clinical Preventive Services and extensive peer review to identify important articles not otherwise found and to assure completeness. Of 673 abstracts examined, we retained 354 for full article review; of these, we used 74 for the systematic evidence review and abstracted data from 13 articles for evidence tables. Four studies addressed the effectiveness of counseling in a clinical setting in changing knowledge, skills and attitudes about contraception and pregnancy; all had poor internal validity and generalizability and collectively did not provide definitive guidance about effective counseling strategies. Nine studies (three in teenage populations) addressed the relationship of knowledge on contraceptive use and adherence. Knowledge of correct contraceptive methods may be positively associated with appropriate use, but reservations about the method itself, partner support of the method, and women's beliefs about their own fertility are important determinants of method adherence that may attenuate the knowledge effect. Many factors influence contraceptive use and adherence; among them are age, marital status, ambivalence about becoming pregnant, attitudes of partner, side effects, satisfaction with provider and costs; however, the impact of such factors may not be consistent across populations defined by cultural, age or other factors. The studies themselves differed materially in outcome variables, populations and methodologies and did not yield a body of work that can reliably identify specific influences on contraceptive use and adherence. No literature reports on harms of counseling or on the costs or cost-effectiveness of different approaches to counseling about unintended conceptions in the primary care setting. Virtually no experimental or observational literature reliably answers questions about the effectiveness of counseling in the clinical setting to reduce rates of unintended (unwanted, mistimed) pregnancies in this country. Existing studies suffer from appreciable threats to internal validity and loss to follow-up and are extremely heterogeneous in terms of populations studied and outcomes measured. The quality of the existing research does not provide strong guidance for recommendations about clinical practice but does suggest directions for future investigations. Numerous issues warrant rigorous investigation.

Adolescent↗

PubMed2000

Pulmonary infections in immunocompromised hosts: the importance of correlating the conventional radiologic appearance with the clinical setting.

The lung is one of the most frequently involved organs in a variety of complications in the immunocompromised host. Among the pulmonary complications that occur in this kind of patient, infection is the most common and is associated with high morbidity and mortality. Although chest radiography and computed tomography (CT) are essential diagnostic tools, radiologists often have difficulty in establishing the correct diagnosis on the basis of radiologic findings alone. The reasons are that the immunocompromised host is potentially susceptible to infection from many different microorganisms and that radiologic findings are seldom specific for the detection of a particular pathogen. Experience has shown that a particular clinical setting predisposes patients to infection by particular pathogens. The setting comprises (a) the specific epidemiologic or environmental exposure, (b) the type of underlying immune defect, (c) the duration and severity of immune compromise, and (d) the progression rate and pattern of the radiologic abnormality. Correlating the radiologic appearance with the clinical setting can expedite diagnosis and appropriate therapy. In this review, the authors describe the clinical settings that are helpful in choosing the radiologic approach to treatment of the immunocompromised host who presents with suspected pulmonary infection.

B-Lymphocytes↗

PubMed1998

Gram stain method shows better sensitivity than clinical criteria for detection of bacterial vaginosis in surveillance of pregnant, low-income women in a clinical setting.

OBJECTIVE: The purpose of the study is to determine whether the Gram stain method is superior to the clinical criteria for the diagnosis of bacterial vaginosis in low-income pregnant women seen in a resident clinic setting. The clinical criteria is the current diagnostic method employed to diagnose bacterial vaginosis. STUDY DESIGN: In this study, 51 pregnant women with vaginal discharge were prospectively evaluated. All were screened using the clinical criteria, Gram stain method, and culture of the discharge. The modified scoring system instituted by Nugent et al. (J Clin Microbiol 29:297-301, 1991) was employed in reading the Gram stain smears. The clinical criteria were then compared with the Gram stain method. Isolation of moderate to many Gardnerella vaginalis growth by culture was used as the confirmatory finding. RESULTS: Sensitivity of the Gram stain method (91%) was significantly higher than that of the clinical criteria (46%), (sign test P = 0.0023, < 0.01). The Gram stain method also has both a low false-negative (4%) and high negative predictive value (96%), making it an ideal diagnostic test. CONCLUSION: The Gram stain method is a rapid and cost-effective test that is also highly reproducible and readily available in many laboratories. These features make the Gram stain method a more desirable screening procedure for bacterial vaginosis in a clinic population.

Cost-Benefit Analysis↗

PubMed2006

Knowledge in the Palm of your hands: PDAs in the clinical setting.

OBJECTIVE: To explore the impact of hand-held computers on patient care by identifying: (i) how often clinical staff accessed resources on hand-held computers to inform their clinical decision making; (ii) Which hand-held resources were thought to be most useful in the clinical setting; (iii) the barriers to using hand-held resources to support patient care. DESIGN: A descriptive study comparing aspects of Personal Digital Assistant (PDA) resource use in two phases, between August 2002 and December 2003. There was variability in the way that resources were accessed between the two studies. SETTING: University Hospitals of Leicester NHS Trust, an acute teaching hospital, and one primary care practice. PARTICIPANTS: A purposive sample of 14 clinical and librarian staff participated in phase one and 14 in phase two of the study. Participants consisted of consultants, nurses, pharmacist, junior doctors, clinical librarians, and a general practitioner. MAIN OUTCOME MEASURES: Baseline Data Questionnaire to identify the participants' level of knowledge and use of hand-helds on entering the study. End-of-phase questionnaire with self-reported measures of use of the hand-held and PDA resources during the study. RESULTS: All of the participants used hand-helds in their clinical setting to support evidence-based practice and education, but with varying frequency. More staff reported using the hand-held to answer specific patient questions in phase two than phase one of the study. UK resources were preferred to American resources. The 'plug-in and go' method using Secure Digital (SD) cards was preferred to downloading resources from the Internet. CONCLUSIONS: Hand-held technology is emerging as an effective clinical tool to aid evidence-based practice and support the educational needs of clinical staff. The hand-held can provide a critical mass of information that is relevant, quickly accessible and in a coherent format: delivering clinical information at the point of need with a resulting benefit to patient safety.

Computer Literacy↗

PubMed2002

Efficacy and safety of penile biopsy in a GUM clinic setting.

The UK National Guidelines on Sexually Transmitted Infections recommend penile biopsy in patients with persistent balanitis and balanitis of uncertain aetiology. Many GUM clinics perform penile biopsy. However, few studies have looked at the usefulness and safety of penile biopsy in a GUM clinic setting. We assessed the spectrum of dermatological conditions seen in a penile dermatoses clinic and looked at the usefulness and safety of penile punch biopsy in a GUM clinic setting. We reviewed the case notes of patients who attended the penile dermatoses clinic at the GUM department, Royal Berkshire Hospital, Reading over a period of 18 months. A total of 87 patients were seen in the penile dermatoses clinic. Their ages ranged from 17 to 73 and 70 (80%) were uncircumcised. Twenty-four (28%) patients had biopsies and five (6%) declined. Forty-nine (56%) patients did not have a biopsy either because of a clinically apparent diagnosis (45) or lesions were close to the urethral meatus (4). Five were referred for circumcision and one was referred to a dermatologist. Three patients were lost to follow-up. Penile biopsy was performed to exclude malignancy in 17 (71%) cases and due to diagnostic uncertainty in seven (29%) cases. Histological diagnoses were consistent with initial clinical diagnoses in 17 (71%) cases. Four (17%) had minor complications following biopsy, two had wound dehiscence, one had bleeding and another had a wound infection. In conclusion, a wide spectrum of penile skin disorders were seen in the penile dermatoses clinic. The majority of patients had a clinically apparent diagnosis. The histological diagnosis was consistent with initial clinical diagnosis in most of the biopsied patients. The main indications for biopsy were to exclude malignancy and for diagnostic dilemma. Penile biopsy is a safe procedure with minimal complications.

Adolescent↗

PubMed1990

Online access to MEDLINE in clinical settings. A study of use and usefulness.

STUDY OBJECTIVE: We introduced self-service access to the medical literature database, MEDLINE, into clinical settings to assess the frequency, patterns, purposes, and success of use. DESIGN: Longitudinal descriptive study. SETTING: Inpatient and outpatient services of a university medical center. PARTICIPANTS: All trainees and attending staff working at the service sites were invited to participate; 158 (84%) did so. INTERVENTIONS: Free online access was provided to MEDLINE through GRATEFUL MED software. Participants were offered a 2-hour introduction to online searching and 2 hours of free search time. MEASUREMENTS AND MAIN RESULTS: For each search, a computer program requested identification of the user and the question to be addressed. Search transactions were recorded automatically. Interviews were conducted after a random sample of searches, and search questions were given to more expert searchers to run for comparison with the original. Eighty-one percent of participants did searches on study computers, at a mean rate of 2.7 searches per month. On comparison searches, participants retrieved 55% of the number of relevant articles retrieved by reference librarians (P = 0.024) and 50% more irrelevant articles (P less than 0.001). Forty-seven percent of searches on patient problems affected clinical decisions, but often on scanty information. CONCLUSIONS: MEDLINE searching from clinical settings is feasible with brief training and affects clinical decisions. However, inexperienced searchers miss many relevant citations and search inefficiently. Further studies are needed to assess the impact of searching on physician performance and patient care.

Academic Medical Centers↗

PubMed1996

Stress and coping: first-year Nepalese nursing students in clinical settings.

The purpose of this descriptive study was to identify stressful events of first-year Nepalese nursing students in the clinical setting and to determine how they cope with the stressful events. The sample consisted of 104 nursing students who had been in the clinical setting for 6 to 8 weeks. Four stressful events identified were: interpersonal relationships, initial experiences, feeling helpless, and demeaning experiences. The most frequently reported stressful event was interpersonal relationship (50%). Eight categories of coping from students' description were problem-solving, accepting responsibility, seeking social support, self-control, tension reduction, avoidance, wishful thinking and negative feelings. The majority of students utilized the "seeking social support" category of coping.

Adaptation, Psychological↗

PubMed2006

What happened to lithium? Antidepressant augmentation in clinical settings.

OBJECTIVE: Antidepressant augmentation is recommended when patients do not respond to antidepressant monotherapy. However, little is know about antidepressant augmentation in clinical settings and whether these practices reflect the research evidence. METHOD: The authors identified 244,859 patients in Veterans Administration mental health settings with a diagnosis of depression and an antidepressant prescription during fiscal year 2002. Patients with schizophrenia, dementia, or bipolar I disorder were excluded. The authors examined the prevalence and characteristics of antidepressant augmentation during the year, defined as receiving an antidepressant and an augmenting agent (lithium, second-generation antipsychotics, combinations of antidepressants, anticonvulsants, or "other") for >/=60 consecutive days in specified doses for those without other clinical indications. Mixed-effect models were used to examine predictors of augmentation. RESULTS: Some patients (22%) received an augmenting agent. The most commonly used agents were a second antidepressant (11%) and a second-generation antipsychotic (7%). Only 0.5% of the patients received lithium. Whites, younger patients, and those with a prior hospitalization were more likely to receive augmentation. African Americans were more likely to receive antipsychotic augmentation; whites were more likely to receive lithium. CONCLUSIONS: Antidepressant augmentation is common in clinical settings. Although lithium currently has the most research support, antipsychotic medications and a second antidepressant are the most widely used augmenting agents. Many augmenting agents are used across clinical and demographic groups. Research is needed on the relative effectiveness of these agents, along with efforts to promote the use of agents with the greatest level of research support.

Black or African American↗

PubMed2003

Teaching and learning in the clinical setting: a qualitative study of the perceptions of students and teachers.

OBJECTIVE: To describe the perceptions of medical students and clinical teachers of teaching and learning in the clinical setting. DESIGN: Qualitative study of focus groups with undergraduate medical students and semistructured interviews with hospital consultant clinical teachers. SETTING: The School of Medicine, University of Leeds and the Leeds Teaching Hospitals Trust, UK. PARTICIPANTS: Fourth year medical students and consultant clinical teachers. MAIN OUTCOME MEASURES: Analysis of narratives to identify students' perceptions of clinical teaching and consultants' views of their delivery of undergraduate clinical teaching. RESULTS: Students believed in the importance of consultant teaching and saw consultants as role models. However, they perceived variability in the quality and reliability of teaching between physicians and surgeons. Some traditional teaching venues, especially theatre, are believed to be of little clinical importance. Generally, consultants enjoyed teaching but felt under severe pressure from other commitments. They taught in a range of settings and used various teaching strategies, not all of which were perceived to be 'teaching' by students. CONCLUSIONS: While students and teachers are educational partners, they are not always in agreement about the quality, quantity, style or appropriate setting of clinical teaching. To enable teachers to provide more high quality teaching, there needs to be support, opportunities and incentives to understand curricular developments and acquire teaching skills.

Attitude of Health Personnel↗

PubMed1999

Anti-Semitism in the clinical setting: transference and countertransference dimensions.

Despite the salient presence of Jews in the history of psychoanalysis, literature on the subject of anti-Semitism in the clinical setting is surprisingly sparse. This paper attempts to comprehend the reasons for the dearth of literature on this important topic. A clinical section then breaks the silence surrounding expressions of anti-Semitism in the consulting room. The major focus is on transference and countertransference reactions that arise with regard to anti-Semitism in the clinical setting. Since the first section is concerned with silence in the psychoanalytic community, its focus is primarily on countertransference issues that may hinder the analyst's understanding and use of anti-Semitic material. The second, clinical section focuses on the ways both transference and countertransference reactions combine and influence one another and how they may, when properly attended to, serve as catalytic tools for advancing therapeutic goals.

Adult↗

PubMed1984

Factor structure of the WPPSI in mental health clinic settings.

Factor analyzed the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) scores of children (N = 181) seen at several outpatient mental health clinics. A two-factor solution that approximated Wechsler's grouping into Verbal and Performance sections was extracted. The Arithmetic subtest, however, loaded strongly onto both factors. The results suggest that the structure of intelligence for emotionally disturbed children is similar to that for normal children. The results also suggest that WPPSI profile analysis that uses subtest scores may be invalid in clinical settings because the specific variance of most subtests was low and because error variance exceeded specific subtest variance for half of the subtests. Further research is needed to clarify the utility of the WPPSI in outpatient clinical settings.

Aggression↗

PubMed2000

Techniques for identifying the applicability of new information management technologies in the clinical setting: an example focusing on handheld computers.

This article describes techniques and strategies used to judge the potential applicability of new information management technologies in the clinical setting and to develop specific design recommendations for new features and services. We focus on a project carried out to identify the potential uses of handheld computers (i.e., the Palm Pilot or a small WinCE-based device) in the ambulatory practice setting. We found that the potential for a robust handheld computing device to positively affect the outpatient ambulatory clinical setting is enormous, and that the information derived from the exploratory research project is useful in creating specific design recommendations for further development.

Ambulatory Care Facilities↗