Current Status Of Clinical Practice Research Articles

Current Status of Cognition and Clinical Practice of Refractory Cancer Pain in Shanghai: A Questionnaire Survey.

This study aimed to assess the current status of clinical practice of refractory cancer pain (RCP) among a sample of physicians specializing in cancer pain management in Shanghai. From 2019 to 2021, a questionnaire survey was conducted among physicians engaged in diagnosis and treatment of cancer pain through the questionnaire WJX network platform in Shanghai, China. A total of 238 responses participated in the survey. This survey reports physicians' understanding and incidence rate of breakthrough cancer pain (BTCP). The choice of analgesics and satisfaction of analgesic effect were investigated. We also investigated doctors' knowledge of the diagnostic criteria for RCP and their tendency to choose analgesics. Oral immediate-release morphine and intravenous or subcutaneous morphine injection have been the common treatment approach for transient cancer pain exacerbations. The main barriers to pain management are lack of standardized treatment methods for RCP, lack of knowledge related to RCP, and single drug dosage form. Doctors believe the most necessary measures to improve the current situation of poor cancer pain control include improving medical staff's understanding and treatment techniques for RCP, updating treatment techniques and methods, and improving the configuration of drug types in medical institutions. Clinicians expect to improve understanding and treatment techniques through systematic training. Despite multiple available analgesic measures, the treatment of RCP remains challenging. Improving the understanding of medical staff towards RCP, improving treatment techniques, and increasing the accessibility of multiple drug types are important ways to improve the satisfaction of cancer pain management in the future.

Mucopolysaccharidosis I: disease knowledge and patient's journey in Saudi Arabia and Gulf Region

Background: For the last few years, the diagnosis of lysosomal storage disorders (LSDs) has increased in Saudi Arabia and the Arabian Gulf region. Mucopolysaccharidosis (MPS) is one of the LSDs that showed high rates of consanguinity in Arabian countries. Therefore, an online survey was designed to measure the clinical knowledge of Saudi pediatricians about MPS I. Methods: A multinational, cross-sectional study was conducted to collect data through an online survey administered to pediatricians and other physicians mostly involved in MPS-I management. The survey was formed of two long clinical cases scenarios, seven close-ended questions related to general knowledge about MPS-I disease, and five close-ended questions related to MPS-I patient's journey. Results: Study surveys were filled by 58 physicians. High rates of MPS diagnosis were noted among physicians' responses. Other than musculoskeletal symptoms, physicians reported the following symptoms; hepato-splenomegaly, corneal clouding, skeletal abnormalities, coarse facies, hernias, and mental retardation. The multidisciplinary team was the most selected option when considering patients' referrals. Regarding MPS complications, musculoskeletal abnormalities including irreversible skeletal deformities, growth retardation, and mobility loss were the most MPS late complications. Conclusion: The current results give key insights into the current status of clinical practice in countries of the Arabian Gulf region. Physicians of Kingdom of Saudi Arabia (KSA) and other countries of the Arabian Gulf region have solid knowledge and long experience in the management of MPS I patients.

Level of ERAS understanding affects practitioners\u2019 practice and perception of early postoperative resumption of oral intake: a nationwide survey

BackgroundEarly postoperative resumption of oral intake is supposed to be safe and beneficial to patients recovery. However, practitioners still have great confusion and disagreement about postoperative resumption of oral intake. This is a nationwide survey to investigate the current status of clinical practice and practitioners’ attitude toward postoperative resumption of oral intake along with their level of understanding of the ERAS guidelines.MethodsAn anonymous web-based survey questionnaire via mobile social platform was carried out in mainland China from December 11–20, 2020. The Wilcoxon signed rank test or chi-square test was used to compare the propensity of the resumption of oral intake.ResultsTotally 5370 responses were received, and 89% of them were from anesthesiology departments. The nature of the responses from clinical practitioners was highly diverse, but each of the three surgery types showed unique patterns of ERAS implementation. The respondents were more conservative regarding the commencement of both fluid and solid diets after gastrointestinal (GI) and hepato-pancreato-biliary (HPB) surgery than after non-abdominal (NA) surgery. Most respondents agreed that early oral intake is beneficial to reduce postoperative complications improve bowel recovery and overall outcome. 55% respondents considered themselves to have a better understanding of ERAS and tended to initiate oral intake early for all three surgery types (P < 0.001).ConclusionsThe postoperative resumption of oral intake is highly variable among GI, HPB and NA surgeries. A better understanding of ERAS would encourage practitioners to commence oral intake resumption much earlier.

Current Status of Clinical Practice for Gout in Korean Medicine - On-line (Web-Based) Survey

Current Status of Clinical Practice for Gout in Korean Medicine - On-line (Web-Based) Survey

Diabeties Predection Using Biosensors

Biosensors are little investigative gadgets that join a component of natural acknowledgment and a physio-compound transducer to change an organic sign into an electrical perusing. Their specialized allure these days lies in their solid proficiency, high affectability, and consistent limit with regards to estimation. A biosensor embedded in contact central focuses to decide the degree of tear glucose and to hand-off the information to the patient’s body siphon. The siphon can mix insulin, the missing hormone, the necessary degree. This machine evades the distinctive blood checks and implantations for interesting sorts of diabetes that are really basic consistently. Diabetes characteristics are calculated by the sensor and the algorithms of machine learning are used to obtain the solution. Glucose measurements in blood plasma are positive, suggesting that the sensor is designed to estimate physiological blood glucose levels with negligible atomic effects. We are aimed at contributing to the growing biotechnology sector, with a focus on Glucose-Oxidise Biosensor (GOB) modelling from a regression perspective through quantitative learning methods. Blood glucose monitoring was developed as an effective tool for diabetes administration. Since it is suggested to maintain typical levels of blood glucose, a progression of appropriate biosensors of glucose has been developed. The technology of glucose biosensors, including treatment tools, reliable glucose monitoring systems and non-invasive glucose detection frameworks, has been fully developed over the last 50 years. In any case, a few steps are still associated with the achievement of accurate and reliable measurement of glucose. Utilizing a few AI calculations to demonstrate the amperometric reaction of a GOB with subordinate factors under various conditions, for example, temperature, benzoquinone, pH and glucose levels. In particular, kernel-based regression techniques, such as support vector machines, are being used today as one of the best machine learning techniques. Since a GOB reaction’s affectability is emphatically connected with these needy factors, their cooperations ought to be advanced to boost the yield signal for which a hereditary calculation and mimicked tempering is utilized. This dataset is modelled by a nonlinear regression approach which uses a rather simple model of the biosensor performance to allow a very low prediction error. This demonstrates the brief history, basic principles, analytical results, and the current status in clinical practice of glucose biosensors. We report a model that is consistent with the optimization and shows a good generalization error. The results obtained show that the sensor created is a contender for persistent blood glucose checking.

Current Status of Clinical Practice of Periodontal Therapy by Predoctoral Dental Students at Tokyo Medical and Dental University (TMDU)

Current Status of Clinical Practice of Periodontal Therapy by Predoctoral Dental Students at Tokyo Medical and Dental University (TMDU)

Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus.

Since December 2019, an epidemic caused by novel coronavirus (2019-nCoV) infection has occurred unexpectedly in China. As of 8 pm, 31 January 2020, more than 20 pediatric cases have been reported in China. Of these cases, ten patients were identified in Zhejiang Province, with an age of onset ranging from 112 days to 17 years. Following the latest National recommendations for diagnosis and treatment of pneumonia caused by 2019-nCoV (the 4th edition) and current status of clinical practice in Zhejiang Province, recommendations for the diagnosis and treatment of respiratory infection caused by 2019-nCoV for children were drafted by the National Clinical Research Center for Child Health, the National Children’s Regional Medical Center, Children’s Hospital, Zhejiang University School of Medicine to further standardize the protocol for diagnosis and treatment of respiratory infection in children caused by 2019-nCoV.

Uridine triacetate - an antidote in the treatment of 5-fluorouracil or capecitabine poisoning

ABSTRACTIntroduction: In 2015, vistogard was approved both the US FDA and the European Medicines Agency (EMA) as an antidote in the treatment of 5-FU poisoning following an overdose of 5-FU or capecitabine or in patients exhibiting early-onset, severe or life-threatening toxicity affecting the cardiac or central nervous system, and/or early-onset, unusually severe adverse reactions (e.g. gastrointestinal toxicity and/or neutropenia) within 96 h following the end of 5-FU or capecitabine administration.Areas covered: This paper reviews the history of the development of vistogard (uridine triacetate) to its current status in clinical practice. Vistogard is an orally active prodrug of uridine, which has made a more effective uridine administration technique possible to improve the tolerability of intravenous and oral fluoropyrimidines, including capecitabine. In addition to preclinical data, we also reviewed the data on all the published patients who received vistogard secondary to overdosed 5-FU or capecitabine, or exhibited early onset of severe toxicities.Expert opinion: Vistogard is the first and the only antidote to overdose and early-onset, severe, or life-threatening toxicities from 5-Fluorouracil or capecitabine.

A multicenter survey on the use of neuromuscular blockade in Greece. Does the real-world clinical practice indicate the necessity of guidelines?

Background and Aims:The aim of this study was to investigate the current status of clinical practice regarding neuromuscular blocking drugs and their antagonists in Greece.Material and Methods:This is a multicenter survey, including a questionnaire based on previous studies, which was translated and modified by a Task Force of the Hellenic Society of Anaesthesiology. It was completed on a web-based database after invitation via e-mail and was left online for a period of 2 months.Results:A total of 1,100 questionnaires were sent, with a response rate of 7.9%. 13.7% stated that they do not use neuromuscular monitoring. Rocuronium was most commonly used for intubation [“often” stated by 19 (21.8%) and “very often” by 62 (71.2%)], followed by cis-atracurium, atracurium, and succinylcholine. Neostigmine and sugammadex were both used, with reversal not always administered by 23 (26.4%). Both agents were mostly used at fixed doses and not calculated based on TOF monitoring or body weight. Sugammadex was preferred in special patient groups and in operations of short duration. Reversal was most often administered based on clinical signs of neuromuscular recovery rather than objective monitoring. A significant percentage of respondents used an inadequate TOF ratio for extubation [37 (43.2%) used a TOF ratio <90%]. The reported incidence of observed residual neuromuscular blockade (RNMB) was 44.8%.Conclusion:Great variability was observed in Greek clinical practice regarding the use of neuromuscular blockade, which indicates serious issues that must be addressed. The needs for educating anesthesia providers and developing official guidelines are obvious in order to improve patient outcomes.

Policy paper nuclear cardiology - update 2018 - Current status of clinical practice

The joint position paper of the working community "Cardiovascular Nuclear Medicine" of the German Society of Nuclear Medicine (DGN) and the working group "Nuclear Cardiology Diagnostics" of the German Cardiac Society (DKG) updates the former 2009 paper. It is the purpose of this paper to provide an overview about the application fields, the state-of-the-art and the current value of nuclear cardiology imaging. The topics covered are chronic coronary artery disease, including viability imaging, furthermore cardiomyopathies, infective endocarditis, cardiac sarcoidosis and amyloidosis.

Risk stratification of coronary artery disease using radionuclides. Current status of clinical practice

A discussion is presented on the current use of radionuclides for evaluation of coronary artery disease in relation to other available techniques. The review is focused on coronary artery disease risk stratification employing single photon emission computed tomography and positron emission tomography, as well as on ischemic cardiomyopathy and myocardial viability applications.Concepts are presented regarding coronary blood flow reserve, diagnostic and prognostic values, criteria for its appropriate use, as well as current methods to reduce unnecessary patient irradiation, in order to optimize nuclear cardiology practice.

E-mail survey on the current status of clinical practice and activation measures for Korean medicine in stroke care

E-mail survey on the current status of clinical practice and activation measures for Korean medicine in stroke care

치위생학 임상실습교육 현황 분석

치위생학 임상실습교육 현황 분석

Cross-Sectional Survey on Bronchoscopy in Germany – The Current Status of Clinical Practice

Bronchoscopy is an integral part of pulmonary medicine. In recent years, a series of new technologies have evolved. It is to assume that significant changes have also occurred in clinical practice. We conducted a nationwide survey to evaluate the current status of care and to compare it with earlier reports. A standard questionnaire was sent to 1875 institutions to assess the clinical practice of bronchoscopy in Germany with respect to general issues, education, sedation/anaesthesia and technical aspects. The returned questionnaires cover 301,965 bronchoscopies, performed by 2158 physicians over 12 months, making it the largest survey to date. The proportion of rigid bronchoscopies has decreased and amounts to 7.3% at present. Atropine as a premedication is hardly used any more. Sedation is routinely applied in 88% of flexible bronchoscopies, for which a combination of propofol and midazolam is preferred by most institutions (41.3%), followed by propofol monotherapy (28.3%). 74.4% of institutions accept aspirin for transbronchial biopsy, 8.1% dual platelet inhibition. 62.4% of all institutions perform airway recanalisation, favouring cryotherapy and argon plasma coagulation. 9.1% of bronchoscopies are supported by endobronchial ultrasound. Compared to preceding surveys, the experience of bronchoscopists, especially regarding interventional procedures, has increased. Endobronchial ultrasound has become a standard of care, as has patient sedation with propofol.

Evaluating Methods of Reinforcing the Clinical Clerkship

This study evaluated the meaning of the clinical clerkship through in-depth interviews with students who had experienced a clinical clerkship. The clinical clerkship is one of the most important steps in the curriculum for becoming a doctor. While students perform actual clinical practice, the experience also reinforces a great deal of medical knowledge and competence as a reserve doctor. However, departments that operate inefficiently have caused some problems. Therefore, this study analyzed the data from interviews of 25 students who finished the clinical clerkship in terms of the meaning of the clinical clerkship, the attitude of the students toward work in clinical practice, the attitude of professors toward the clinical clerkship, benefits, and drawbacks. Comments are feedback from a students experience in the clinical clerkship, and they may be an important resource illuminating the current status of clinical practice. This study also discusses how to run an effective clinical clerkship by checking in with students on the problems they face in clinical practice.

To pack or not to pack: the current status of periodontal dressings.

Surgical wound dressings have been employed over several centuries for the purpose of protection of surgical sites, to prevent postoperative infection and to accelerate healing. Periodontal dressings, also known as periodontal packs, provide similar benefits when applied after periodontal surgical procedures. They can broadly be categorized as eugenol-based dressings and noneugenol dressings. Over the years, many modifications have been made to the composition of such dressings to improve their physical and therapeutic properties. Controversies surrounding the rationale for their use, advantages and disadvantages of the most commonly employed periodontal dressings and their current status in clinical practice are described in this comprehensive review. From the evidence-based literature presented here, we have also attempted to answer the question of whether there is a universal need for the application of periodontal dressings.

Japanese cohort study of first-line chemotherapy (CT) for metastatic colorectal cancer (mCRC) containing fluorouracil, oxaliplatin, and bevacizumab: EMERaLD study, first report.

586 Background: An observational cohort study plays a crucial role to understand the current status of clinical practice and can be utilized as database for multi-purpose outcome research. Such database is available in Europe and the United States based on several cohort studies especially in mCRC, while there is no database available including treatments for mCRC patients in Japan. Methods: We planned and conducted a large cohort study to establish database available including treatments for mCRC patients. Major enrollment criteria included documented mCRC and first line CT containing fluorouracil, oxaliplatin and bevacizumab, started treatment in or after January 2010. The primary objectives are to evaluate overall survival(OS), liver metastasectomy rate (LMR), R0 liver resection rate (R0). The secondary objectives are progression-free survival, response rate (RR), and safety. We performed a preplanned interim analysis of 6-month efficacy and safety data after the 500th patient registration. Results: From October 2010 to September 2011, data from 1,353 patients were recruited from 132 centers in Japan, and we analyzed data on 538 patients of them. The background of 538 patients were as the following; male/female, 335/203; median age of 65 (range, 27-85); ECOG PS 0/1/2/3, 453/77/6/2; site of primary tumor colon/rectum/colorectal, 299/238/1; and site of metastatic disease liver/lung/others, 352/162/226; FOLFOX/ CapeOx/ others with bevacizumab, 234/290/14, KRAS-status wild/mutant/unknown, 131/88/319. 6-month efficacy and safety data were OS 97.5%, LMR 15.1%, R0 12.5%, RR 48.3%, G3/4(CTC-AEv4.0) related to bevacizumab; hypertension 1.5%, proteinuria 0.2%, thromboembolism 0.6%, bleeding 1.0%, and gastrointestinal perforation 1.3%. Conclusions: We have started the large Japanese cohort study which investigates first line CT for mCRC. We performed a preplanned interim analysis on 538 patients and there was no difference from past reports. We will further investigate and analyze 2-year efficacy and safety data on all 1,353 patients. This study is sponsored by the Public Health Research Center Foundation CSPOR in Japan. Clinical trial information: UMIN000006392.

Status of clinical practice on diagnosis and management of atopic dermatitis in Korea: a questionnaire survey of physicians

Purpose: The prevalence of atopic dermatitis (AD) has been increasing in many developed countries including Korea. There has been little information on the status of real clinical practice for atopic dermatitis by physicians in Korea. Methods: This study investigated the current status of clinical practice on allergy test and treatment of AD in Korea by analyzing a questionnaire survey of 155 physicians who attended the educational program for practical management of AD by the Korean Academy of Asthma, Allergy and Clinical Immunology. The questionnaire was mainly composed of 20 items regarding diagnosis, treatment of AD. Results: Among the 155 physicians who completed the questionnaire survey, most of subjects (90%) agreed that allergy test was necessary, but only 68% performed allergy test in their practice for AD. The barriers to allergy testing were lack of test personnel or facilities (61%), disbelief on the clinical importance of allergy test in the treatment (41%), and difficulty in explanation about the test results to patients (16%). Problems interfering the active treatment of patients with AD were the difficulty in acquiring a sufficient time for education and explanation about treatment (54%), incomplete clinical efficacy of current medication and concern on the side effects (41%), and the difficulty in establishing a good doctor-patient relationship (40%). Conclusion: There are difficulties of physicians in the active management of AD in Korea. To solve current difficulties, changes in medical system to encourage the physicians’ effort for active clinical practice for patients with AD and education for physicians are needed. (Allergy Asthma Respir Dis 2013;1:257-265)

653 - Japanese Cohort Study of First Line Chemotherapy (CT) for Metastatic Colorectal Cancer (MCRC) Containing Fluoropyrimidine, Oxaliplatin and Bevacizumab: Emerald Study, First Report

ABSTRACT Background An observational cohort study plays a crucial role to understand the current status of clinical practice and can be utilized as database for multi-purpose outcome research. Such database is available in Europe and the United States based on several cohort studies especially in mCRC, while there is no database available including treatments for mCRC patients in Japan. Methods According to the Japanese Ethical Guideline for Epidemiologic Study, we planned and conducted a large cohort study in Japan. Data from more than 1000 patients were planned to be collected between October 2010 and September 2011 with 2-year follow-up period. Enrollment criteria included documented mCRC and first line CT containing fluoropyrimidine, oxaliplatin and bevacizumab, started treatment in or after January 2010, tumor response image assessment available, safety assessment available and able to offer information outside of originally enrolled studies. The primary objectives are to evaluate overall survival, liver resection rate, R0 liver resection rate; the secondary objectives are to evaluate response rate, progression-free survival, sub-group analysis by treatment regimens and by KRAS gene status, and safety. Results From October 2010 to September 2011, 1270 patients were recruited from 132 centers in Japan. The background of patients were as the following; male/female, 766/504; median age of 65 (range, 21-89); ECOG PS 0/1/2/3, 1045/203/17/5; FOLFOX/ CapeOX/ others with bevacizumab, 563/667/40, KRAS gene status at baseline was wild/mutant/unknown, 286/223/761; CEA median of 13.8 (range, 0.0–90055.0 ng/ml) and comorbidity no/yes, 798/472. Conclusion We have started the large Japanese cohort study which investigates first line CT containing fluoropyrimidine, oxaliplatin and bevacizumab for metastatic colorectal cancer. We performed a preplanned interim analysis. We present the first report of 6-month efficacy and safety data on 500 patients at the ESMO 2012 Congress. The final results will be available in 2013. This study is sponsored by the Public Health Research Center Foundation CSPOR in Japan. Disclosure All authors have declared no conflicts of interest.

Current status of clinical practice and associated factors with satisfaction among students in the department of Emergency Medical Service

Purpose : The purpose of this study was to investigate the current status of clinical practice and associated factors with satisfaction among students in the department of emergency medical service. Methods : The study subjects were 498 students who finished clinical practice course in 9 universities. General characteristics, current status of clinical practice, frequency of some medical procedure and practice satisfaction were collected using self-administered questionnaire. The association between clinical practice and satisfaction was tested by t-test, ANOVA and multiple regression analysis. Results : Of 498 students, 257 (51.6%) subjects were male and the mean age was . The overall satisfaction score of clinical practice was . Male students had higher satisfaction scores than that of female. The students who were satisfied with the emergency room practice wanted to work in hospital or fire station and they had a tendency to take paramedic as their lifelong career. The students preferred to practicing in the emergency department that hire the paramedic. Conclusion : Gender, grades, future jobs, occupational views, practical places, agency orientation, departments, and educators were associated with educational satisfaction. The practice program considering the results of this study will help to increase the educational satisfaction in students of emergency medical service.