Professional Clinical Experience Research Articles

Feline neonatology: From birth to commencement of weaning - what to know for successful management.

Despite considerable interest in the field of companion animal reproduction, feline neonatology remains largely unstudied. This contrasts with the need for a more professional veterinary approach to newborn kittens and feline husbandry, across the pet, breeding cattery and rescue shelter settings, to reduce kitten mortality. Feline neonatology has relevance for veterinarians around the world as cats are continuing to become established as popular companion animals. Perinatal mortality in cats is remarkably high. Therefore, adequate neonatal evaluation and assistance at birth, careful monitoring of kittens in the vulnerable period until weaning begins, assessment of maternal factors and well-informed management of orphans are crucial in helping to reduce kitten losses. This review aims to deepen the basic knowledge of the veterinary clinical team regarding the characteristics of feline newborns under normal conditions at birth through to the commencement of weaning. Much of the information is also relevant to breeders and rescue/shelter caregivers. In compiling the present review, the authors have drawn on specific feline research data, where available, complemented by data extrapolated from scientific publications on newborn dogs, and also their own and their colleagues' professional clinical experience.

Analysis of Preparatory Courses for the Practical Component of the PLAB Exam for International Medical Graduates in the UK.

BackgroundMedical workforce shortages are a major threat to the future of the UK National Health Service (NHS) and countless other healthcare systems globally. Reliance on international medical graduates is likely to continue and may increase, although these doctors face many educational and professional challenges. The Professional and Linguistic Assessment Board (PLAB) test, delivered by the General Medical Council (GMC), is the “gateway” exam that doctors must pass through in order to practice in the UK. Despite the central importance of this exam, no official or accredited training courses are provided or approved by the GMC.MethodsThis study used online and social media searches to identify and categorise preparatory courses available for the practical (clinical) component of the PLAB assessment.ResultsA total of 13 courses were identified, delivered predominantly in the cities of Manchester and London, ranging from 1 to 28 days in duration and from £24.99 to £649.99 in cost. Most courses were organised by previous PLAB candidates and websites focussed on testimonials from previous participants rather than educational credentials or professional clinical experience of teachers running the courses. Courses were all provided by private education companies, and none were delivered by universities or National Health Service organisations.DiscussionA variety of preparatory services and courses exist for the PLAB assessment, although the public information about them is variable and limited. Further research is required to examine the quality of these courses and the potential for alternative avenues of training for international medical graduates preparing to practice in the UK.

The combination of MMSE with VSRAD and eZIS has greater accuracy for discriminating mild cognitive impairment from early Alzheimer's disease than MMSE alone.

Alzheimer's disease (AD) is assessed by carefully examining a patient's cognitive impairment. However, previous studies reported inadequate diagnostic accuracy for dementia in primary care settings. Many hospitals use the automated quantitative evaluation method known as the Voxel-based Specific Regional Analysis System for Alzheimer's Disease (VSRAD), wherein brain MRI data are used to evaluate brain morphological abnormalities associated with AD. Similarly, an automated quantitative evaluation application called the easy Z-score imaging system (eZIS), which uses brain SPECT data to detect regional cerebral blood flow decreases associated with AD, is widely used. These applications have several indicators, each of which is known to correlate with the degree of AD. However, it is not completely known whether these indicators work better when used in combination in real-world clinical practice. We included 112 participants with mild cognitive impairment (MCI) and 128 participants with early AD in this study. All participants underwent MRI, SPECT, and the Mini-Mental State Examination (MMSE). Demographic and clinical characteristics were assessed by univariate analysis, and logistic regression analysis with a combination of MMSE, VSRAD and eZIS indicators was performed to verify whether the diagnostic accuracy in discriminating between MCI and early AD was improved. The area under the receiver operating characteristic curve (AUC) for the MMSE score alone was 0.835. The AUC was significantly improved to 0.870 by combining the MMSE score with two quantitative indicators from the VSRAD and eZIS that assessed the extent of brain abnormalities. Compared with the MMSE score alone, the combination of the MMSE score with the VSRAD and eZIS indicators significantly improves the accuracy of discrimination between patients with MCI and early AD. Implementing VSRAD and eZIS does not require professional clinical experience in the treatment of dementia. Therefore, the accuracy of dementia diagnosis by physicians may easily be improved in real-world primary care settings.

Reliability and accuracy of the brachial plexus neurodynamic test

Study DesignObservational study. IntroductionThe brachial plexus neurodynamic test (BPNT), based on previous neurodynamic tests, is considered a clinically meaningful tool to objectively assess brachial plexus extensibility. This novel test's psychometric properties have yet to be determined. Purpose of the StudyThe primary study aim was to assess the inter- and intrarater reliability and accuracy of the BPNT, which biases the median nerve and brachial plexus, among clinicians of various professional experience levels and geographic US regions. The secondary study aim was to determine if professional experience or geographic region affects the accuracy levels of this test. MethodsIn phase 1, inter-rater reliability and accuracy was determined. About 307 participants attending neural mobilization conferences and courses were instructed in the BPNT and asked to score 7 different videos of 14 possible test levels. In phase 2, intrarater reliability was determined via scoring the same test videos twice. ResultsHigh inter-rater intraclass correlation coefficient (range, 0.98-0.99) and accuracy (range, 0.88-0.94) levels were determined for all clinical experience levels and geographic regions. Intrarater intraclass correlation coefficient values were high (range, 0.96-1.0) among all participants. One-way analysis of variance indicated no significant differences on test accuracy based on professional clinical experience (F = 0.104; P = .958) and geographic region (F = 0.416; P = .416) among all 307 participants. DiscussionExcellent inter- and intrarater reliability and accuracy levels may allow clinicians to correctly identify BPNT positions regardless of their professional experience or geographic location. ConclusionThe BPNT can reliably and accurately quantify outcomes in neural mobility scoring.

Commentaries on health services research

Commentaries on health services research

Insider Action research as an approach and a method – Exploring institutional encounters from within a birthing context

The aim of this paper was to describe the first person perspective of being a peer midwife and a novice researcher initiating collaborative AR in her own organization to develop knowledge about the first encounters between the labouring woman and her care-givers in a hospital birthing context. It was motivated by the author’s longstanding professional clinical experience of observing and hearing parents’ stories of vulnerability and fear of childbirth, and how staff’s attitudes affected the childbirth experience negatively. Data were collected between 2010 and 2013 and included the researcher’s log with reflections from clinical work, as well as interviews, participant observation, and research group communications. A reflective interpretative lifeworld research approach was used to analyze the data. The experience of being a novice insider action researcher (IARr) consisted of three thematic meanings: “the struggle to initiate a clinical insider action research project,” “standing alone at the messy front line,” and “being a catalytic counterbalance to the prevailing medico technical focus.” The comprehensive understanding was “learning how to clinically reflect on and to voice the tacit components of care.” The strategy used in undertaking this study was influenced by the philosophies of both midwifery care and AR.

Besoins, usages, bénéfices–inconvénients, bonnes pratiques et perspectives en matière de déambulateurs chez les sujets âgés dépendants

Non-use of the walker may be secondary to an initial inappropriate prescribing, a lack of adequate training, a lack of monitoring and side effects of using. Improving both stability and mobility in users is due to several biomechanical mechanisms. The benefits of walker are: general physiological effects, more confidence, better social life and decrease in the burden of care. The disadvantages of walker are: technical or practical aspects criticized by users, musculoskeletal disorders, delayed reaction time, fall risk and stigma. Few scientific data evaluating the interest of the walker concerning mobility exist, thus recommendations are low grade and are often taken from professional clinical experiences. The choice of technical walking assistance depends on the pathology and biomechanical mechanism. The walker robots are few distributed.

Nutrition, metabolism, and integrative approaches in cancer survivors.

To review emerging issues about metabolic changes occurring in cancer survivors during and as a result of therapy, the role of nutrition, weight control, stress management, nutritional supplements, and other complementary diet therapies, methods of mitigating side effects of treatment affecting dietary intake, and to suggest future research directions. Literature review and professional clinical experience with oncology patients. Enhancing cancer survivorship requires knowledge and application of nutritional science and integrative health care approaches. Reliable, personalized, team-generated nutritional advice must be provided to cancer patients and cancer survivors to reduce risk of recurrence, optimize energy balance, and improve quality of life.

Attitudes and views on chiropractic: A survey of United States midwives

A survey of midwives' knowledge and views about chiropractic. Cross-sectional descriptive survey. An anonymous on-line self-administered survey. United States midwives. Respondent demographics, professional training, personal and professional clinical experience, opinions on safety of chiropractic, and scope of chiropractic practice. A total of 187 midwife respondents completed the questionnaire resulting in a superficial response rate of 2.1%. Responders were certified nurse-midwives and had some form of training regarding chiropractic. The responders were aware that chiropractors worked with "birthing professionals" and attended to patients with both musculoskeletal and non-musculoskeletal disorders. A vast majority indicated a positive personal and professional clinical experience with chiropractic and that chiropractic was safe for pregnant patients and children. There is great awareness of and positive personal and professional experience with chiropractic on the part of midwives who participated in this survey. We encourage further research in this field.

Assessing Ethnicity in Preconception Counseling: Genetics—What Nurse Practitioners Need to Know

To define and discuss five genetic disorders--Tay-Sachs, sickle cell anemia, Canavan's disease, thalassemia, and cystic fibrosis (CF)--and to explain the importance of the nurse practitioner's (NP's) assessment of clients' ethnicity during preconception counseling, which should address these genetic conditions. Review of literature from professional journals, professional organizations' Web sites, guidelines from the American College of Obstetricians and Gynecologists, the National Institute of Health Consensus Statement, and the authors' professional clinical experience. The goal of preconception counseling is to identify potential or actual medical, psychological, or social conditions that may affect the mother or fetus. NPs are often the health care providers that initiate preconception counseling to women in varied primary care settings. NPs must be familiar with ethnicity-related inheritable conditions in order to provide appropriate client information and education and to implement testing and, when needed, referral for genetic counseling to individuals and families at risk for genetic disorders such as Tay-Sachs, Canavan's disease, CF, sickle cell anemia, and thalassemia. NPs providing health care to women of child-bearing age should assess the client's use of contraception and intent for future pregnancy. Preconception counseling when indicated should be initiated to all women to increase their potential for healthy pregnancy outcomes. Although a comprehensive personal, family, medical, and psychosocial history and initiation of folic acid are the mainstays of preconception counseling, assessment for risk of ethnicity-related genetic conditions must also be included in prepregnancy health care.

The turn of the tide.

The turn of the tide.

Divorce counseling and values

Because my subject is divorce counseling, I feel it necessary to make some personal statements. I have never been divorced. I have been married for more than 41 years to the same man and have three married children and six grandchildren. I am writing not out of any traumatic personal experience with divorce, but rather out of extensive and intensive professional clinical experience with the divorcing and divorced through many years. I have a law degree. My husband is an active and rather well-known matrimonial lawyer in New York City. For years, I observed the pain and suffering of the divorcing and the divorced and the futile efforts at reconciliation and help by humane lawyers who tried to understand but whose understanding was not supported by clinical training and knowledge. Naively, I thought: "Somewhere there must be people who help these persons in their emotional, physical, social, and economic distress." There was no one: no agency, no therapists, no ministers really equipped to help those either in the process of divorcing or already divorced. As a result of my interest and concern, I determined to enter a doctoral program and eventually become clinically trained in marriage counseling. My research culminated in a doctoral thesis entitled "Education for the Divorced." In 1960, when I was choosing the title for this research, I planned to call it "Education for Divorce." This was immediately rejected. I would never get any population, and it would not be acceptable generally and particularly to the church. Why? It indicated a readiness to prepare people for divorce. This was against public policy. So the title became "Education for the Divorced"?acceptable because it indicated that I was ready to help those who had already gotten a divorce, and if I thought I could help such people?good luck! Now, about 15 years later, I have a book published under the title Divorce: The