Reality Of Daily Practice Research Articles

The use of minimal residual disease in thoracic oncology: Gaps between promises and the on-the-ground reality of daily practice.

The assessment of minimal residual disease (MRD) from blood samples of patients with resected non-small cell lung carcinoma (NSCLC) is promising and opens up many opportunities for the optimisation of patient care in daily practice. Notably, this includes the potential for escalation or de-escalation of adjuvant therapies. Thus, the evaluation of MRD status can directly contribute to an increase in the overall survival of early stage NSCLC patients and/or limit therapeutic but also "financial" toxicity. Therefore, several clinical trials recently evaluated MRD in early stage NSCLC by integrating and retrospectively comparing the results of MRD assessments. In this context, there is an urgent need to close the gap between clinical research and the use of the evaluation of MRD in routine daily practice. Further action needs to be taken, particularly in evaluating the pertinence of the detection of MRD in prospective interventional clinical studies. This may be done in part by comparing different parameters, such as the techniques used, the different time points and the cutoffs of MRD assessments. This article investigates the assessment of MRD in non-small cell lung cancers, with a special focus on the issues associated with the various assays and the limitations of using circulating free DNA analyses for MRD assessment in early stage lung cancer. Recommendations and tips for the optimisation of MRD evaluation in non-small cell lung cancers are provided.

Current and future applications of virtual reality technology for cardiac interventions.

Virtual reality is a fast-evolving technology that already has several promising applications in medicine. In this Clinical Outlook, we discuss the current evidence and the future challenges for virtual reality applications in cardiac interventions. The incorporation of virtual reality in daily practice will inevitably make clinical care more robust, patient-centred and safe.

Ativação de alinhadores ortodônticos com alicates – uma alternativa para obtenção de resultados

The great demand for aesthetics has led to the development of increasingly discreet orthodontic appliances. For this reason, treatments with orthodontic aligners have become a reality in daily practice and the understanding of their biomechanics and especially the resources to obtain the desired results is of fundamental importance. Therefore, this work aims to demonstrate how the activation of the aligners through orthodontic pliers can be performed in order to help complement the movement, especially when only a force exerted by the aligners is not sufficient for the desired tooth movement.

Ulcer pressure prevention and opportunity for innovation during the COVID-19 crisis

The coronavirus disease (COVID-19) pandemic has put the health system under stress in many places around the world. Worldwide, the shortage of health supplies, including medical devices and medications, has become a reality in daily practice. Restrictions on production related to the pandemic itself has increased the demand for treatment methods/strategies, and the dependence on imports has led to a parallel crisis in the healthcare system (). However, crises provide excellent opportunities for innovation in processes, products, and technologies, some [...]

Translating EBP Into the Reality of Daily Practice: Leadership Solutions for Creating a Path Forward

NURSING'S AGENDA CALLS on us to lead evidence-based practice (EBP) for quality care. 1 Auerbach D. Martsolf G. Pearson M.L. et al. The DNP by 2015: A study of the institutional, political, and professional issues that facilitate or impede establishing a post-baccalaureate doctor of nursing practice program. http://www.aacnnursing.org/Portals/42/DNP/DNP-Study.pdf?ver=2017-08-01-105854-190Date: 2015 Date accessed: June 26, 2018 Google Scholar , 2 Institute of Medicine Leadership Commitments to Improve Value in Healthcare: Finding Common Ground: Workshop Summary. National Academies Press, Washington, DC2009 Google Scholar , 3 Melnyk B.M. Fineout-Overholt E. Gallagher-Ford L. Kaplan L. The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. J Nurs Adm. 2012; 42: 410-417 Crossref PubMed Scopus (355) Google Scholar The Institute of Medicine set a goal for 90% of health care to be evidence-based by 2020, yet clinicians and organizations are struggling to achieve this goal. 2 Institute of Medicine Leadership Commitments to Improve Value in Healthcare: Finding Common Ground: Workshop Summary. National Academies Press, Washington, DC2009 Google Scholar Growing and sustaining programs to promote evidence-based health care remain elusive. Commitment to building programs and infrastructures that promote EBP and continuous learning in health care are essential, yet few exemplars and little research is available as a guide. 4 Institute of Medicine Best Care at Lower Cost: The Path to Continuously Learning in Health Care in America. National Academies Press, Washington DC2013 Google Scholar , 5 Stetler C.B. Ritchie J.A. Rycroft-Malone J. Charns M.P. Leadership for evidence-based practice: Strategic and functional behaviors for institutionalizing EBP. Worldviews Evid Based Nurs. 2014; 11: 219-226 Crossref PubMed Scopus (76) Google Scholar , 6 Warren J.I. McLaughlin M. Bardsley J. et al. The strengths and challenges of implementing EBP in healthcare systems. Worldviews Evid Based Nurs. 2016; 13: 15-24 Crossref PubMed Scopus (84) Google Scholar , 7 Williams B. Perillo S. Brown T. What are the factors of organisational culture in health care settings that act as barriers to the implementation of evidence-based practice? A scoping review. Nurse Educ Today. 2015; 35: e34-e41 Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar , 8 Wilson M. Sleutel M. Newcomb P. et al. Empowering nurses with evidence-based practice environments: Surveying Magnet®, Pathway to Excellence®, and non-magnet facilities in one healthcare system. Worldviews Evid Based Nurs. 2015; 12: 12-21 Crossref PubMed Scopus (66) Google Scholar Expanding nurse-led EBP remains a journey, not a destination. 9 Cullen L. Hanrahan K. Journey to evidence-based healthcare. Reflections Nurs Leadersh. 2018; (Available at:)https://www.reflectionsonnursingleadership.org/features/more-features/journey-to-evidence-based-healthcareDate accessed: June 25, 2018 Google Scholar , 10 Melnyk B.M. Gallagher-Ford L. Zellefrow C. et al. The first U.S. study on nurses' evidence-based practice competencies indicates major deficits that threaten healthcare quality, safety, and patient outcomes. Worldviews Evid Based Nurs. 2018; 15: 16-25 Crossref PubMed Scopus (159) Google Scholar Best evidence and decades of work have created a path forward with solutions for integrating EBP improvements in daily care. However, programs and resources require piloting, evaluation, and revision to match local context. Core elements will be described that create a climate and capacity that empowers nurses to lead EBP within their span of influence. Laura Cullen, DNP, RN, FAAN, Office of Nursing Research, Evidence-Based Practice & Quality Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA.

Haste makes waste: Are the data regarding TARGIT-A IORT ready for prime time?

We would like to comment on the manuscript written by Esserman and colleagues [1] regarding the application of a decision analytic framework for adoption of clinical trial results. It is true that due to the prevalence of breast cancer, any management decision concerning its treatment may have significant implications concerning medical resources use and costs. However, this also holds true for any mistake or hasty decision that might carry a heavy price on public health in the long term. If the purpose of the model presented in the article aimed to describe an analytic framework, then for the purpose of proof of concept, the statistical analysis should be applied first on treatments for which long-term follow-up is available, in order to prove and validate that the model can predict the same results as in the reality of daily practice. The use of the currently available TARGIT-A trial data to evaluate this model is inappropriate since follow-up in the TARGIT-A trial is immature [2, 3]

Personalized treatments of cancer patients: a reality in daily practice, a costly dream or a shared vision of the future from the oncology community?

Therapies targeting activated oncogenes have been associated with several successes in the last decades that are described in this review, together with their limits and related unsolved questions. Most of the tumours will eventually develop drug resistance potentially due to intratumor heterogeneity and selection of additional molecular events. Moreover, studies in the field of molecular characterisation of cancers have shown that most tumors include large number of rare genomic events. Developing new drugs requires the use of large-scale molecular screening programs to enrich phase I/II trials with patients presenting the genetic alterations to treat them with the appropriate drug(s). Administering one single drug will incur in non-durable results, so the future is to cleverly combine drugs. Development of personalized immunotherapeutics and/or anti-angiogenic agents could change the natural history of several cancers. Finally, other systems including DNA repair and metabolism have become targetable. These considerations justify the development of molecular medicine with the characterisation of each tumour to assess defects in all the systems previously mentioned to propose a unique combination of therapies to each patient. Current drug development is clearly not appropriate, and studies with drugs given in relevant combinations should be favoured by new relationships between academia and industry. New organisational and medico-economics approaches are required to minimize the financial burden of personalized medicine by considering the foreseen decrease of the costs of new technologies, and the money saved by avoiding the use of many costly, useless but nonetheless toxic treatments given after failure of standard therapy.

Non Sequitur

It is important to determine the take-up and results of the adolescent health check-up (KiGGS survey data). The conclusions drawn by the authors do not follow. The take-up of the J1 depends on: How often adolescent patients present to their doctors. According to studies by statutory health insurers, 12–14 year old girls, for example, visit their doctor an average of 1.3 times a year. If during the winter months they contract an acute infection and the J1 is mentioned, this recommendation quickly pales into oblivion. Parental attitudes On the one hand, I see in my practice adolescents with the “best risks,” that is, healthy children from intact families with good integration at school and in a social context. These patients are often known to the practice. Abnormal findings are rare. On the other hand, other problems exist whose further discussion might take place within the context of the J1 (migraine, asthma, etc). Those who really need such screening examinations are not interested. This includes adolescents from dysfunctional family backgrounds with extreme media consumption; experience with alcohol, nicotine, or drugs; early sexual activity; known existing comorbidities such as obesity and its sequelae; or poorly controlled conditions such as asthma and eczema. Among the data the authors analyzed, adolescents with known obesity or nicotine misuse problems, for example, were underrepresented. Billing options for the adolescent health check-up The J1 is financially supported for adolescents aged 13–14. The association of statutory health insurers for Berlin has abolished the J1 for 15-year-olds. Since physical and mental developments happen at very different times and in different ways, it would make sense to approve health check-ups for adolescents aged 15 or 16 years. It may not make sense to talk to every 14-year-old boy about alcohol, drugs, sex, and contraception, but if a boy is aged 16, it usually does make sense. Time restrictions in routine practice In the first quarter of 2011, 1450 patients presented in my practice some 3100 time. 255 screening examinations U2 to U9 were undertaken. In the context of the practice’s opening times, this translates as a consultation time of 5.07 minutes. I gladly take part in adolescent health check-ups, but the reality in daily practice does not really leave any spare capacity for such examinations.

Using written information in clinical work with patients and carers

In all areas of medicine there is increasing awareness that patients need information that is clear, relevant and appropriately timed. This is obviously connected with ethical concerns of patient dignity and autonomy, but it also underpins the principle of informed choice. It is not possible to make an informed choice about how you want a problem to be managed, if you do not have the relevant information. Doctors have, historically, been poor communicators of such information. Although, on the face of it, this seems a straightforward issue to rectify, there are a surprising number of practical problems to be addressed before such communication can become a reality in daily practice.

Hospital Administration in the Early 1900s: Visions for the Future and the Reality of Daily Practice

This article explores the first vision of modern hospital management as it was advanced by the American Hospital Association in the early 1900s and compares it with the reality of daily practice at the time. The findings show a wide gap between vision and reality. They also show that many of the issues faced by hospital administrators a hundred years ago remain relevant today. They include the tension between adoption of new technology and the cost of hospital care, advocacy for business practices from the private sector, and the administrator's responsibility in the area of quality of care.

Why the professional-Client Ethic is Inadequate in Mental Health Care

Patients who are subject to compulsory care constitute a substantial proportion of the work-load of mental health professionals, particularly psychiatric nurses. This article examines the traditional 'beneficence-autonomy' approach to ethics in compulsory psychiatric care and evaluates it against the reality of daily practice. Risk to the public has always been an important but often unacknowledged consideration. Inequalities exist among ethnic and socio-economic groups and there is a lack of agreement on what constitutes mental disorder. Two major changes in compulsory psychiatric care--community orders and care for patients with untreatable severe personality disorders--further challenge the traditional ethical approach. There are also important human rights implications. The simple patient-health professional relationship no longer provides an adequate framework for mental health professionals on which to base their ethical decisions. The public and organizations may have different perspectives and their interests are becoming increasingly important. Mental health professionals, particularly psychiatric nurses, may face ethical dilemmas because of these different perspectives.

Topic selection in undergraduate medical education and relevance to general practice.

Most patients who have possibly malignant diseases are first seen by physicians not specifically trained in oncology. The cancer education that undergraduate medical students receive is frequently dominated by basic science topics, detailed staging data, pharmacology of cancer drugs, and treatment protocols. This is not in accordance with the needs in general practice. In pre-course information and correspondence with reference to the International Summer School "Oncology for Medical Students," held in Groningen, The Netherlands, it is emphasized that the Summer School focuses on cancer care in general practice. As part of the education program participants are required to prepare abstracts and posters on oncologic topics in general health care in their own countries. Despite the emphasis on cancer care in general practice and despite suggestions for topics, some students have first sent in abstracts describing basic sciences research projects. Evidently during their medical training the relevancy of cancer education to the reality of daily practice had not been taught or had already been lost. In teaching undergraduate medical students, it should be realized that the vast majority will choose non-oncology disciplines. Thus, cancer education of these students should focus mainly on clinical cancer issues that are relevant in general practice.