Use Of Case Histories Research Articles

Investigating current clinical practice in assessment and diagnosis of voice disorders: A cross-sectional multidisciplinary global web survey.

Published best-practice guidelines and standardized protocols for voice assessment recommend multidisciplinary evaluation utilizing a comprehensive range of clinical measures. Previous studies report variations in assessment practices when compared with these guidelines. To provide an up-to-date evaluation of current global multidisciplinary practice patterns and the opinions of otolaryngologist, ear, nose and throat (ENT) and speech-language pathology (SLP) clinicians on initial assessment and differential diagnosis of adults with voice disorders (VDs). ENTs and SLPs worldwide who had worked with VDs within the last 10 years completed an anonymous online survey. Themes explored demographic information about the clinical practice, information about diagnostic assessment pathways, clinical assessments routinely used for initial voice evaluation and clinician perceived value of clinical assessments important for diagnosis. Patterns in the clinical practice of 88 SLPs and 21 ENTs from 18 countries with 1 to more than 25 years' experience were analysed. Clinicians provided services across a range of locations, and a range of assessment pathways was available for initial evaluation. Case history, laryngoscopy and auditory-perceptual measures were the most frequently selected assessments. Most clinicians favoured formal assessment measures for auditory-perceptual evaluation. Clinicians placed equal weighting on ENT and SLP assessment to aid diagnosis for muscle tension VDs and functional neurological voice disorders (FVDs). Practice patterns for initial diagnostic voice assessment are largely consistent with the currently published guidelines. Decisions for the selection of assessment tools vary according to VD classification, and assessment decisions appear to be guided by case history. Clinicians are not always following established protocols for obtaining reliable standardized measures. Further research is needed to understand the barriers to adhering to standardized protocols and to develop evidence for the use of case history in the process of VD diagnosis. What is already known on the subject Best-practice guidelines recommend a multidisciplinary and multidimensional assessment of adults with vocal symptoms. Prior uni-disciplinary survey studies have reported a divergence in clinical practice with the recommended guidelines. No previous studies have examined otolaryngologists and SLPs concurrently to investigate the multidisciplinary approach clinicians' use in a diagnostic voice assessment. What this paper adds to the existing knowledge This study highlights new insights into multidisciplinary voice evaluation practice patterns with an emphasis on diagnostic assessment from a global perspective. The findings build on prior research exploring clinical assessment pathways, service utilization and clinicians' preferences when selecting clinical tools to inform a differential diagnosis. What are the potential or actual clinical implications of this work? This paper provides insights to inform future service and resource planning to ensure the delivery of evidenced-based diagnostic assessment pathways. This study also makes recommendations for areas of future research to understand barriers to clinicians following recommended best-practice guidelines.

Reconsidering the patient: pauvres malades and malades pauvres in eighteenth-century medical contexts

Abstract When humoral medicine gave way to more scientific approaches in the nineteenth century, the physician’s gaze changed. Amongst the epistemological transformations were representations and perceptions of the poor patient: the pauvre malade—a pauper who happened to be sick and was to be taken care of by traditional medical charities—became a malade pauvre, a sick person who happened to be poor and was to be treated in new institutions. This article explores these changes but in settings beyond the clinic. In three case studies, we explore the practice of the Genevan physician Louis Odier, the management of the poor in the French spa of Saint-Amand and, finally, treatises about British spas. The agency of physicians, administrators and the poor themselves are analysed. Physicians played an ambiguous role. Some resisted innovation and refused to consider the poor as suffering from the same diseases as the affluent; others made opportunistic use of case histories, including those of the poor, to convince richer patients of the benefits of specific treatments, thereby reinforcing ‘class-blind’ ontological conceptions of disease. Administrators, for their part, tended to see the poor foremost as patients and put pressure on physicians to arrive at precise diagnoses.

Development and Evaluation of the POPBL (Patient-Oriented Problem-Based Learning) Module in Pathology: A Comparative Analysis of Performance and Perception Among Second-Year Pathology Students.

Background and objectiveEmploying the POPBL (Patient-Oriented Problem-Based Learning) method to teach students offers a fresh take on the classroom experience. It helps to enhance the motivation of the students, improves knowledge, self-learning behavior, and clinical reasoning, and also helps to promote long-lasting memory. In our medical college, we adopted a newer technology-oriented method with the use of case history, laboratory findings, a gross specimen of the same case, microscopic live sessions via Deca and Penta head microscopes, television, and microscopic camera. In light of this, in this study, we aimed to develop a patient- and technology-oriented new Problem-Based Learning (PBL) method and compare its effectiveness with the traditional tutorial method.Materials and methodsA total of 149 second-year MBBS students were enrolled in the study. Consent was taken from all students. A total of eight systems of systemic pathology from the second-year MBBS curriculum were selected. Of the eight systems, four were covered under POPBL with gross and microscopic features associated with the help of newer-generation audiovisual aids, and the other four systems were covered under the traditional tutorial/lecture method. The evaluation was performed using prevalidated objective types of questions after exposure of about one week. The objective was to evaluate and compare the outcomes and students' performance between these two sets of pathology systems.ResultsStudents gave excellent responses. Performance (87.92% of students had scores >75%) and attendance (94.14%) parameters with respect to POPBL gross and microscopic features associated with the help of newer-generation audiovisual aids like Deca and Penta head microscopes were superior compared to the traditional tutorial/lecture method, where 53.02% of students scored more than 75% and the attendance was 76.12%. The difference in attendance was also statistically significant (p=0.05).ConclusionUsing POPBL instead of standard tutorial/lecture methods leads to better outcomes. Students also found POPBL more appealing than standard lectures. It is a student-centered method that provides a significant level of motivation and encourages active participation among students. The efficacy of this new way of teaching and demonstrating will attract more students to this method.

Use of Case Histories to Illustrate the Effect of Installation Activities on the Side Resistance of Pipe Piles in Plastic Soils

This paper presents observations of the influence of pile installation methods on the measured side resistance of driven pipe piles bearing in plastic soils. Pile installation practices that can reduce the capacity of completed piles in plastic soils from that calculated include re-driving of piles after partial or full dissipation of excess pore water pressure, long installation times, slow jacking, the influence of surface casing in soft soils, and the use of vibratory hammers. Selected case histories are used to illustrate how deviations from rapid and nearly continuous pile installation can result in poor performance. Designers and Contractors need to be more aware of the damaging effects of these practices and that the selected design approach may not effectively consider the selected installation procedures. Where project requirements dictate use of these installation approaches that damage pile side resistance, the proposed construction influence factors may be used to modify a SHANSEP-based side resistance method to estimate the potential reductions in side resistance associated with the selected approach. Although the number of case histories available are too few to characterize the reliability of the construction influence factor approach, the cases sufficiently demonstrate the damage that can occur when these practices are used and the importance of construction procedures for driven pipe pile foundations that minimize or avoid damage to side resistance and to highlight where special design and testing are merited.

Case Histories in the Education of Advanced Practice Nurses

Case histories--rich, anecdotal narratives--are theorized to support the acquisition of cognitive, social, cultural, and emotional knowledge and motor skills through active learning. This manuscript focuses on the value of case histories in teaching and evaluating acute and critical care advanced practice nursing students. Information about the use of case histories in advanced critical care education and clinical practice is limited. Case histories support student-centered learning and development of clinical reasoning. An exemplar of a case history is provided, and application of case histories to both electronic and classroom settings is explored.

Neorealism Reconsidered: Human Nature or State Behavior?

History and Neorealism. Edited By Ernest R. May, Richard Rosecrance, Zara Steiner . Cambridge: Cambridge University Press, 2010. 394 pp., $35.00 paperback (ISBN-13: 978-0-521-13224-4). Political Realism, Freud, and Human Nature in International Relations. The Resurrection of the Realist Man. By Robert Schuett . Houndmills, Basingstoke: Palgrave Macmillan, 2010. 237 pp., $89.00 hardcover (ISBN-13: 978-0-230-62354-5). Neorealism remains the most widely criticized theoretical approach in international relations (IR) today. The literature that attempts to show the conceptual limits, theoretical flaws, and moral obtuseness of Neorealist or post-classical realist theorizing continues to grow, attesting to the ongoing institutional dominance of Neorealist thought just as much as to the sustained dissatisfaction with its intellectual legacy. The two books reviewed here contribute to the three-decade-old critique of Neorealism, but from two different perspectives. While the volume edited by Richard Rosecrance, Zara Steiner and the late Ernest May, History and Neorealism , focuses on Neorealism's, and more generally realism's inability to explain how states actually behave on the international scene, Robert Schuett, in Political Realism, Freud, and Human Nature in International Relations. The Resurrection of the Realist Man , resurrects realism's philosophical frame of analysis and addresses Neorealism's failure to sustain a coherent reflection on human nature and its role in international behavior. History and Neorealism aims to show “through the use of case histories addressing different countries and covering different periods, that, even in those episodes where power is centrally involved, ‘realism’ characteristically fails to explain what is happening” (p. 6). More specifically, the authors of the volume successfully demonstrate, contra the (Neo)realist balance-of-power/survival-and-hegemony explanatory scheme, that states have historically often made the choice to either “overuse” or “underuse” their power, and that these choices depend on their “different understandings of what power permits or of the elements of which it is composed” (Rosecrance, p. 12). Moreover, they show that states' behavior can only be understood if both non-systemic and systemic factors are taken into account, such as “ideological, economic, and social constraints,”“ideological leadership,”“geography,” as well as “transnational and institutional, economic, and social factors which affect the international environment in which states operate” (pp. 6–7). The ways wherein these …

What's in a Line? Is Partition a Solution to Civil War?

Does territorial partition of countries in civil wars help to end these wars, reducing the risk of recurrence? Researchers have proposed territorial partition with or without formal recognition of sovereignty as a solution to civil wars and a way to create self-enforcing peace. Quantitative studies of the effect of partition on the risk of renewed civil war, however, suffer several main shortcomings, including conflicting results in the extant literature that result mainly from data coding differences, selective use of case histories, and methodological problems. A new data set and a benchmark empirical analysis find that, on average, partition is unlikely to reduce the risk of a return to civil war and, in some cases, may increase that risk.

Madness in Buenos Aires: Patients, Psychiatrists, and the Argentine State, 1880-1983

In Madness in Buenos Aires, Jonathan Ablard convincingly demonstrates that Argentine psychiatric institutions were not the agents of social control that Foucauldian scholars have maintained they were in Europe and the United States. While Argentina had the most developed system of mental hospitals in Latin America, according to Ablard a weak state limited these institutions' policing and coercive functions. Buenos Aires's two main hospitals, the Hospital Nacional de Alienadas (for women) and the Hospicio de las Mercedes (for men) attempted to replicate European psychiatric practice, including even having an equal percentage of the national population interned. Nonetheless, lack of funds, ineffective administration, chronic overcrowding, bureaucratic incompetence and the absence of proper legal controls made Buenos Aires's hospitals places where patients were more often neglected than captured by a ‘clinical gaze’. The book is based on meticulous use of primary and secondary sources and is divided into five chapters plus an introduction and conclusion. Chapters 2 to 5 cover the period between 1900 and 1946 and are a comprehensive history of the development and misfortunes of Buenos Aires's two hospitals. These chapters are made compelling by Ablard's skilful use of case histories to illustrate diagnosis, treatment and legal problems of the patients. The last chapter of the book deals with the changes in psychiatry from the time of Perón until the end of the military dictatorship in 1983. Argentina prided itself on its modernity and large European population, yet the conditions that existed in the two Buenos Aires hospitals were similar to those in other Latin American manicomios. In the first decades of the twentieth century, patients often lacked adequate food, clothing and even beds, to say nothing of medical attention. In the early 1930s, the women's hospital had over 3,000 patients in facilities designed for 1,900 and in 1935 the men's asylum had a population of 2,580, more than twice its capacity.

History-based joins: Semantics, soundness and implementation

In this paper we study the use of case history for control structures in workflow processes. History-dependent control offers much more modeling power than classical control structures and it solves several semantical problems of industrial modeling frameworks. In particular, we introduce a history-dependent join. We study the modeling power by means of workflow patterns. Since proper completion (i.e. the ability of any configuration reachable from the initial one to reach the final one) is always an important “sanity check” of process modeling, we introduce a modeling method that guarantees this property holds. Finally we consider an implementation of the proposed control structures on top of an existing workflow engine.

Handbook of Clinical Psychopharmacology for Therapists, 4th ed

This book ended up being more than I expected. I was anticipating a handy reference source for commonly used psychotropic medications, which it is, but that is only part of what makes this a useful and valuable resource tool. The Handbook of Clinical Psychopharmacology for Therapists is logically organized into 3 major sections. The first, “Understanding Psychopharmacology: The Basics,” is easily the most academic of the three. Liberal use of case histories and sidebars with interesting anecdotal information, however, make it surprisingly readable and user-friendly. The second section, “Clinical Syndromes: Etiology, Diagnosis, and Treatment Implications,” is the largest and most clinical segment. In it the reader will find a comprehensive list and description of the most common psychiatric disorders. Included in these descriptions are helpful suggestions regarding possible drugs and medical conditions that cause similar behavioral patterns as well as guidelines for when nonmedical practitioners should consider referral for medication treatment. The third section, “Medications and Pharmacologic Treatment,” contains the information that I was initially looking for. Again the authors organize their material in a logical and clinically useful manner on the basis of major drug categories. They also provide handy thumb-tabs along with numerous charts and tables relating to issues such as dose guidelines, common side effects, special considerations, and treatment algorithms. I particularly appreciate their inclusion of a review on over-the-counter and herbal products, an area of increasing interest in recent years. This third section is what will make this text a frequent reference source for me and is the reason I plan to keep it on my desk rather than in my bookcase. The book ends with 8 appendices intended for readers looking for a more in-depth discussion of topics mentioned earlier in the book. Included here are an expanded review of pharmacokinetics, numerous tables listing psychotropic drug interactions, an outline for performing a neurocognitive mental status exam, and a reference list of books to recommend to patients. All in all, the Handbook of Clinical Psychopharmacology for Therapists is a well-written text that is capable of providing the reader with comprehensive review information as well as quick reference assistance.

Controversies in Pregnancy and Congenital Heart Disease

As increasing numbers of children with congenital heart disorders reach adulthood, the family physician, cardiologist, and obstetrician will increasingly be called upon to give advice regarding the safety of pregnancy. This need has been further highlighted by the recognition that maternal mortality associated with cardiac disease is rising. Unfortunately, this field of practice remains relatively "evidence-sparse" with many management decisions being guided by anecdote and "best guess" common sense. Not surprisingly, this results in many fundamental controversies over the optimal care these patients should receive. This article highlights, through the use of case histories, some of these contentious areas, reflecting the different manifestations of congenital maternal cardiac disease and highlighting the limitations of our knowledge.

Children Involved in Road Traffic Accidents: Psychological Sequelae and Issues for Mental Health Services

Although road traffic accidents involving children are common daily events it is only recently that the psychological consequences arising from such traumas have been investigated. This article summarizes the current research and highlights, by the use of case histories, the psychological reactions typically experienced by child traffic accident victims. Mental health services are not routinely provided to this group of children and the possible treatment implications are discussed.

The Unrecognized Social Stressors of Migration and Reunification in Caribbean Families

Black Caribbean parents often immigrate in order to increase their fortune and improve opportunities for themselves and their families. Frequently, they leave their children in their country of origin, to be raised by family members. Reunification with their children often occurs at the time of adolescence and, for a multitude of reasons, is often fraught with conflict which sometimes necessitates the involvement of social services and other agencies. Some reasons for these difficulties are presented and are illustrated through the use of case histories. Mental health professionals are advised to take societal and cultural factors into consideration when creating treatment plans for this population.

From Conant's Education Strategy to Kuhn's Research Strategy

The seminal influence of Kuhn's The Structure of Scientific Revolutions on the history, philosophy, and sociology of science illustrates how changes in pedagogical demands can significantly alter patterns of research. Kuhn's book was honed as a teacher in the General Education of Science curriculum designed by Harvard President James Bryant Conant, to whom Structure is dedicated. The courses targeted non-scientists who would have to make policy decisions in the dawning ‘Atomic Age’, where science would play an increasing role, despite the public skepticism generated by the atomic bomb (which Conant administered). Conant wanted these future policymakers to be ‘connoisseurs’ of science who understood problematic Big Science as continuing the basic mindset of culturally valued Little Science. This partly explains why Kuhn presented science as following the same stages, regardless of the specific science and period under discussion. I consider three other senses in Conant's curriculum left its imprint on Kuhn's research practice: the use of case histories to manufacture the internal/external history distinction; the invention of the historiographical mirage known as ‘normal science’; the application of the incommensurability thesis to create a more receptive attitude to past scientists.

When dying is living: hospice pastoral care and education.

Explores the relevance of Robert Kegan's concepts to the practice of pastoral care in a hospice context and illustrates the explanatory power of the concepts through the use of case histories. Outlines the implications of Kegan's theory for supervision in Clinical Pastoral Education within a hospice environment.

Long-term care decisions: ethical and conceptual dimensions

Physical, mental, or social changes in the life of an elderly person may result in a loss of self-sufficiency. Deciding how to compensate for changes-a process that often involves family members, tends, or health professionals-frequently leads to consideration of long-term care. Most of the existing literature on ethics and decision making, however, focuses on acute care and does not necessarily-apply to issues involved in choosing long-term care. This book offers the first conceptual and ethical framework for thinking about long-term care decision making in gerontologic and geriatric practice. It is also the first to examine these issues at the level of decision making by elders, family members, and professionals and to consider the broad range of options from receiving care at home to entering a nursing home. The discussion ranges from the philosophical, historical, and societal to the sometimes painfully specific and personal. Topics include the current system of long-term care in the United States and how it evolved, value considerations facing professionals involved with home care and care plans, the basic concepts of autonomy and independence, the effect on longterm-care of changing intrafamilial relationships and responsibilities, and a preventive ethics approach to long-term care decision making. The chapters make effective use of case histories and offer a strong sense of how individual human lives are affected by these issues.

A case study method for teaching theoretical criminology

We describe a method of introducing students to criminological theory through the use of case histories. This method uses the assumptions of various criminological theories to match theories with cases for illustrating how theories explain real-life events. It was designed to stimulate interest in theory among students and to develop their ability to synthesize explanations. The method has the latent function of encouraging students to use rigorous logic and theory construction methods. It also introduces some ideas usually relegated to methodology courses.

Periodontal Margin in the Older Adult: Considerations for Position, Placement, and Support

Some of the oral health problems of older adults arise from loss of function, which is catalyzed by changes in oral health induced by systemic disease and its treatment. The successful maintenance of a healthy gingival to root surface interface depends on the development of appropriate dental and gingival contours to facilitate self-cleansing and proper hygiene procedures by the patient. This article, with the use of case histories, discusses only one of the complications to restorative care in older adults, that is, loss of function and its relationship to marginal placement. Prevention of oral disease in the older adult may require modification of the long-held periodontal/restorative philosophy of placing margins above the tissue wherever possible. In addition, the professional prophylaxis of restorations adjacent to the gingival margin must address the problems of the creation of a roughened surface by abrasion to composites from pastes and polishing.

A case history analysis of the “manic type” and the “melancholic type” of premorbid personality in affectively ill patients

The use of case histories in examining the premorbid personality of affectively ill patients is especially useful in the case of patients with a predominantly manic course of the disorder, because this kind of affective illness is very rare. The concept of the "manic type" of premorbid personality is described in detail and contrasted with the concept of the "melancholic type" often found in patients with a purely depressive course of the illness.

Healers in transition

This paper, through the use of case histories illustrates the variety of traditional practitioners to be found in Plateau State Nigeria. The changes that some of them have undergone in the absence of official policy regarding integration, and under the influence of Western medicine, are discussed in terms of role adaptation. The options for collaboration between traditional and Western medicine are discussed and specific examples in Ghana, Nigeria, Senegal and Zambia are given. Potential problems facing such programmes are raised together with possible benefits. The need for a deeper understanding of traditional practitioners and their interest in co-operating with Western medical systems is discussed as well as the contribution that the use of case histories could make to this process.