Global ETD Search

271	Practitioners' Use of Clinical Practice Guidelines: An Evidence-Based Approach Santana, Sondra Michelle Phipps 01 January 2013 (has links) Pre-diabetes is a serious health problem in the United States. Distinguished by plasma glucose levels that are above the normal threshold, patients with pre-diabetes are 10 times more likely to develop type 2 diabetes. Patients with pre-diabetes suffer the same complications as patients with diabetes including diabetic retinopathy, nephropathy, and microalbuminuria. There is considerable evidence to support the idea that early identification and aggressive treatment of pre-diabetes has the potential to delay disease progression. The American Diabetes Association’s clinical practice guideline recommends management of with lifestyle modification and metformin for patients who are at risk for developing type 2 diabetes. The purpose of this project was to evaluate the implementation of the 2012 ADA clinical practice guidelines regarding the management of patients with pre-diabetes by the health care providers at a volunteer-run clinic located in a large metropolitan area in the southeastern United States. This study, even with a small sample size (n=26) revealed that the providers at the clinic had not implemented the 2012 ADA clinical practice guidelines. Clinical practice guidelines promote health care interventions that have proven benefits and improve the consistency of care provided to patients. The greatest benefits of implementing clinical practice guidelines for patients with pre-diabetes are early diagnosis and aggressive disease management. This would improve patient outcomes and in the long run, decrease the cost of medical care. University of North Florida UNF Project DNP D.N.P. Pre-diabetes clinical practice guidelines impaired fasting glucose impaired glucose tolerance metformin pharmacologic intervention prevention of type 2 diabetes Diseases Endocrine System Diseases Family Practice Nursing Medicine and Health Sciences Nursing
272	Přístup zaměřený na člověka a jeho místo v klinické praxi / Person-Centered Approach in clinical practice Dizon, Adam January 2020 (has links) This thesis explores the position of Person-Centred Approach (PCA) in the practice of Czech clinical psychologists and psychiatrists who went through the PCA psychotherapy training and they use this approach in their current clinical practice. The main principles of PCA theory (1), principles of biomedical model in which clinical practice is rooted (2) and the new forms of person-centred psychopathology and psychodiagnosis (3) are the theoretical background of the following research. Based on the qualitative analysis of five recorded interviews (three clinical psychologists, two psychiatrists) the experience of the respondents is organised as comprehensive concepts concerning various areas and topics of the clinical practice (diagnosis, psychotherapy, dealing with PCA, dealing with biomedical model, therapeutic relationship, relation to the profession). Several common mechanisms are identified in the concept's dynamics. Through these mechanisms Person-Centred Approach is applied in areas and activities mentioned. The concepts based on experience and the PCA application mechanisms enrich the theories and ongoing research of PCA practice in the Western mental health care. Key words: Person-Centred Approach, Client-Centred Therapy, psychiatry, clinical psychology, psychotherapy, psychodiagnosis,...
273	Prescribing cotrimoxazole prophylactic therapy (CPT) before and after an electronic medical record system implementation in two selected hospitals in Malawi Gadabu, Oliver Jintha 11 1900 (has links) Opportunistic infections (OIs) have been identified as a leading cause of poor outcomes in the ARV therapy (ART) programme. In order to reduce OIs, the Malawi, MoH introduced routine prescription of cotrimoxazole preventive therapy (CPT) in 2005. The MoH also started scaling up a point-of-care electronic medical record (EMR) system in 2007 to improve monitoring and evaluation. This study had the following objectives: i) to quantify prescription of CPT before and after implementing EMR; ii) to compare the difference in CPT prescription before and after implementing EMR. A historically controlled study design was used to compare CPT prescriptions one year before, and one year after implementation of the EMR at two health facilities. The data indicated that there was a significant (P <0.001) decrease in CPT prescribing at one health facility and a significant increase in CPT prescription at another. / Health Studies / M.A. (Public Health) Point-of-care EMR Clinical practice guidelines Cotrimoxazole prophylactic therapy Clinical decision support Electronic medical record Adherence Opportunistic infections Resource limited setting Clinicians Processes 614.5993920096897 AIDS (Disease) -- Malawi -- Prevention HIV infections -- Malawi -- Prevention
274	Development of a Guideline for Hospice Staff, Patients, and Families on Appropriate Opioid Use Alexander-Goreá, Trenika 01 January 2017 (has links) There is an identified problem with patients receiving suboptimal pain management at a hospice agency in the northwestern United States. At this agency, undertreatment of pain is prevalent. Evidence indicates that this may be a result of a lack of guidelines, education, and knowledge of appropriate prescribing. Known barriers to the correct prescription and administration of potent opioids in the hospice setting include prevailing beliefs, knowledge, skills, and attitudes, all of which can impact care negatively. Contextually, hospice principles mandate patient comfort and caregiver involvement in continuous quality improvement, which includes adequate and informed pain management. Moreover, hospice metrics demand requisite knowledge, skills, and attitudes for optimal care, including pain management at the end of life. The Academic Center for Evidence-Based Practice (ACE) star model was used to guide the development of an evidence-based, guideline-supported educational program that will improve pain management at the hospice agency when implemented. The purpose of this project was to use transdisciplinary expertise and team collaboration to develop the program and then to conduct a formative and summative evaluation utilizing experts to prepare the guidelines and process for implementation. Ten experts reviewed the guideline, the educational materials, the process, and the evaluation plan and conducted reviews using the AGREE II tool. The panel of experts agreed within the 6 AGREE domains. Future implementation of this guideline, translation process, and evaluation tool will impact social change through the empowerment of the clinical staff, patients, and caregivers to provide the best pain control and comfort at end of life, a vulnerable time for all patients. comfort care practitioners dying evidence-based practice EBP death theory concept guideline transdisciplinary multidiciplinary ethical end-of-life care EOLC Appropriate Opioid Use hospice hospice care palliative care palliate palliation end-of-life EOL actively dying opioid epidemic opioid crisis opioids prescribing opioids and practitioners pain control pain management clinical practice guideline hospice guidance Ethics and Political Philosophy Nursing
275	Inter-professional Clinical Practice Guideline for Vocational Evaluation following Traumatic Brain Injury Stergiou-Kita, Mary Melpomeni 11 January 2012 (has links) Due to physical, cognitive and emotional impairments, many individuals are unemployed or under-employed following a traumatic brain injury. The research evidence links the rigour of a vocational evaluation to future employment outcomes. Despite this link, no specific guidelines exist for vocational evaluations. Using the research evidence and a diverse panel of clinical and academic experts, the primary objective of this doctoral research was to develop an inter-professional clinical practice guideline for vocational evaluation following traumatic brain injury. The objective of the guideline is to make explicit the processes and factors relevant to vocational evaluation, to assist evaluators (i.e. clients, health and vocational professionals, and employers) in collaboratively determining clients’ work abilities and developing recommendations for work entry, re-entry or vocational planning. The steps outlined in the Canadian Medical Association's Handbook on Clinical Practice Guidelines were utilized to develop the guideline and include the following: 1) identifying the guideline’s objective/questions; 2) performing a systematic literature review; 3) gathering a panel; 4) developing recommendations; 4) guideline writing; 5) pilot testing. The resulting guideline includes 17 key recommendations within the following seven domains: 1) evaluation purpose and rationale; 2) initial intake process; 3) assessment of the personal domain; 4) assessment of the environment; 5) assessment of occupational/job requirements; 6) analysis and synthesis of assessment results; and 7) development of evaluation recommendations. Results from an exploratory study of the guideline’s implementation by occupational therapists in their daily practices revealed that clinicians used the guideline to identify practice gaps, systematize their evaluation processes, enhance inter-professional and inter-stakeholder communication, and re-conceptualize their vocational evaluations across disability groups. Statistically significant improvements were also noted in clients’ participation scores on the Mayo-Portland Adaptability Inventory–4 following guideline use. This guideline may be applicable to individuals with TBI, clinicians, health and vocational professionals, employers, professional organizations, administrators, policy makers and insurers. clinical practice guidelines vocational rehabilitation traumatic brain injury evidence-based practice health plan implementation return to work employment work capacity evaluation brain injury vocational evaluation work assessment job performance work performance employment status re-employment review work integration work re-integration brain injuries practice guideline knowledge transfer knowledge translation implementation occupational therapy neurological rehabilitation knowledge exchange research utilization continuing professional development quality improvement practice change change management health care technology implementation research 0382 0769 0354
276	Inter-professional Clinical Practice Guideline for Vocational Evaluation following Traumatic Brain Injury Stergiou-Kita, Mary Melpomeni 11 January 2012 (has links) Due to physical, cognitive and emotional impairments, many individuals are unemployed or under-employed following a traumatic brain injury. The research evidence links the rigour of a vocational evaluation to future employment outcomes. Despite this link, no specific guidelines exist for vocational evaluations. Using the research evidence and a diverse panel of clinical and academic experts, the primary objective of this doctoral research was to develop an inter-professional clinical practice guideline for vocational evaluation following traumatic brain injury. The objective of the guideline is to make explicit the processes and factors relevant to vocational evaluation, to assist evaluators (i.e. clients, health and vocational professionals, and employers) in collaboratively determining clients’ work abilities and developing recommendations for work entry, re-entry or vocational planning. The steps outlined in the Canadian Medical Association's Handbook on Clinical Practice Guidelines were utilized to develop the guideline and include the following: 1) identifying the guideline’s objective/questions; 2) performing a systematic literature review; 3) gathering a panel; 4) developing recommendations; 4) guideline writing; 5) pilot testing. The resulting guideline includes 17 key recommendations within the following seven domains: 1) evaluation purpose and rationale; 2) initial intake process; 3) assessment of the personal domain; 4) assessment of the environment; 5) assessment of occupational/job requirements; 6) analysis and synthesis of assessment results; and 7) development of evaluation recommendations. Results from an exploratory study of the guideline’s implementation by occupational therapists in their daily practices revealed that clinicians used the guideline to identify practice gaps, systematize their evaluation processes, enhance inter-professional and inter-stakeholder communication, and re-conceptualize their vocational evaluations across disability groups. Statistically significant improvements were also noted in clients’ participation scores on the Mayo-Portland Adaptability Inventory–4 following guideline use. This guideline may be applicable to individuals with TBI, clinicians, health and vocational professionals, employers, professional organizations, administrators, policy makers and insurers. clinical practice guidelines vocational rehabilitation traumatic brain injury evidence-based practice health plan implementation return to work employment work capacity evaluation brain injury vocational evaluation work assessment job performance work performance employment status re-employment review work integration work re-integration brain injuries practice guideline knowledge transfer knowledge translation implementation occupational therapy neurological rehabilitation knowledge exchange research utilization continuing professional development quality improvement practice change change management health care technology implementation research 0382 0769 0354

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