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Elsevier is a leading publisher of medical content, and ClinicalKey is the company's latest endeavor to aggregate multiple resources in one easily searchable interface. ClinicalKey merges medical education with clinically relevant information. This review will provide an overview of the contents, search options, features and limitations of this database.

INTRODUCTION: This Capstone project provided preliminary data on the OT Feeding Outcome Tool and general data on outcomes of feeding interventions at Children’s Specialized Hospital. The OT Feeding Outcome Tool is an internally developed and utilized tool to assess a wide range of pediatric feeding difficulties, regardless of diagnosis and intervention. THEORETICAL PERSPECTIVE: Sensory Integration and Behaviorism were the major theoretical frameworks. DESCRIPTION OF DOCTORAL CAPSTONE: A literature review, focus groups, interviews, chart audits, an online questionnaire and clinical participation and observation provided quantitative and qualitative data on the current state of the literature, barriers to implementation and outcomes of children who have received feeding therapy at Children’s Specialized Hospital. RESULTS: The majority of pediatric feeding assessments are based in behavioral theory and interventions and fail to capture the multi-faceted etiologies and intervention approaches that are seen in practice. Data analyses revealed children who receive feeding therapy at Children’s Specialized Hospital, regardless of diagnosis or intervention, have positive responses recorded by the OT Feeding Outcome Tool. Major barriers to tool implementation were logistical challenges, forgetting and lack of competency. Most effective education methods of the tool were discussion with colleagues, staff meeting and an education presentation. CONCLUSION: There is a significant lack of feeding assessment tools for pediatric populations in the literature, and specifically a lack of evaluations that incorporate an occupational therapy and sensory integration lens. The OT Feeding Outcome Tool is a promising assessment tool for the evaluation of feeding difficulties in pediatric populations.

BACKGROUND: In March of 2020, the novel coronavirus 2019 (COVID-19) pandemic required healthcare systems to be rapidly responsive to adapt hospital guidelines for the most up-to-date care and safety protocols as knowledge of the disease rapidly evolved. Rates of COVID-19 infections continue to fluctuate, and non-COVID-19 patients have now returned to the emergency department for care. This increase in patient volume leads to new challenges and threats to patient and clinician safety as suspected COVID-19 patients need to be quickly detected and isolated amongst other patients with non-COVID-19 related illnesses. In addition, emergency physicians face continued personal safety concerns and increased work burden on the front lines, heightening stress and anxiety. Burnout is a serious concern for emergency physicians due to the cumulative pressures of their daily practice, even under non-pandemic circumstances. Given the prolonged course of the pandemic, burnout may likely present as a longer-term outcome of these acute stressors. METHODS: A rapidly adaptive simulation-based approach was implemented to understand and improve physician preparedness while decreasing physician stress and anxiety. A randomized control trial was conducted to test the effectiveness of a simulation preparedness intervention on physician physiologic stress as measured by decreased heart rate variability on shift and anxiety as measured by the State-Trait Anxiety Inventory. OUTCOMES: Front-line EM physicians participated in a simulation-based educational intervention aimed to facilitate the adoption of protocols and treatment algorithms. Four virtual simulation scenarios highlighted the care pathways a practitioner might implement when managing a COVID-19 positive patient. A debriefing session followed each scenario to interactively analyze the learners' management decisions. The discussion focused on the most current hospital protocols so that any gaps in knowledge could be successfully addressed. The scenarios were iteratively updated, and the debriefing emphasis changed to deliver the newest clinical guidance and operational procedures as they evolved while continuing to highlight the aspects of care that remained challenging. Ongoing analysis of the physiological data is still being conducted. NEXT-STEPS: Mixed model analysis of physiologic and self-report measures of stress and anxiety will be used to determine if this virtual simulation intervention improves adherence to guidelines and protocols in the clinical setting and its impact on physicians while on shift. The next steps include further dissemination and objective feedback from institutions that may adopt this learning intervention.

No description available.

Regardless of the tinnitus sound (itself), tinnitus can be especially challenging for clients when paired with traumatic brain injury and post-traumatic stress. Research offers insight into how clinicians can help clients manage this co-occurrence.

The two longitudinal case studies that make up this dissertation sought to explain and predict the relationship between usability and clinician acceptance of a health information system. The overall aim of the research study was to determine what role usability plays in the acceptance or rejection of systems used by clinicians in a healthcare context. The focus was on the end users (the clinicians) rather than the views of the system designers and managers responsible for implementation and the clients of the clinicians. A mixed methods approach was adopted that drew on both qualitative and quantitative research methods. This study followed the implementation of a community health information system from early beginnings to its established practice. Users were drawn from different health service departments with distinctly different organisational cultures and attitudes to information and communication technology used in this context. This study provided evidence that a usability analysis in this context would not necessarily be valid when the users have prior reservations on acceptance. Investigation was made on the initial training and post-implementation support together with a study on the nature of the clinicians to determine factors that may influence their attitude. This research identified that acceptance of a system is not necessarily a measure of its quality, capability and usability, is influenced by the user’s attitude which is determined by outside factors, and the nature and quality of training. The need to recognise the limitations of the current methodologies for analysing usability and acceptance was explored to lay the foundations for further research.

abstract: With new trends in drug development and testing, it must be determined whether the current state of balance of ethos (the moral norm) and regula (the legal framework) can successfully protect patients while keeping the door to scientific innovation open. The rise of the Clinician Investigator (CI) in both academic and private research introduces a challenge to the protection of subjects in the conflicting dual role of physician and scientist. Despite the constant evolution of regulation and ethical standards, questions about the roles' combined effectiveness in relation to this challenge persist. Carl Elliot describes the suicide of a patient-subject enrolled in an industry-funded physician-run anti-psychotic pharmaceutical drug trial in a 2010 Mother Jones article. Elliot provides a personal account of discrepancies seen in the ethical principles of beneficence, respect for subjects and justice. Through analysis of the problems presented in the case as a model for potential dangers in clinical research, the effectiveness of ethics and law in protecting human subjects is examined. While the lag between ethical standard and regulation has historically shown to cause similar issues, the misconception of current regulation and ethical standards may be contributing to the decrease in subject protections. After IRB approval of subject protections in the research protocol, CIs have been shown to downgrade their responsibility to maintaining ethos through the course of the trial. And, despite their experience in patient-centered ethos as a physician, CIs may be inclined to substitute these values for the ethos of a researcher, with the goal to avoid therapeutic misconception. Maintaining personal responsibility for subjects beyond regulatory structure, and promoting the welfare of the subjects in regards to the ethical standard of research investigators, will provide added security for subjects and decrease opportunity for exploitation in future research. / Dissertation/Thesis / M.S. Biology 2012

Social camouflaging is prevalent among patients with Autism spectrum disorder [ASD] and entails copying and/or masking behaviours, personality traits and adaptive functioning in order to adjust to environmental demands. The aim of this thesis was to explore clinicians’ experiences of working with adult patients with ASD who display social camouflaging. Research questions explored clinicians’ perceptions of frequency and nature of social camouflaging among males and females with ASD, as well as their competence and confidence in working with these patients. This was examined using a mixed-methods sequential explanatory design, consisting of a quantitative and a qualitative phase. Quantitative data was collected through a web-based questionnaire which was completed by clinicians [n=31] working in a specialised setting in Sweden. Four clinicians [n=4] also participated in qualitative semi-structured interviews. Paired samples t-tests indicated that females were observed to display social camouflaging more often. Clinicians’ competence and confidence did not differ to a significant degree between males and females when social camouflaging was displayed. Possible explanations for this were discussed through the main themes found in the qualitative thematic analysis. The themes consisted of clinicians’ understanding of social camouflaging, perceived obstacles when working with this group of patients and important prerequisites for clinicians in order to overcome these obstacles. The findings emphasized the need to broaden the view of ASD through future research, since it causes gaps of knowledge that clinicians seldom have the opportunities to fill. Furthermore, measures to enable support and resources for clinicians are needed to help this patient group. / Social kamouflering förekommer hos patienter med Autismspektrumtillstånd [AST] och kan yttra sig genom kopiering och/eller maskering av beteenden, personlighetsdrag och adaptiv funktion för att möjliggöra en anpassning i linje med omgivningens krav. Syftet med denna uppsats var att undersöka klinikers upplevelser av att möta vuxna patienter med AST som uppvisar social kamouflering. Frågeställningarna undersökte klinikers upplevelse av frekvens och natur av social kamouflering hos män och kvinnor med AST, samt deras kompetens och självsäkerhet i mötet med dessa patienter. Detta undersöktes genom en mixad metod med sekventiell förklarande design, innehållande en kvantitativ och en kvalitativ fas. Kvantitativa data samlades in genom ett webb-baserat formulär som fylldes i av kliniker [n=31] från specialiserade enheter i Sverige. Fyra av dessa kliniker [n=4] deltog även i kvalitativa semi-strukturerade intervjuer. Parade t-tester indikerade att kvinnor observerades uppvisa social kamouflering mer frekvent. Klinikers kompetens och självsäkerhet skilde sig inte till en betydande grad mellan män och kvinnor när social kamouflering uppvisades. Möjliga förklaringar till detta diskuterades utifrån de huvudteman som återfanns i den kvalitativa tematiska analysen. Teman inkluderade klinikers förståelse av social kamouflering, upplevda hinder i mötet med denna patientgrupp samt viktiga förutsättningar för att överkomma dessa hinder. Resultaten betonade vikten av att framtida forskning breddar bilden av AST, eftersom det tycks skapa kunskapsluckor som kliniker sällan ges möjlighet att fylla. Utöver detta framhölls behovet av åtgärder för att möjliggöra stöd och resurser för kliniker för att de skall kunna hjälpa denna patientgrupp.

The major goal of supervisors in the area of Speech Pathology is to help student clinicians improve efficiency and effectiveness in attaining a therapeutic goal. This study was designed to provide systemic feedback of recorded data to student clinicians to determine the effect of a particular supervisory instrument on the future performance of inexperienced clinicians. The subjects for this study were six beginning student clinicians in Speech Pathology at Portland State University, two of which were randomly selected to represent the control group. All of the clinicians were observed for a randomly selected consecutive five-minute period from each of six management sessions. During these observations a content analysis was made of the interactions between the clinicians and their clients. The Analysis of Behavior of the Clinician (ABC) System, developed by Schubert and Miner (1971) was used to record interactions on a three-second interval schedule. The observation sessions for the control group coincided in time with the experimental group’s observation sessions, though no feedback was given to the control clinicians and they were unaware that tracking was done.