Abstract This paper examines the current debate among cardiologists and cardiac surgeons regarding the use of coronary artery bypass surgery (CABG) versus drug-eluting stents (DES). The author concludes that the research indicates that, even though cardiac surgeons have conducted many studies that appear to show the benefits of percutaneous coronary interventions (PCI) with accompanying DES, there are still very serious considerations to using these interventions in certain groups of patients, especially those with multivessel coronary artery disease. This paper recommends future research with multicenter trials comparing use of PCI with DES as compared to CABG in terms of both short-term and long-term benefits, mortality rates, revascularization rates and other benefits or complicating factors in order to establish or disavow the superiority of PCI with DES. Thirteen figures are included with the paper.
Table of Contents:
Abstract
Statement of Problem
Key Terms and Definitions
Background of Study
Unprotected Left Main Stenosis
Multivessel Coronary Artery Disease
Summary
Conclusion
Recommendations for Future Research
From the Paper "According to Gunn and Crossman other energy sources are also useful. Sonotherapy, or unltrasound may potential more as a treatment than as a facilitator 'for gene delivery and is 'benign' in its effect on healthy tissue." Photodynamic therapy, or the interacting of photosensitizing drugs, light and tissue oxygen, is under investigation and still only in very early development. Laser energy delivered "via a fine intracoronary wire, is used in a few centers to recanalize block arteries." Gunn and Crossman state that the role of percutaneous clinical "has extended to the point where up to 70% of patients treated have acute coronary syndromes.""
Tags:clinicalpercutaneousrevascularizationsurvival, comorbid conditions, and
Abstract This paper examines some suggestions for outdoor professionals on how to survive in extreme environments. It discusses the essential elements of water, shelter and food necessary for survival in the desert, in the arctic, in the tropics and at sea. The paper aims to offer strategies at locating and exploiting resources necessary for survival.
From the Paper "The elements necessary for survival in extreme environments are much the same for survival in a conventional one. Without water, shelter and food death is imminent. However, one essential difference separates the two. In conventional environments the resources are plenty and quite accessible. In extreme environments resources are harder to find and are more difficult to exploit. Following are suggestions and strategies to survive in the desert, in the arctic, in the tropics and at sea. These suggestions primarily focus on the location..."
Abstract Part I of this paper deals with the three most common kinds of child abuse ? physical, sexual and emotional. It discusses clinical issues, behavioral issues, symptoms, signs and tests for these specific kinds of child abuse. Part II of the paper deals with several disorders in children that are not easy to detect and cure, specifically Autism, Attention Deficit Disorder/Attention Deficit and Hyperactivity Disorder and Down Syndrome. The paper covers diagnosis, treatment and cure (if applicable).
From the Paper "The problem in identifying and dealing with emotional abuse is that at lower levels of intensity, the occurrence of abuse is debatable. For instance mild levels of belittling could be seen as "kidding". Another example could be that of criticizing and insulting. Depending on the issue that leads to such abuse, the grown up could actually be convinced that they are doing this to the child for "his own good". These mild forms of abusive behavior could actually be seen as "nurturing"."
A critical analysis of "Computerized Patient Model and Simulated Clinical Experiences: Evaluation with Baccalaureate Nursing Students," written by C.E. Feingold, M. Calaluce and M.A. Kallen.
Abstract This paper reviews the article "Computerized Patient Model and Simulated Clinical Experiences: Evaluation with Baccalaureate Nursing Students," written by C.E. Feingold, M. Calaluce and M.A. Kallen. The paper begins by discussing the purpose for the research and then reviews the research design and literature. It concludes with a look at the recommendations by the authors and a discussion of the implications of the study.
Table of Contents:
Problem and Purpose
Literature Review
Study Framework
Research Questions/Hypothesis
Study Variables
Study Design
Population, Sample and Setting
Method of Measurement
Data Collection
Data Analysis
Interpretation of Findings
Conclusions
Recommendations
Implications for Practice
Qualification of the Researchers
Significance of Study
From the Paper "As mentioned above, the significance of this study is in the fact that simulated clinical situations with the use of technology, while still being improved, is progressing towards a more realistic experience in the setting of timely faculty guidance and a safe environment within which to acquire fundamental clinical skills. It is also significant in that it provides insight into the disparity between faculty, student and student subset perspectives regarding the value of these simulations, aspects which need to be explored further in future research."
Tags:clinical, nursing, research, design, practice
Abstract Six-page essay that explores why Primo Levi chose to write "Survival in Auschwitz" using literary techniques instead of writing it as a strictly journalistic account.
Abstract This research examines clinical pathways which chart and document the care and expected outcomes of care for patients. It evaluates how clinical pathways represent a procedure in contemporary healthcare with a potential to both improve the quality of care and reduce the cost of care. A focus is placed on clinical nurse specialists who are well positioned to play critical roles in their use.
Outline
Introduction
Overview of Clinical Pathways and their Purpose
Clinical Pathways as Multi-Disciplinary Documents
Specific Statements and Flexible Application
The Development of Clinical Pathways
Resistance to Collaboration in the Development of Clinical Pathways
Clinical Pathways and Diagnosis Groups
Consensus Development
Dealing with the Resistance through the Application of Change Theory
Clinical Ethics by CNSs in the Application of Change Theory to Improve Collaboration in the Development of Clinical Pathways
Practicing Patient Advocacy by CNSs in the Application of Change Theory to Improve Collaboration
The Implementation of Clinical Pathways
Clinical Pathways and Holistic Care
Clinical Nurse Specialists as Case Managers in the Implementation of Clinical Pathways
Conclusion
References
From the Paper "Important in the definition of clinical ethics is an emphasis on clinicians, not only physicians, thus underscoring the fact that clinical ethics needs to be a multi-disciplinary endeavor that encompasses the range of clinician expertise involved in patient care. The central goal must be the resolution of ethical dilemmas through a process that promotes cooperation and collaboration among those parties involved. Clinical ethics holds that, while the traditional patient-centered approach is dominant, there is a need for the pragmatic acknowledgment that decisions about patient care take place in a context that of necessity involves the interests of others, such as institutions, families, and caregivers."
Tags: case, care, patients, contemporary, healthcare
Abstract This paper examines clinical trial management practices and how they vary in the United States and Europe as a result of wide-ranging governmental bodies and regulations. It compares and contrasts the rules of the the Food and Drug Administration (FDA) in the United States and its equivalent in Europe, the European Agency for the Evaluation of Medicinal Products (EMEA). In particular, it provides a brief analysis of several areas involved with oncology clinical trial management in the United States and Europe, including a discussion of medical ethics, the role of the Institutional Review Board in clinical trials, quality of life issues and health economics in oncology studies. It also looks at investigator attitudes towards clinical trials, clinical trial length, compliance and decisions regarding new drug applications (NDAs).
From the Paper "Investigator attitudes towards clinical trials vary widely and are often dependent upon the investigator's direct involvement in the clinical trial as well as the balance between routine patient care and clinical trial management. According to Abelson, Welch, and Lynch (86), ?In a trial, the clinician's judgment carries a lot of weight. The U.S. Food and Drug Administration bases approval of drugs upon a clinician's judgment of who should be in the trial, how to categorize adverse events, whether there is a drug interaction and the interpretation of specific parameters. These judgments are critical.? Investigators are ultimately responsible for all areas of the study, from recruitment and participant selection to event reporting and monitoring."
Abstract This paper explains that the authors of the clinical study titled "The Overcrowded Clinic" observe that, while the clinic offered adequate family planning services to the target community it failed to do so because of a variety of competing factors. The author points out that these factors include staff apathy, under-staffing and poor client management. The paper states that logistical functioning of any medical clinic is an essential part of the overall effectiveness of the clinic the treatment and to the positive experience of the patients.
From the Paper "This paper examines the clinical study titled "The Overcrowded Clinic". In this work, the authors observe that while the clinic offered adequate family planning services to the target community, it failed to do so because of a variety of competing factors including staff apathy, under-staffing, and poor client management. The logistical functioning of any medical clinic is an essential part of the overall effectiveness of the clinic, the treatment, and to the positive experience of the patients. Ultimately, if the processes and flow of the clinic are ill conceived, poorly executed, or prove to be inadequate for the needs of the patient volume, that clinic cannot succeed in the core mission of every medical institution: to provide the best and most conscientious care for its patients."
Abstract This proposal concerns the introduction of a diabetes IT program for the Cleveland Clinic, following a successful eClinic initiative to involve patients in their heart care. The product presented in this paper is a home health care diabetes monitor which is web-based, but uses some of the digital download capabilities of common glucose testers. This paper demonstrates that the patient's closer monitoring will result in better outcomes and a better financial picture for the Cleveland Clinic. The writer concludes that the adoption of a diabetes home monitoring system will bring benefits to all concerned, and help the Clinic to meet and expand its mission. By insuring patient compliance through feedback to the patient, his/her family, and the healthcare professionals, the patient not only improves his/her outcome, but also reduces costs to the healthcare system.
Table of Contents:
Introduction
Cleveland Clinic Achieving the Overall Business Plan of the Organization
Diabetes Monitoring will Strengthen this Institution
Using IT Tools will Strengthen Loyalty to the Clinic Positive Partnering with the Patient and the Clinic's Staff
Patient Outcomes are Improved
Quality
Staff is Competent to Use the Technology
Organization is Ready to Employ this Technology
Improving Access and Service to Patients
Safety
The Technology Facilitates Providing a Safe Workplace
Integration/Implementation
Conclusion
From the Paper "Diabetes monitoring at home is a logical extension of the work done at the Cleveland Clinic. That is because our institution serves patients who are obese, who have vascular problems, and who have other results of diabetes. By reaching out to the community and helping diabetes sufferers, we offer both a continuation of their treatment in the Clinic, as well as an early-warning method which ties those patients to our institution.
"By tending to those patients within our capitated health plan, we can assure better compliance, and therefore lower patient costs. Given that the greater Cleveland area is home to 1.1 million people, and the number of diabetics is estimated at 44,000 people . This means that the Cleveland Clinic can offer outpatient services using IT which improve our overall market coverage and improves patient care."
Abstract The writer of this paper proposes a marketing plan for the Castlerock Veterinary Clinic in Maine. According to the author, from being the leading facility in the area, the clinic has seen a gradual decline and is now in need of revitalization. The writer gives an overview of the clinic and discusses the key issues facing it in its quest to regain its market status. The writer also discusses the strong and weak points of the practice and finally makes a number of recommendations that, in his opinion, will help reverse the downward trend of the clinic's business.
Table of Contents:
Overview
Key Issues
Discussion of Key Issues
T.O.W.S. Analysis
Threats
Opportunities
Weaknesses
Strengths
Recommendations
Justifications/Rationale
Obstacles/Risks
Bibliography
From the Paper "Because of the friendship and the long-term business relationship that exists between the clinics, competitive advertising has been considered inappropriate in the veterinary community. Advertising is crucial for consumers to learn more about an organization and its products and services. Advertising allow consumers to become more aware of the organization, build a reputation within the market, and create a preference amongst consumers. Because Castlerock wants to maintain their relationship with the other clinics, failing to advertise keeps the organization from gaining a competitive advantage within the market."
Tags: animals, pet lovers, examination rooms, operating rooms, boarding grooming training
Abstract This paper proposes a solution to the problem at XYZ Health Clinic concerning the lack of effective communication between the front office staff of the clinic and patients coming to the clinic for certain medical tests. The proposed solution is heavily dependent on information technology, so an overview of information resource management is included in the paper as well.
From the Paper "Recently, it has come to the attention of the administrators of the XYZ Health and our team, that there has been a lack of effective communication between the front office staff of the clinic and patients coming to the clinic for certain medical tests. Many patients report that they have been ill informed as to the procedures they must follow regarding such tests before coming to the clinic. For instance, in terms of glucose tolerance tests, the front office staff has often been remiss in informing individuals how long they must fast before the test is conducted. This lack of information has caused a backlog. Individuals come to the clinic improperly prepared, not having fasted for the proper duration, or in other cases, not brought the appropriate referral slips or personal equipment (such as eyeglasses) for exams. ("Glucose Tolerance Testing," 2003) The exam must then be rescheduled, causing a waste of time for doctors, patients, and the nursing staff."
Abstract This paper uses the definition by Benner, Tanner and Chelsea that clinical judgment is often based on patterns of responses, the specific case and the people involved in the situation. The author points out that making a clinical judgment requires nurses to use critical thinking skills. The paper relates that often clinical judgment is based on the patient, family, diagnosis and the situation.
From the Paper "What is clinical judgment? How does a nurse decide what clinical judgment to make in different cases? The definition by Benner, Tanner, and Chelsea states that clinical judgment is often based on patterns of responses, the specific case, and the people involved in the situation. Making a clinical judgment requires nurses to use critical thinking skills. Often clinical judgment is based on the patient, family, diagnosis, and the situation. The definition of clinical judgment by Benner, Tanner, and Chelsea makes common sense. This definition of clinical judgment most nurses will agree that it is the best definition because past experiences and knowledge mixed with the relationship the nurse has with the patient and family are combined in making clinical judgments. "
Abstract This literature review discusses how healthcare clinics are generally viewed by its patients, as well as how the healthcare employees view their work. It then discusses how the interactions between the patients and employees provides a healthcare environment that will allow for the improvement of healthcare. The paper discusses how the country of Malaysia, and specifically the city and area of Kuala Lumpur, is quickly becoming a modern, developed country complete with the medical facilities that denote that development. It finally discusses how healthcare clinics are able to generate revenue and profits for themselves or the hospitals they are affiliated with.
From the Paper "This anticipation may not be necessarily what the citizens of Malaysia have earmarked as their highest priorities. Much of the health care provided for them at any of the local clinics may not be what the citizens are looking for. The citizen's attitudes towards health care are likely to be different than the citizens from other developed countries."
"This study will seek to discover those attitudes and how they affect health care coverage, and efficiency of the doctors, nurses and health care professionals at a health care facility in Kuala Lumpur. The study will seek to determine whether the attitudes affected by the citizens affect the health care coverage."
Abstract Sara Tuvel Bernstein's memoir, "The Seamstress: A Memoir of Survival", is one of the most memorable of first-person accounts of survival during the Holocaust. The book is well-told by the late Bernstein and deserves a prominent place in the archive of Holocaust survival stories. In 1944, she was transported with her sister and two friends to the Ravensbruck concentration camp. In a moving afterward, Seren's daughter describes her mother's strong personality. Published posthumously, Bernstein's work evolved literally thread by thread as she worked in her sewing room, methodically recording her tale of survival during the Holocaust.
Abstract Clinical supervision is noted to be the 'cornerstone' of psychological training and support. This paper examines how it is a reflection upon the psychotherapeutic practice of trainee psychologists and involves the establishment of a symbiotic relationship, which is focused towards the trainee's development as a professional. It looks at how clinical supervision is an integrated process in which numerous relationships exist and overlap: that of the supervisor and the supervisee, the supervisee and the client and the supervisor's support within the relationship between the supervisee and the client.
From the Paper "Helpful aspects sought after by supervisees within the supervisory process, have been noted as a positive and supportive relationship, involving teaching, support and feedback; and thus ultimately allowing supervisee's to enhance their clinical competence (Cushway & Knibbs, 2004). From a supervisory point of view, however, helpful behaviour has been noted as giving feedback to supervisees, monitoring their behaviour during the therapeutic process and providing contingent consequences for such behaviours (Worthington & Roehlke, 1979). Such inconsistency within the concept of 'high-functioning' clinical supervision between supervisors and their supervisees demonstrates the ease of incongruence between perceived effectiveness within the supervisory relationship. "
Tags:clinical, psychology, psychotherapist, psychotherapy, training
