The primary purpose of educational interventions is to optimize the clinical management of patients. General practitioners (GPs) play a major role in the detection and management of diseases. This ...systematic literature review will describe the type and outcomes of educational interventions designed for general practitioners (GPs) in the Australian context.
PubMed, CINHAL, and Scopus databases were systematically searched for studies on educational interventions conducted for GPs in Australia during 1st January 2008 to 11th June 2018. Data collected on the methodology of the interventions, GPs satisfaction regarding the educational intervention, changes in knowledge, confidence, skills and clinical behavior of the GPs. We also assessed whether the acquired clinical competencies had an impact on organizational change and on patient health.
Thirteen publications were included in this review. The methods with which educational interventions were developed and implemented varied substantially and rigorous evaluation was generally lacking particularly in detailing the outcomes. The reported GP response rate varied between 2 and 96% across studies, depending upon the method of recruitment, the type of intervention and the study setting (rural vs. urban). The most effective recruitment strategy was a combination of initial contact coupled with a visit to GP practices. Nine of the studies reviewed reported improvement in at least one outcome measure: gaining knowledge, improving skills or change in clinical behavior which was translated into clinical practice. In the 3 pre- and post-intervention analysis studies, 90-100% of the participating GPs reported improvement in their knowledge and attitudes.
Education interventions for GPs in Australia had low response (recruitment) and retention (GPs that participated in follow-ups) rates, even when financial benefits or CPD points were used as incentives. Higher GP response rates were achieved through multiple recruitment strategies. Multifaceted interventions were more likely to achieve the primary outcome by improving knowledge, skills or changing practice, but the effect was often modest. Inconsistent results were reported in studies involving the use of multiple contact methods within an intervention and conducting online interventions.
Endoprosthetics for bleeding esophageal varices Dannhorn, Emily H., MBBS, MRCP; O′Beirne, James P., MBBS (Hons), FRCP, MD, EDIC
Techniques in gastrointestinal endoscopy,
04/2014, Letnik:
16, Številka:
2
Journal Article
Abstract Refractory esophageal hemorrhage and early rebleeding following endoscopic therapy remain challenging conditions to treat and are associated with a high mortality. Techniques such as balloon ...tamponade (BT) and transjugular intrahepatic portosystemic shunt (TIPS) are highly effective at controlling refractory bleeding, but they can be associated with a high rate of complications and, in the case of TIPS, may not be immediately available outside specialist centers. Recently, removable self-expanding metal stents (SEMSs) have been introduced in clinical practice for the management of esophageal variceal bleeding. SEMSs control bleeding by tamponade of varices in the distal esophagus and can remain in situ for a number of days, thus preventing early rebleeding. The use of SEMSs does not require the transfer of the patient to a specialist center, and unlike TIPS, it is not associated with deterioration in liver function. The use of SEMSs has been described in small series of patients with refractory bleeding. These series report high rates of hemostasis with low complication rates, suggesting that SEMSs may have an important role in the management of refractory bleeding either as an alternative to BT or where TIPS is contraindicated. SEMSs may also have a role in treating complications of therapy for bleeding esophageal varices, such as postbanding ulceration and BT-induced esophageal tears. The aim of this review is to summarize the published data on the efficacy of SEMSs and suggest future studies that may clarify its role in the management of esophageal variceal hemorrhage.
The vision of a precision medicine-guided approach to novel cancer drug development is challenged by high intratumor heterogeneity and interpatient diversity. This complexity is rarely modeled ...accurately during preclinical drug development, hampering predictions of clinical drug efficacy. To address this issue, we developed Comparative In Vivo Oncology (CIVO) arrayed microinjection technology to test tumor responsiveness to simultaneous microdoses of multiple drugs directly in a patient's tumor. Here, in a study of 18 canine patients with soft tissue sarcoma (STS), CIVO captured complex, patient-specific tumor responses encompassing both cancer cells and multiple immune infiltrates following localized exposure to different chemotherapy agents. CIVO also classified patient-specific tumor resistance to the most effective agent, doxorubicin, and further enabled assessment of a preclinical autophagy inhibitor, PS-1001, to reverse doxorubicin resistance. In a CIVO-identified subset of doxorubicin-resistant tumors, PS-1001 resulted in enhanced antitumor activity, increased infiltration of macrophages, and skewed this infiltrate toward M1 polarization. The ability to evaluate and cross-compare multiple drugs and drug combinations simultaneously in living tumors and across a diverse immunocompetent patient population may provide a foundation from which to make informed drug development decisions. This method also represents a viable functional approach to complement current precision oncology strategies.
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Aims
This analysis explored and characterized adolescent and adult women's lay language and discourse related to bladder health/function.
Methods
Forty‐four focus groups were conducted across seven ...United States research centers with 360 adolescents and adult women, organized by six age categories. Multilevel content analyses classified emergent themes. A transdisciplinary lens and inductive approach guided data interpretation. Interpretive insights were validated by a community engagement panel.
Results
A repertoire of bladder function terms emerged, including explicit functional terms, formal and polite euphemistic terms, and informal familiar terms, as well as cultural and regional metaphors and idioms. Terminology usage was historically grounded, developmental, and cumulative across the life course. Lay discourse was contextual and affectively valent, suggesting unspoken, commonly understood, situation‐based “rules” for talking about bladder function. Discourse appeared to be siloed within family and friendship circles. Adolescents and adult women often described, rather than named, bladder sensations or problems. Terminology for bladder issues tended to minimize severity and frequency, with medical language only relevant to extreme examples and not applicable to mild episodes.
Conclusions
A definitional discordance between medical and lay views of bladder problems was identified, signifying a need to clarify the meaning of medical terms for lay persons. Adolescents and adult women do not have or use standardized precise terminology for bladder health and function, relying instead on social convention and interpersonal context. Findings can be used to foster shared understandings between lay persons and health professionals, informing development of clinical, research, and public health initiatives to promote bladder health.
A fundamental problem in cancer drug development is that antitumor efficacy in preclinical cancer models does not translate faithfully to patient outcomes. Much of early cancer drug discovery is ...performed under in vitro conditions in cell-based models that poorly represent actual malignancies. To address this inconsistency, we have developed a technology platform called CIVO, which enables simultaneous assessment of up to eight drugs or drug combinations within a single solid tumor in vivo. The platform is currently designed for use in animal models of cancer and patients with superficial tumors but can be modified for investigation of deeper-seated malignancies. In xenograft lymphoma models, CIVO microinjection of well-characterized anticancer agents (vincristine, doxorubicin, mafosfamide, and prednisolone) induced spatially defined cellular changes around sites of drug exposure, specific to the known mechanisms of action of each drug. The observed localized responses predicted responses to systemically delivered drugs in animals. In pair-matched lymphoma models, CIVO correctly demonstrated tumor resistance to doxorubicin and vincristine and an unexpected enhanced sensitivity to mafosfamide in multidrug-resistant lymphomas compared with chemotherapy-naïve lymphomas. A CIVO-enabled in vivo screen of 97 approved oncology agents revealed a novel mTOR (mammalian target of rapamycin) pathway inhibitor that exhibits significantly increased tumor-killing activity in the drug-resistant setting compared with chemotherapy-naïve tumors. Finally, feasibility studies to assess the use of CIVO in human and canine patients demonstrated that microinjection of drugs is toxicity-sparing while inducing robust, easily tracked, drug-specific responses in autochthonous tumors, setting the stage for further application of this technology in clinical trials.
Purpose:
Management of anticoagulated patients has changed significantly over the past 10 years. The change occurred after the introduction of the international normalized ratio (INR) in 1983. This ...method of reporting prothrombin time for anticoagulated patients has resulted in a decrease in the level at which hematologists and cardiologists keep their patients anticoagulated. Currently, patients are anticoagulated less for the successful prevention of thromboemboli. Recent recommendations are to keep patients anticoagulated to an INR no greater than 3.5. It has been proposed that the extraction of teeth can be performed with INRs of 4 or less. Therefore, the current trend is to maintain patients on their anticoagulation regimens without altering their warfarin dosages.
Conclusion:
With proper local measures, teeth can be extracted safely and the development of thromboemboli in high-risk patients can still be prevented. However, with procedures having a high risk of bleeding, warfarin dosage may need to be modified.
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