Respect in clinical practice

Respect is naturally presumed to be a component of the therapeutic relationship. Therapists, however, need to go beyond the everyday understanding of respect and be prepared to provide a dimension that we do not expect to find in other human relations.     

Hepatitis in clinical practice

Abstract

Objective: This report illustrates the treatment progression of a patient with rapidly decompensating type 2 diabetes. Methods: The patient had to transition to insulin therapy within 2 years of her initial diagnosis, following only a brief period of glycemic control with diet management, weight loss, and oral agents. This relatively rapid progression to insulin requirement is occasionally seen in adults with typical type 2 diabetes that may classify as a number of different subtypes of diabetes. Results: The case presented demonstrates how a simple stepwise approach to dose titration with basal insulin helped a patient with severe depletion of endogenous insulin achieve initial glycemic control, and how the addition of prandial insulin helped control her mealtime glycemic excursions. Conclusion: The use of basal-prandial insulin therapy is an effective option for patients with rapidly decompensating type 2 diabetes to achieve their glycemic goals without delays and to minimize associated morbidities.     

Plasmapheresis in clinical practice

The authors presented their experience of the use of intermittent plasmapheresis in 220 children with bacterial-inflammatory and immune-mediated diseases characterized by extreme severity and refractoriness to common therapeutic methods. Its use against a background of adequate etiological and pathogenetic therapy was shown to improve therapeutic results. In virus hepatitis with liver insufficiency, bullous erythema and hemorrhagic vasculitis plasmapheresis can be used as an independent method. Differentiated programs of the use of plasmapheresis were proposed, its safety was shown.     

Biomechanics in clinical practice

Evidence from dynamic biomechanical analyses of physical activities has greatly expanded our knowledge about the mechanical bases for human movement function with potential implications for further understanding movement dysfunction. The purpose of this review is to relate these findings to present knowledge about the effect on human joints during movement, the role of muscle action on human skeletal levers during movement, and the application of this information to functional tasks by physical therapy clinicians. Also presented are some thoughts regarding what must be accomplished so that this material can be generalized to clinical practice.     

Statins in clinical practice

The review covers principles of treatment with statins, their pharmacokinetics, characterizes six most usable in clinical practice statins and one novel drug--rozuvastatin from a "superstatins" group. Statins proved effective in primary and secondary prophylaxis of coronary atherosclerosis, secondary prevention of ischemic stroke and diseases of peripheral arteries with intermittent claudication, prevention of Alzheimer's disease. Statins are indicated in dyslipidemia in diabetes mellitus type 2, nephrotic syndrome and renal insufficiency. Further studies are needed on statins' effects on hypercholesterolemia, their antiinflammatory and immunomodulating properties, the ability to enhance revascularization of ischemic tissue and stimulate proliferation of osteoblasts in osteoporosis.     

Erythropoietin in clinical practice

In numerous studies, erythropoietin (EP) has been shown to be a "universal" protective tissue cytokine, and EP receptors have been shown to exist in a lot of tissues. The pleiotropic effects of EP (the anti-inflammatory effect, angiogenesis, anti-apoptosis etc.) make clinical application of EP (especially recombinant EP, REP, and EP analogs without erythropoietic activity) promising in different diseases. Possibilities provided by REP application in neurology, cardiology, hematology, oncology, and other clinical areas are being studied intensively. Clinical studies of EP are now solitary, and they should be continued; new EP analogs with specified qualities and selective mechanisms of action should be developed. This review discusses the modern state of EP investigation and possibilities provided by its clinical application.     

Triangulation in clinical practice

• The aim of the article is to clarify the research term ‘triangulation’.
• Examples are given to illustrate the use of triangulation in clinical practice.
• The strength of using triangulation in both the design and analysis stages are highlighted.

     

Research in clinical practice

Clinical research in the practice setting can be a rewarding experience. The atmosphere of research is changing, however, with tighter budgets, more oversight, increasing litigation risks, financial pressures, and increased competition. Sites must be increasingly careful to negotiate appropriate study budgets and contract language that is not overly burdensome or risky for the site. The focus on investigator training and use of qualifies personnel is paramount to preserve and improve the quality of clinical research in the United STates. The future may find certification examinations necessary for all research staff, including investigators. Eventually, the number of clinical research sites in the community will decrease, and academic sites, along with international sites, will once again fill the void.     

Non-linearity in clinical practice

The whole spectrum of medicine consists of complex non-linear systems that are balanced and interact with each other. How non-linearity confers stability on a system and explains variation and uncertainty in clinical medicine is discussed. A major theme is that a small alteration in initial conditions may have a major effect on the end result. In the context of non-linearity, it is argued that 'evidence-based medicine' (EBM) as it exists today can only ever be relevant to a small fraction of the domain of medicine, that the 'art of medicine' consists of an intuitive 'tuning in' to these complex systems and as such is not so much an art as an expression of non-linear science. The main cause of iatrogenic disease is interpreted as a failure to understand the complexity of the systems being treated. Case study examples are given and analysed in non-linear terms. It is concluded that good medicine concerns individualized treatment of an individual patient whose body functions are governed by non-linear processes. EBM as it exists today paints with a broad and limited brush, but it does promise a fresh new direction. In this context, we need to expand the spectrum of scientific medicine to include non-linearity, and to look upon the 'art of medicine' as a historical (but unstated) legacy in this domain.     

A reliable potentiometric measurement of ionized calcium and pH on the ICA2 Radiometer in clinical practice

A second generation analyser for potentiometric measurement of ionized calcium and pH (ICA2 Radiometer, Copenhagen) was tested with respect to analytical performance in two different laboratories. Newly-developed aqueous buffered solutions were used at different Ca2+ concentrations as well as biological specimens prepared from human subjects. The overall precision of ICA2 was very good: CV = 0.0-0.4% for within-run and 0.4-1.7% for day-to-day precision with protein-free solutions and CV = 0.3-0.9% for within-run precision on biological specimens. The adjusted value of Ca2+ to pH 7.40 is an analytical advantage for which the calculation is correct but the assumption made for this algorithm may limit its clinical relevance. Measurements were comparable on ICA2 when performed on either whole blood, serum or plasma. Pre-analytical conditions should be observed such as the choice of anticoagulant and anaerobic conditions. Such a reliable and accurate instrument may promote the use of ionized calcium measurement in daily clinical practice.