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951.
AIM: This paper is a report of a study to examine how nurse practitioners combine information when estimating patient risk of coronary heart disease. BACKGROUND: In the United States of America and other countries, nurse practitioners are increasingly working alongside physicians in primary healthcare settings. Given this role, nurse practitioners represent an important resource in early detection of numerous diseases. Understanding how nurse practitioners use patient characteristics (cues) to form estimates of patient risk for disease may improve general disease prevention efforts. METHOD: Social judgment theory and its lens model analysis are concerned with the correspondence between a person's judgments and the environment. This approach was applied to examine how 15 nurse practitioners weighted eight risk factors for coronary heart disease, how accurate practitioners were in assessing patient risk for coronary heart disease, and how much self-insight practitioners had into their own risk estimation processes. The data were collected in 2006. RESULTS: Nurse practitioners showed moderate to high accuracy and evinced a variety of cue-weighting strategies. Insight into their own judgment policies was modest. The lens model analysis revealed that most practitioners had lower values on knowledge of the ecology than they did on cognitive control. CONCLUSION: Educational efforts aimed at improving detection of patients at risk for diseases might do better to target increasing clinicians' understanding of cue-criteria relationships, than to stress themes of consistency in evaluating patients. 相似文献
952.
Kelly JR 《Clinical oral implants research》2007,18(Z3):205-217
Objective: Clinical literature was examined for evidence supporting use of CAD/CAM reconstructions and fiber‐reinforced materials. Materials and methods: Potential evidence was identified via databases [PubMed; EMBASE (R) Drugs & Pharmacology; Center for Reviews and Dissemination, University of York; Cochrane Library], hand search of non‐indexed literature, secondary reference searches, and personal contacts with clinical trial PI's. Search terms included: dental restorations; CAD/CAM; CEREC; LAVA; CERCON; Procera; inlay/onlay; dental prosthesis; fiber‐reinforced composite (FRC). Results: Two randomized‐controlled clinical trials were identified as examined in one Cochrane Collaboration review relevant to CAD/CAM inlays. One systematic review of 15 CAD/CAM inlay studies was examined. Six studies were identified of three commercial FRC endodontic posts and eight reported on FRC use for fixed denture prostheses. Fifteen ongoing prospective trials were identified studying CAD/CAM fabricated zirconia‐based prostheses. A total of 76 papers were referenced including those related to use of in vitro measures as evidence. Conclusions: Review of the Cochrane analysis raised concerns that typical RCT protocols may prove insufficient for stratification of confounding variables (patient, practitioner, material) when treatment outcomes are primarily prosthesis‐ or material‐based (not patient‐based, e.g., as in fracture). RCT designs are most straightforward when treatment outcomes are patient‐based (e.g., soft tissue changes). When treatment responses are material‐based, controls also become difficult to define and studies become tests of equivalency/superiority; where well‐stratified cohort designs are likely preferred. Large numbers of independent cohort studies support the use of CAD/CAM ceramic inlay/onlay restorations and crowns but many complications inhibit the application of high‐level systematic review. Except perhaps for fiber‐based endodontic posts, the clinical FRC literature appears insufficient for expert review. Single in vitro measures cannot currently serve as evidence for clinical practice, except in limited cases of simple function (e.g., impression material accuracy). Batteries of in vitro measures are often applied during materials development but cannot substitute for clinical study. 相似文献
953.
Sawatzky B Denison I Langrish S Richardson S Hiller K Slobogean B 《Archives of physical medicine and rehabilitation》2007,88(11):1423-1428
Sawatzky B, Denison I, Langrish S, Richardson S, Hiller K, Slobogean B. The Segway Personal Transporter as an alternative mobility device for people with disabilities: a pilot study.
Objectives
To determine the functional measures that best correlate with the skill levels of people with disabilities who operate a Segway Personal Transporter, and—using a qualitative analysis—to explore subjects’ experience with the Segway.Design
A prospective study encompassing 3 training sessions with the Segway to correlate subjects’ functional ability (eg, cognition, balance, mobility, muscle strength) with their skill level on the device.Setting
A provincial adult rehabilitation center.Participants
Twenty-three subjects (age range, 19−65y) with a wide range of disabilities (eg, multiple sclerosis, spinal cord injury, amputation) who could walk at least 6m with or without assistance.Interventions
Not applicable.Main Outcome Measures
Segway Task Assessment, Berg Balance Scale, and Timed Up & Go test.Results
No correlation was found because all participants successfully completed the final Segway Task Assessment, regardless of scores on functional assessments.Conclusions
The Segway is a useful device for a broad range of populations with functional disabilities. Subjects found the Segway easy to use and were excited about its potential as an assistive device for use in their communities. 相似文献954.
Components of the renin-angiotensin system (RAS) are expressed in a number of areas in the brain involved in cardiovascular control. However, it has been difficult to link RAS actions in circumscribed brain regions to specific physiological functions. In a study appearing in this issue of the JCI, Sakai and associates use a combination of sophisticated transgenic techniques and stereotaxic microinjection of recombinant viral vectors to demonstrate a pivotal role in the regulation of thirst and salt appetite of angiotensin II generated in the subfornical organ in the brain (see the related article beginning on page 1088). 相似文献
955.
956.
957.
Sherzer AI Feigenblum DY Pina JW Salka KA Simons GR 《Pacing and clinical electrophysiology : PACE》2007,30(3):436-437
We report a case of biventricular implantable cardioverter-defibrillator (ICD) insertion in which standard lead placement techniques could not achieve left ventricular capture. Protrusion of the guidewire beyond a venous stenosis provided adequate left ventricular capture. 相似文献
958.
959.
Likourezos A Chalfin DB Murphy DG Sommer B Darcy K Davidson SJ 《The Journal of emergency medicine》2004,27(4):419-424
Electronic Medical Records (EMRs) are intended to support clinical activity, improve efficiency, and reduce error. Reluctance to use EMRs may exist among clinicians. The purpose of this study was to assess physician and nurse satisfaction with an Emergency Department (ED) EMR. We surveyed Emergency Medicine (EM) physicians and nurses at a large urban teaching hospital after implementation of an Emergency Department EMR. The questionnaire assessed: 1) computer background and experience; 2) perceptions regarding EMR use; and 3) concerns about impact upon quality of patient care. The clinicians find the EMR easy to use and are generally satisfied with the impact on their work. However, they report that the EMR has no positive impact on patient care. They report confusion in following the sequence of screens, and are concerned with the amount of time it takes to use the EMR and the confidentiality of patient information. Similar results were found between physicians and nurses. Nurses, but not physicians, report that they are able to finish work much faster than before implementation (p < 0.05). We were unable to correlate computer background and experience with satisfaction with an EMR. This survey suggests that EM physicians and nurses favor the use of an EMR and suggests opportunities for EMR enhancement. 相似文献
960.
Elissa R. Engel Adrienne Hammill Denise Adams Roderic J. Phillips Michael Jeng Megha M. Tollefson Ionela Iacobas Deborah Schiff Shoshana Greenberger Michael Kelly Ilona Frieden Nibal Zaghloul Beth Drolet Amy Geddis Dov Goldenberg Kiersten Ricci 《Pediatric blood & cancer》2023,70(4):e30215