Gotowa bibliografia na temat „Pharmacology – Examinations – Study guides”

AbstractPatients want more information and active participation in medical decisions. Information and active participation correlate with increased adherence. A conversation guide, combining patient-relevant drug information with steps of shared decision-making, was developed to support physicians in effective and efficient prescription talks. Six GP trainees in community-based primary care practices participated in a controlled pilot study in sequential pre-post design. Initially, they conducted 41 prescription talks as usual, i.e., without knowing the guide. Then, they conducted 23 talks considering the guide (post-intervention phase). Immediately after the respective talk, patients filled in a questionnaire on satisfaction with the information on medication and physician–patient interaction, and physicians about their satisfaction with the talk and the application of the guide. Patients felt better informed after guide-based prescription talks (e.g., SIMS-D in median 10 vs. 17, p < 0.05), more actively involved (KPF-A for patient activation 2.9 ± 0.8 vs. 3.6 ± 0.8, p < 0.05), and more satisfied with the physician–patient interaction. Physicians rated the guide helpful and feasible. Their satisfaction with the conversation was significantly enhanced during the post-intervention phase. The evaluation of the duration of the talk was not influenced. Enhanced patients’ and physicians’ satisfaction with prescription talks encourages further examinations of the conversation guide. We invite physicians to try our guide in everyday medical practice.

The effectiveness of using a commercially available computerized study guide to improve performance on examinations in two general psychology courses was investigated. The experimental design required 37 students to use a computerized study guide on two examinations and not on two others, counterbalanced across two classes. Analysis suggested that use of the study guides was associated with an increase in examination scores. These commercially available computerized study guides may be effective because they use many empirically established general principles of learning.

The effectiveness of using a commercially available computerized study guide to improve performance on examinations in two general psychology courses was investigated. The experimental design required 37 students to use a computerized study guide on two examinations and not on two others, counterbalanced across two classes. Analysis suggested that use of the study guides was associated with an increase in examination scores. These commercially available computerized study guides may be effective because they use many empirically established general principles of learning.

Background: The cervical vertebrae have attracted the interest of orthodontists, as the cervical portion of the spine serves as a reference structure to guide the normal head position. Skeletal age is determined by examining changes occurring in the morphology of the cervical vertebrae. There is relatively little data available from all the examinations that compare cervical vertebral phases between the various malocclusions. The purpose of this study was to compare the cervical vertebral maturation index (CVMI) stages of skeletal Class I and Class II malocclusions in the horizontal as well as vertical growth patterns. With distinct malocclusions, however, there are differences in cervical vertebral phases. Aim: To evaluate, compare and correlate the skeletal maturation using CVMI stages in cases with Class II (horizontal and vertical) using 3D-DVT and lateral cephalogram. Methodology: In the present observational study, a total of 45 adult patients reporting at the Orthodontics department at a dental college and hospital set up in Wardha district and diagnosed with Class II Horizontal and/or Class II vertical will be recruited. The patients will be divided into three sub-groups and biosafety measures will be taken. Conclusions: This study would give us a scope to compare the efficiency of lateral cephalogram versus 3D-DVT in estimating the skeletal maturity of patients who need to undergo growth modification in the orofacial region and orthodontic treatment.

Abstract This article continues a discussion of the results of a nationwide study that reviewed 2100 impairment ratings and found a large number of errors (see the May/June issue of The Guides Newsletter). Spinal impairment ratings, for example, often are erroneous. Although the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides) clearly specifies use of the Diagnosis related estimates (DRE) method, evaluators sometimes incorrectly use the range-of-motion (ROM) method, which is fraught with potential error and typically results in higher impairment ratings. The most common problem associated with rating the lower extremities is combining multiple duplicative impairments. Multiple impairments typically are combined rather than added because the latter usually results in overrating impairments. A sidebar highlights red flags to erroneous AMA Guides ratings, and evaluators can take a number of steps to ensure accurate ratings. The first of these is to ensure an unbiased rating, preferably by a board-certified physician who, ideally, also has certification in the performance of independent medical and impairment examinations. The client requesting the evaluation should provide a cover letter describing the specifics of the evaluation, and the evaluator's report should comply with standards defined in the AMA Guides. All submitted reports should be reviewed by a physician experienced in the use of the AMA Guides; this cannot be accomplished by a nonphysician reviewer.

Abstract In the adversarial setting of an independent medical evaluation (IME), claimants may be incentivized to exaggerate the severity of their problems. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) describes a protocol for assessing impairment associated with chronic pain, including the Impairment Impact Inventory (I3) that consists of 26 items that assess the burden of illness in three domains: pain intensity, interference with activities of daily living, and emotional distress. A study was performed to establish preliminary norms for the I3 and to compare responses of claimants undergoing IMEs with those of treatment-seeking chronic pain patients: 183 patients completed the I3, including fibromyalgia syndrome patients (FMS group), 35 multidisciplinary pain center patients (PC group), and 72 claimants undergoing IMEs. Patients in the latter two groups had a variety of chronic pain problems (and hypothetically may be more likely to exaggerate their problems). The three groups had similar mean scores on the total I3 and for each of the FMS, PC, and IME groups. Results support the hypothesis that participants, in aggregate, do not exaggerate their pain when they undergo IMEs, although some quite possibly do. These results are a step toward establishing a scientific basis for the impairment rating system described in the AMA Guides from consensus-based rules to an evidence-based system for making decisions about impairment.

Ethnobotanical exploration was undertaken to document the Wild edible plants (WEPs) utilised by the inhabitants of the Leh district. Traditionally exploited WEPs are an indispensable part of every household culinary. This place is known for its unique culture and cuisine which diversifies it from the rest of India. Pre-structured questionnaires, guided field visits, field examinations, and group discussions were conducted to gather ethnobotanical data. Detailed inquiries were made on the plant’s part used, time of collection and method of food preparation. In the present study, 40 wild consumable plants were documented, these belong to 18 families and spreads to 31 genera; out of which four are new records as wild food plants. They are Cotoneaster integerrimus, Dracocephalum heterophyllum, Astragalus frigidus, and Turritis glabra. Diverse use of wild leafy plants was observed and some of the most famous dishes are ‘Shangsho tsodma’ and ‘Kabra tsodma’ vegetables. The utilisation of wild plants helps enrich diet diversity and enhances the availability of green vegetables hence broadening food choices. Our study also reveals that the gathering of wild plants is confined to village people, shepherds, and farmers, and a majority of this knowledge exists in the memory of the elderly and these wild resources are under threat due to various anthropogenic activities. Therefore, the present finding highlights the value of these plants along with maintaining regional traditional knowledge and preserving the old ethnic traditional way of living and eating. Further, this information will provide baseline data to upcoming researchers dealing with nutrition and nutraceutical aspects. In addition, these wild plants are nutritionally rich and their consumption should be encouraged.

The Keller Plan for a personalized system of instruction as applied to college-level courses is usually characterized by (a) individual pacing, (b) a mastery orientation, (c) the presence of student tutors, (d) the use of printed study guides, and (e) the inclusion of a few lectures for enrichment (Kulik, Kulik, & Carmichael, 1974). In mathematics courses the plan has led to positive reactions from students, lower dropout rates, and higher final examination scores (Anderson & Pritchett, 1977; Peluso & Baranchik, 1977; Rogers & Young, 1977; Struik & Flexer, 1977; Waits & Riner, 1975; Weir, 1977). The issue of the long-term retention of concepts in personalized mathematics courses, however, appears not to have been addressed.

Objective To review the clinical pharmacology, pharmacokinetics, and clinical efficacy and safety of intravenous amiodarone. Data Identification Articles were identified through a computer search of the English-language literature using MEDLINE (KR Information OnDisc) and the search term amiodarone. Additional articles were identified through examination of the bibliographies of the articles initially retrieved. Study Selection Relevant or representative animal studies, clinical trials, and case reports were selected for evaluation. Particular emphasis was placed on studies pertaining to the use of intravenous amiodarone in treatment-refractory ventricular fibrillation (VF) and hemodynamically unstable ventricular tachycardia (VT). Data Extraction The literature was assessed for adequate description of patients, study methodologies (e.g., study design, number of patients), and outcomes. Data Synthesis Amiodarone is an unusual class III antiarrhythmic that produces each of the four main types of antiarrhythmic action in addition to other effects, such as vasodilatory, selective antithyroid, and other activities that may be therapeutically relevant. Amiodarone pharmacokinetics demonstrate extensive interpatient variability and are characterized by wide tissue distribution (steady-state volume of distribution 40–84 L/kg), slow total body clearance (90–158 mL/h/kg), long terminal elimination half-life (20–47 d), and extensive hepatic metabolism. The onset of maximal antiarrhythmic effect is a function of both amiodarone dosage and time. The high plasma concentrations achieved with intravenous dosing do not fully replicate the electrophysiologic effects observed following long-term oral administration, particularly with respect to class III activity. Available data suggest that intravenous amiodarone is associated with an efficacy rate of 50% or more in treatment-refractory VT/VF, and has a relatively rapid (2–24 h) onset of action. The drug is relatively well tolerated, but close hemodynamic, electrocardiographic, and hepatic function monitoring are required. The value of using amiodarone serum concentrations to guide therapy remains uncertain. Conclusions Intravenous amiodarone is an effective, relatively safe antiarrhythmic for the treatment of recurrent, hemodynamically unstable VT/VF refractory to other drug therapy in the acute care setting.

Recent advances in smartphone technology now allow clinicians to use commercially produced applications when studying for nursing certification examinations. The quality of currently available CCRN review applications varies in this first generation of products. Most are limited to multiple-choice practice questions, although a few have additional elements such as study guides and reference charts. Weaknesses found in the applications evaluated include poorly written and edited content, questions limited to rote memorization rather than application and analysis of knowledge, and content too basic or outside the scope of experienced critical care nursing practice. A list of important factors for consumers to consider before purchase is provided.

Clinical cases are presented with questions and answers to allow the reader to assess knowledge and identify areas for additional study. A small number of questions in this chapter address details of pharmacology that are not included in the text of previous chapters. We have included these questions because they are representative of clerkship shelf, residency in-training, or American Board of Psychiatry and Neurology examinations.

Overview Skin cancer prevention is a component of the new Cancer Plan 2022–27, which guides the work of the Cancer Institute NSW. To lessen the impact of skin cancer on the community, the Cancer Institute NSW works closely with the NSW Skin Cancer Prevention Advisory Committee, comprising governmental and non-governmental organisation representatives, to develop and implement the NSW Skin Cancer Prevention Strategy. Primary Health Networks and primary care providers are seen as important stakeholders in this work. To guide improvements in skin cancer prevention and inform the development of the next NSW Skin Cancer Prevention Strategy, an up-to-date review of the evidence on the effectiveness and feasibility of skin cancer prevention activities in primary care is required. A research team led by the Daffodil Centre, a joint venture between the University of Sydney and Cancer Council NSW, was contracted to undertake an Evidence Check review to address the questions below. Evidence Check questions This Evidence Check aimed to address the following questions: Question 1: What skin cancer primary prevention activities can be effectively administered in primary care settings? As part of this, identify the key components of such messages, strategies, programs or initiatives that have been effectively implemented and their feasibility in the NSW/Australian context. Question 2: What are the main barriers and enablers for primary care providers in delivering skin cancer primary prevention activities within their setting? Summary of methods The research team conducted a detailed analysis of the published and grey literature, based on a comprehensive search. We developed the search strategy in consultation with a medical librarian at the University of Sydney and the Cancer Institute NSW team, and implemented it across the databases Embase, MEDLINE, PsycInfo, Scopus, Cochrane Central and CINAHL. Results were exported and uploaded to Covidence for screening and further selection. The search strategy was designed according to the SPIDER tool for Qualitative and Mixed-Methods Evidence Synthesis, which is a systematic strategy for searching qualitative and mixed-methods research studies. The SPIDER tool facilitates rigour in research by defining key elements of non-quantitative research questions. We included peer-reviewed and grey literature that included skin cancer primary prevention strategies/ interventions/ techniques/ programs within primary care settings, e.g. involving general practitioners and primary care nurses. The literature was limited to publications since 2014, and for studies or programs conducted in Australia, the UK, New Zealand, Canada, Ireland, Western Europe and Scandinavia. We also included relevant systematic reviews and evidence syntheses based on a range of international evidence where also relevant to the Australian context. To address Question 1, about the effectiveness of skin cancer prevention activities in primary care settings, we summarised findings from the Evidence Check according to different skin cancer prevention activities. To address Question 2, about the barriers and enablers of skin cancer prevention activities in primary care settings, we summarised findings according to the Consolidated Framework for Implementation Research (CFIR). The CFIR is a framework for identifying important implementation considerations for novel interventions in healthcare settings and provides a practical guide for systematically assessing potential barriers and facilitators in preparation for implementing a new activity or program. We assessed study quality using the National Health and Medical Research Council (NHMRC) levels of evidence. Key findings We identified 25 peer-reviewed journal articles that met the eligibility criteria and we included these in the Evidence Check. Eight of the studies were conducted in Australia, six in the UK, and the others elsewhere (mainly other European countries). In addition, the grey literature search identified four relevant guidelines, 12 education/training resources, two Cancer Care pathways, two position statements, three reports and five other resources that we included in the Evidence Check. Question 1 (related to effectiveness) We categorised the studies into different types of skin cancer prevention activities: behavioural counselling (n=3); risk assessment and delivering risk-tailored information (n=10); new technologies for early detection and accompanying prevention advice (n=4); and education and training programs for general practitioners (GPs) and primary care nurses regarding skin cancer prevention (n=3). There was good evidence that behavioural counselling interventions can result in a small improvement in sun protection behaviours among adults with fair skin types (defined as ivory or pale skin, light hair and eye colour, freckles, or those who sunburn easily), which would include the majority of Australians. It was found that clinicians play an important role in counselling patients about sun-protective behaviours, and recommended tailoring messages to the age and demographics of target groups (e.g. high-risk groups) to have maximal influence on behaviours. Several web-based melanoma risk prediction tools are now available in Australia, mainly designed for health professionals to identify patients’ risk of a new or subsequent primary melanoma and guide discussions with patients about primary prevention and early detection. Intervention studies have demonstrated that use of these melanoma risk prediction tools is feasible and acceptable to participants in primary care settings, and there is some evidence, including from Australian studies, that using these risk prediction tools to tailor primary prevention and early detection messages can improve sun-related behaviours. Some studies examined novel technologies, such as apps, to support early detection through skin examinations, including a very limited focus on the provision of preventive advice. These novel technologies are still largely in the research domain rather than recommended for routine use but provide a potential future opportunity to incorporate more primary prevention tailored advice. There are a number of online short courses available for primary healthcare professionals specifically focusing on skin cancer prevention. Most education and training programs for GPs and primary care nurses in the field of skin cancer focus on treatment and early detection, though some programs have specifically incorporated primary prevention education and training. A notable example is the Dermoscopy for Victorian General Practice Program, in which 93% of participating GPs reported that they had increased preventive information provided to high-risk patients and during skin examinations. Question 2 (related to barriers and enablers) Key enablers of performing skin cancer prevention activities in primary care settings included: • Easy access and availability of guidelines and point-of-care tools and resources • A fit with existing workflows and systems, so there is minimal disruption to flow of care • Easy-to-understand patient information • Using the waiting room for collection of risk assessment information on an electronic device such as an iPad/tablet where possible • Pairing with early detection activities • Sharing of successful programs across jurisdictions. Key barriers to performing skin cancer prevention activities in primary care settings included: • Unclear requirements and lack of confidence (self-efficacy) about prevention counselling • Limited availability of GP services especially in regional and remote areas • Competing demands, low priority, lack of time • Lack of incentives.