896,501 research outputs found

    Peer observation : a tool for continuing professional development

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    Peer observation has been advocated as a means of monitoring and improving the quality of teaching within Higher Education, whilst peer support and review have been used to provide feedback and monitoring within the clinical context. The process of peer observation of practice within educational, managerial and clinical settings could facilitate improvements in all aspects of practice, have relevance as a tool for continuing professional development (CPD) and help improve the quality of care for service users. This article presents the background and relevance of peer observation to health care professionals, suggests a process that can be implemented and considers relevant contextual issues. Finally it suggests that peer observation has potential benefits for all areas and levels of health care practice

    Clinical observation of pheochromocytoma

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    1976年以降10年間に経験した本症11例についての検討では, 1) 50歳代に最も多く, 男女比は5:6.2)臨床症状では持続型と発作型高血圧が相半ばしており, 頭痛, 動悸, 悪心嘔吐が主であったが, 無症候例も1例みられた.3)腫瘍存在部位は, 右副腎4例, 左副腎3例, 両側副腎2例, 副腎外性3例(うち1例は多発性で右副腎と合併).4)検査成績では, 耐糖能異常が72.7%と高率で, 眼底異常, 心電図異常を認める症例が多かった.カテコールアミンは全例で高値を示したが, 発作型ではA(アドレナリン)優位, 副腎外性ではNA(ノルアドレナリン)優位の傾向がみられた.5)腫瘍の局在診断ではCTが有効であり, 超音波断層法, 副腎シンチ, 静脈血サンプリングも補助診断として有用.6)術前処置として, α-, β-blocker投与と輸血を施行した.術中shockは1例のみにみられた.発作型2例と無症候例では術前処置を施行しなかったが, 術中術後に問題はなかった.7)高血圧治癒率は81.8%であった高血圧持続例については厳重にfollow upしているが, 病変の再発は認めていないEleven cases of pheochromocytoma observed at our department between 1976 and 1985 are presented. There were 5 males and 6 females and they were between 18 and 59 years old. The site of the tumor was in the right adrenal in 4 cases, left adrenal in 3 cases, bilateral adrenals in 2 cases and extra adrenal in 3 cases, 1 of which had multiple lesions and involvement of the right adrenal. Clinical symptoms observed were hypertension in 10 cases, headache in 7 cases, palpitation in 3 cases and nausea in 2 cases. Atypical adrenal pheochromocytoma was seen in 1 case. Definitive diagnosis was established by determination of urinary catecholamine levels in the 24-hour sample. Urinary levels of catecholamine revealed higher adrenaline levels for paroxysmal type and higher nor-adrenaline levels for extra-adrenal cases. For localization of tumors, computed tomography was most useful with a diagnostic rate of 100%, followed by ultrasonography and adrenal scan. As preoperative treatment, blood transfusion and administration of adrenergic blocking agents were performed in 9 cases. In all but 2 cases, hypertension was improved and no recurrence was seen after the operation

    Breast metastasis and lung large-cell neuroendocrine carcinoma: first clinical observation

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    The lung Large-cell neuroendocrine carcinoma (LCNEC) is a very rare aggressive neuroendocrine tumor with a high propensy to metastasize and very poor prognosis. We report an atypical presentation of lung large-cell neuroendocrine carcinoma was diagnosed from a metastatic nodule on the breast. Our patient is a 59 years-old woman that presented in March 2014 non productive cough. A CT scan showed multiple brain, lung, adrenal gland and liver secondary lesions; moreover, it revealed a breast right nodule near the chest measuring 1.8 cm. The breast nodule and a lung lesions were biopsied and their histology and molecular diagnosis were LCNEC of the lung. To our knowledge, this is the first documented case of breast metastasis from LCNEC of the lung. Furthermore, breast metastasis from extramammary malignancy is uncommon and its diagnosis is difficult but important for proper management and prediction of prognosis. Therefore, a careful clinical history with a thorough clinical examination is needed to make the correct diagnosis. Moreover, metastasis to the breast should be considered in any patient with a known primary malignant tumor history who presents with a breast lump. Anyhow, pathological examination should be performed to differentiate the primary breast cancer from metastatic tumor. Therefore, an accurate diagnosis of breast metastases may not only avoid unnecessary breast resection, more importantly it is crucial to determine an appropriate and systemic treatment

    Clinical Observation Reflections from Students in an Interdisciplinary Palliative Care Course

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    The purpose of this study was to gain insight into how a brief clinical observation encounter contributed to students’ experiences in an interdisciplinary palliative care course. This course was required of all graduate nursing students and was available as an elective for medical and other healthcare professions students at a healthcare sciences university. The students were required to spend approximately 8 to 12 hours attending interdisciplinary team meetings or accompanying a team on rounds and patient visits. The students’ summary narratives of their observation experience were analyzed in this qualitative study that focused on six categories of feedback: (1) patients’ and families’ reactions, (2) communication issues with patients and families, (3) how the palliative care team speaks with the patient and family, (4) communication within the interdisciplinary team, (5) students’ reflections, and (6) students’ suffering. This study demonstrated that a clinical observation activity can be a valuable introduction to palliative care principles for healthcare students in an interdisciplinary course. Students benefited from gaining insight into family/practitioner communications regarding difficult issues, interdisciplinary roles and cooperation, and application of palliative care principles to clinical practice. Further research is required to identify appropriate interventions to deal with student distress resulting from such early career clinical encounters

    A clinical instructor observation tool

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    MALE STERILITY : A CLINICAL OBSERVATION

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    A clinical observation was made on male outpatients who visited the Department of Urology, Niigata University Hospital during 2 years, 1971 and 1972 with chief complaints of infertility. A follow-up study was done in all of them in order to make sure pregnancy incidence. Four hundreds and three men visited the anthors' clinic with complaints of infertility, which corresponded to 9.9% of a total number of outpatients and 14.9% of total male outpatients. Age distribution ranged from 22-year-old to 61-year-old with an average of 30.7 years. Most of them visited the clinic for consultation within 5 years after their marriage, 43.6% being within 3 years. 15.7% of their spouses revealed to have some gynecological disorders. Of 349 patients who had semen analysis done, 43.0% showed normospermia, 11.2% hypospermia, 9.8% oligospermia, 8.0% oligo-asthenospermia, 3.4% asthenospermia, 1.4% teratospermia and 23.2% azoospermia. The follow-up study showed that pregnancy was reported in 19.0% of all the patients and in 41.5% of the patients who gave certified answers. Patients in 1971 gave a significantly higher rate of pregnancy than those of 1972. Pregnancy incidence in the normospermic group did not significantly differ from that of the hypospermic group. In the treated group (mesterolone, PMS and others) rates of pregnancy and improvement in seminal findings were 11.6% and 35.2%, respectively, while pregnancy rate in the untreated group (normospermic cases excluded) was 10.7%

    Action Observation for Neurorehabilitation in Apraxia

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    Neurorehabilitation and brain stimulation studies of post-stroke patients suggest that action-observation effects can lead to rapid improvements in the recovery of motor functions and long-term motor cortical reorganization. Apraxia is a clinically important disorder characterized by marked impairment in representing and performing skillful movements [gestures], which limits many daily activities and impedes independent functioning. Recent clinical research has revealed errors of visuo-motor integration in patients with apraxia. This paper presents a rehabilitative perspective focusing on the possibility of action observation as a therapeutic treatment for patients with apraxia. This perspective also outlines impacts on neurorehabilitation and brain repair following the reinforcement of the perceptual-motor coupling. To date, interventions based primarily on action observation in apraxia have not been undertaken

    A Clinical Observation on Renal Tumor.

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    A clinical observation was done on 44 cases o f benigne and malignant renal tumors treated in our department for the past 5 years. The results are as follows : 1) Incidence. The cases o f renal tumor occupied 2.3% of total number of admission during the period. 2) Initi a l symptoms. The commonest symptom was hematuria, especially in cancer of the renal pelvis. One fourth of the patients with renal tumor complained of some equivocal symptoms at onset of the disease. The period in average from onset of the symptoms to admission was 24 months in renal parenchymal tumor and 14 months in cancer of the renal pelvis. 3) Symptoms at admission. Hematuria, palpable tumor and pain in the renal region were commonest symptoms. Percentages of hematuria, palpable tumor and the pain were 82%, 29% and 39% respectively in renal parenchymal tumor, and were 100%, 73% and 55% respectively in cancer of the renal pelvis. 4) Radiographic findings. Intrav e nous pyelography, retrograde pyelography and aortography were useful in making diagnosis of renal tumor, while retroperitoneal pneumography was useful in visualizing outline of tumor and in showing degree of adhesion. In renal parenchymal tumors, elongation and compression of calyx (68%), elongation and compression of the pelvis (46%) and non-visualization of the involved kidney in intravenous pyelography (32%) were common radiographic signs. In cancer of the renal pelvis, pelvic dilatation (64%), filling defect of the pelvis and calyx (55%) and obliteration of the caly x (45%) were common. 5) Treatment. Twenty-four cases of parenchymal tumor were laparotomized and the involved kidney was removed in 22 of them. Ten cases of pelvic cancer were operated on and the involved kidney was removed in 9 of them. Conservative treatment, such as x-ray and radioactive cobalt irradiation and anticancer chemotherapy, was carried out in many cases without noticeable improvement except for Wilms' tumor. 6) Weight of specimens. The specimens of parenchymal tumor were found to be heavier than those of pelvic cancer. 7) Prognosis. Three-year survival rate in parenchymal tumor was 0%, while that of pelvic cancer was 36%. From this result better prognosis could be expected in cancer of the renal pelvis than in parenchymal tumor
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