Small Clinical Trials
Small Clinical Trials

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2001-01-01

Total Pages: 221

ISBN-13: 0309171148

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Clinical trials are used to elucidate the most appropriate preventive, diagnostic, or treatment options for individuals with a given medical condition. Perhaps the most essential feature of a clinical trial is that it aims to use results based on a limited sample of research participants to see if the intervention is safe and effective or if it is comparable to a comparison treatment. Sample size is a crucial component of any clinical trial. A trial with a small number of research participants is more prone to variability and carries a considerable risk of failing to demonstrate the effectiveness of a given intervention when one really is present. This may occur in phase I (safety and pharmacologic profiles), II (pilot efficacy evaluation), and III (extensive assessment of safety and efficacy) trials. Although phase I and II studies may have smaller sample sizes, they usually have adequate statistical power, which is the committee's definition of a "large" trial. Sometimes a trial with eight participants may have adequate statistical power, statistical power being the probability of rejecting the null hypothesis when the hypothesis is false. Small Clinical Trials assesses the current methodologies and the appropriate situations for the conduct of clinical trials with small sample sizes. This report assesses the published literature on various strategies such as (1) meta-analysis to combine disparate information from several studies including Bayesian techniques as in the confidence profile method and (2) other alternatives such as assessing therapeutic results in a single treated population (e.g., astronauts) by sequentially measuring whether the intervention is falling above or below a preestablished probability outcome range and meeting predesigned specifications as opposed to incremental improvement.

Patient Safety and Quality
Patient Safety and Quality

Author: Ronda Hughes

Publisher: Department of Health and Human Services

Published: 2008

Total Pages: 592

ISBN-13:

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"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/

Improving Diagnosis in Health Care
Improving Diagnosis in Health Care

Author: National Academies of Sciences, Engineering, and Medicine

Publisher: National Academies Press

Published: 2015-12-29

Total Pages: 473

ISBN-13: 0309377722

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Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.

Registries for Evaluating Patient Outcomes
Registries for Evaluating Patient Outcomes

Author: Agency for Healthcare Research and Quality/AHRQ

Publisher: Government Printing Office

Published: 2014-04-01

Total Pages: 385

ISBN-13: 1587634333

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This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.

The Role of Telehealth in an Evolving Health Care Environment
The Role of Telehealth in an Evolving Health Care Environment

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2012-12-20

Total Pages: 159

ISBN-13: 0309262011

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In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. In that report, the IOM Committee on Evaluating Clinical Applications of Telemedicine found telemedicine is similar in most respects to other technologies for which better evidence of effectiveness is also being demanded. Telemedicine, however, has some special characteristics-shared with information technologies generally-that warrant particular notice from evaluators and decision makers. Since that time, attention to telehealth has continued to grow in both the public and private sectors. Peer-reviewed journals and professional societies are devoted to telehealth, the federal government provides grant funding to promote the use of telehealth, and the private technology industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others. The Health Resources and Service Administration (HRSA) sponsored the IOM in holding a workshop in Washington, DC, on August 8-9 2012, to examine how the use of telehealth technology can fit into the U.S. health care system. HRSA asked the IOM to focus on the potential for telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also emphasizing the quality and value in the delivery of health care services. This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, is changing the delivery of health care in rural and urban environments. This report also summarizes actions that the U.S. Department of Health and Human Services (HHS) can undertake to further the use of telehealth to improve health care outcomes while controlling costs in the current health care environment.

Small-Bowel Obstruction
Small-Bowel Obstruction

Author: Roberto Di Mizio

Publisher: Springer Science & Business Media

Published: 2007-10-15

Total Pages: 121

ISBN-13: 8847006678

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The aim of this radiological atlas is to connect pathophysiology to imaging using many illustrations and examples, emphasizing the capabilities and limitations of multidetector computed tomography and its role in the correct management approach to these disorders. Furthermore, the place of allied imaging modalities (plain film and ultrasound) in the clinical algorithm is comprehensively illustrated.

Withrow and MacEwen's Small Animal Clinical Oncology
Withrow and MacEwen's Small Animal Clinical Oncology

Author: Stephen J. Withrow

Publisher: Elsevier Health Sciences

Published: 2012-11-13

Total Pages: 775

ISBN-13: 1437723624

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With a unique focus on the most effective interventional techniques, Withrow & MacEwen's Small Animal Clinical Oncology, 5th Edition tells the full story of cancer in dogs and cats - what it is, how to diagnose it, and how to treat many of the most common cancers encountered in clinical practice. Nearly 500 color photographs, diagrams, x-rays, and gross views depict the clinical manifestations of various cancers. This edition covers the latest advances in clinical oncology, including chemotherapy, surgical oncology, and diagnostic techniques. With contributions from 65 veterinary oncology experts, this authoritative reference is a must-have for current, evidence-based therapeutic strategies on canine and feline oncology. "I really love this book. If you are interested in veterinary oncology, have a flick through this book online or at a conference when you get the chance. I hope that you agree with me that this is the definitive oncology reference source for the early 21st century and that you feel compelled to buy it. Your patients will thank you for it." Reviewed by: Gerry Polton MA VetMB MSc(Clin Onc) DipECVIM-CA(Onc) MRCVS, UK Date: July 2014 Cutting-edge information on the complications of cancer, pain management, and the latest treatment modalities prepares you to diagnose and treat pets with cancer rather than refer cases to a specialist. A consistent format for chapters on body system tumors includes coverage of incidence and risk factors, pathology, natural behavior of tumors, history and clinical signs, diagnostic techniques and workup, treatment options, and prognosis for specific malignancies. A systems approach to the diagnosis and management of cancer facilitates access to information about the many malignancies affecting small animal patients. Nearly 500 color images provide accurate depictions of specific diseases and procedures. Helpful drug formularies provide quick access to information on indications, toxicities, and recommended dosages for chemotherapeutic and analgesic drugs used in cancer treatment. Expert contributors provide in-depth coverage of the most current information in his or her respective specialty in veterinary oncology. Chemotherapy protocols are included when case studies prove clinical efficacy. Discussion of compassion and supportive care for the management of pain, nutritional needs, and grief includes methods for handling the pet's pain and nutritional complications as well as the pet owner's grief when treatment is not successful. Thoroughly UPDATED chapters cover the most recent changes in the clinical management of melanoma, mast cell tumors, tumors of the skeletal system, tumors of the endocrine system, tumors of the mammary gland, urinary cancers, nervous system cancers, lymphoma, and histiocytic diseases. NEW Clinical Trials and Developmental Therapeutics chapter discusses the various phases of clinical trials as well as current challenges and opportunities in oncology drug development. NEW! A focus on the best recommended treatment options highlights therapeutic strategies that have been vetted by veterinary oncology experts. NEW co-author Dr. Rodney L. Page adds his valuable perspective, expertise, and research experience.

Unequal Treatment
Unequal Treatment

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2009-02-06

Total Pages: 781

ISBN-13: 030908265X

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Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

Small Animal Pediatrics
Small Animal Pediatrics

Author: Michael E. Peterson

Publisher: Elsevier Health Sciences

Published: 2010-06-22

Total Pages: 545

ISBN-13: 1437701957

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A practical reference for the general veterinary clinician, Small Animal Pediatrics: The First 12 Months of Life compiles into a single location the latest information in the rapidly developing field of canine and feline pediatrics. Editors Michael Peterson, DVM, MS, and Michelle Kutzler, DVM, PhD, DACT are joined by more than 40 expert contributors in providing coverage from prenatal care to one year of age. For ease of use, the text is divided into four sections. A General Considerations section opens the book by covering prenatal care of the bitch and queen, birth, normal physical examinations, growth, husbandry, nutrition, care of orphans, neonatal mortality, behavior, emergency and critical care, and immunology. The second section, Common Infectious Diseases, covers bacterial, viral, fungal, rickettsial, and parasitic infections. The third section describes diagnostic and therapeutic approaches to the young patient including radiology, ultrasound, aesthetic and surgical considerations, pain management, pharmacology, and clinical pathology. Finally, the fourth section covers a variety of organ systems with discussions on normal development, congenital conditions, and acquired diseases. The text also includes information that is usually difficult to find, including a pediatric formulary, care of orphan puppies, clinical pathology values, prenatal care, and normal growth and development guidelines. This book will be a significant asset to any veterinary library! - Offers a practical, clinically oriented resource for the unique diagnostic and treatment challenges posed by pediatric and juvenile animal patients. - Includes comprehensive coverage of all special problems encountered in pet management from birth through the first 12 months of life. - Provides clear, step-by-step guidelines for important clinical procedures and techniques for the most vulnerable of small animal patients. - Covers procedures such as intraosseous catheterization and fluid therapy, venipuncture, and tube feeding. - Includes guidelines for designing and implementing a successful pediatric wellness program tailored to your own practice. - Discusses infectious diseases in young animals, zoonotic potential, and human public health concerns. - Provides key new information on puppy and kitten behavioral development including guidance for prevention and intervention for problem behaviors, the leading cause of pet euthanasia. - Includes guidelines for kennel and cattery health management as well as shelter medicine health considerations. - Discusses controversial health and ethical issues in veterinary pediatrics, such as ear cropping, tail docking, declawing, and early spay/neuter surgery (including both pro and con positions). - Includes the latest recommendations for nutritional care of healthy and "special needs" puppies and kittens as well as the post-parturient and nursing dam. - Offers an easy-to-use, well-organized format for quick and easy access to the most relevant information.