Clinical care

Stroke consultants may be deterred from providing telemedicine-based consultation by the requirement of securing licensure in all states in which they provide consultation. However, acute stroke consultation may be exempt from these rules in states that make exceptions for emergency situations, limited duration of clinical care, or consultation to patients in bordering states. Still, other states prohibit ongoing... 

Boyce PM, Talley NJ, Balaam B, et al. A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome. Am J Gastroenterol 2003 98 2209-2218. 

Another related technique is the use of critical pathways. A critical pathway or clinical care plan is a detailed plan of care for a specific diagnosis, disease, or procedure [27], It describes the use and timing of all the care activities to try to optimize cost-effectiveness and improve patient outcomes. Critical pathways are much more specific than practice guidelines, which means they tend to take much more effort to produce. However, their comprehensive nature can enhance communication and coordination by different practitioners who are providing care to a particular patient. While critical pathways have been accepted within hospitals, their adoption for ambulatory care has been mixed. 

Recommended doses for routine clinical care rarely exceed 5 mg/kg/min in older children and adults. Higher infusion rates contribute to the development of hyperglycemia, excess carbon dioxide production, and increased biochemical markers for liver function. Doses in infants and young children can exceed 5 mg/kg/min. 

Is there a question to be answered for reasons other than clinical care or routine evaluation ... 

Morrow, A. L., and Rangel, J. M. (2004). Human milk protection against infectious diarrhea Implications for prevention and clinical care. Semin. Pediatr. Infect. Dis. 15, 221-228. 

Conventional evaluation of new medical technologies such as pharmaceutical products includes consideration of efficacy, effectiveness, and safety. The methodology for such analyses is well developed, and studies of safety and efficacy often are required prior to drug marketing. Health care researchers from a variety of disciplines have developed new techniques for the evaluation of the economic effects of clinical care and new medical technologies. Clinicians, pharmacists, economists, epidemiologists, operations researchers, and others have contributed to the field of clinical economics , an evolving discipline dedicated to the study of how different approaches to patient care and treatment influence the resources consumed in clinical medicine. 

Fig. 1. The three dimensions of economic evaluation of clinical care (from Bombardier and Eisenberg, 1985, with permission).

Anderson, G.M., Leckman, J.F., and Cohen, D.J. (1998) Neurochemical and neuropeptide systems. In Leckman, J.E and Cohen, D.J. eds. Tourette s Syndrome Tics, Obsessions, Compulsions—Developmental Psychopathology and Clinical Care. New York John Wiley and Sons, pp. 261-281. 

This can serve as the mantra for our approach to clinical care. For any illness that cannot he cured—and even for those that can but where the treatment is painful or prolonged—a major responsibility of the clinician is to help maintain the child s development on course. This means keeping the clinical eye on the child, not the symptoms. 

J.F. Leckman and D.J. Cohen (1999) Tourette s Syndrome—Tics, Obsessions, Compulsions. Developmental Psychopathology and Clinical Care, p. 14... 

The Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar) is a short and practical ten-item instrument for clinical quantitation of the severity of an alcohol withdrawal syndrome. It can be incorporated into the usual clinical care of patients undergoing alcohol withdrawal and into clinical drug trials of alcohol withdrawal ( Sullivan et al.. 1989). 

Many of the larger biochemical genetics laboratories are in academic medical centres and make a significant contribution to research. They have collectively been responsible for much of the progress made in recent years. However, there is always a tension between research, where data need to be accumulated into publishable packets and a degree of secrecy prevails, and clinical care, where results need to reported immediately, perhaps to distant clinicians with their own publication needs. 

Yerby MS (2003) Clinical care of pregnant women with epilepsy neural tube defects and folic acid supplementation. Epilepsia 44 33-40... 

Indications Treatment of symptomatic orthostatic hypotension. Midodrine can cause marked elevation of supine blood. It should be used in patients whose lives are considerably impaired despite standard clinical care, including non-pharmacologic treatment (such as support stockings), fluid expansion, and lifestyle alterations. 

Firth-Cozens J, Greenhalgh J. Doctors perceptions of the links between stress and lowered clinical care. Soc Sci Med 1997 44(7) 1017-1022. 

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