The Uniformed Services Constipation Action Plan: An Effective Tool for the Management of Children with Functional Constipation.

OBJECTIVE: To implement and to evaluate the effectiveness of the Uniformed Services Constipation Action Plan (USCAP) in our gastroenterology clinic for children with functional constipation. STUDY DESIGN: This implementation science study included toilet-trained subjects aged 4 years and older who met the Rome IV criteria for functional constipation. Children were block randomized to receive either the USCAP or control. All clinic functional constipation plans recommended subjects continue pharmacotherapy for 4 months. Endpoints measured were clinical outcomes (resolution of functional constipation and achievement of a Pediatric Bristol Stool Form Scale [PBSFS] score of 3 or 4), patient-related outcomes (health-related quality of life [HRQoL] total scale score), and health confidence outcomes (Health Confidence Score [HCS]). RESULTS: Fifty-seven treatment group subjects (44%) received a USCAP (52% male; mean age, 10.9 [4.9] years) compared with 73 controls (56%; 48% male; mean age,10.9 [5.3] years). A PBSFS score of 3 or 4 was achieved by 77% of the treatment group compared with 59% of controls (P = .03). Subjects from the treatment group were more likely than the controls to endorse adherence to the 4-month course of pharmacotherapy (P < .001). Subjects who received a USCAP had greater improvements in HRQoL total scale score by the end of the project (P = .04). CONCLUSIONS: The USCAP is a simple, inexpensive tool that has the potential to improve global outcomes for functional constipation in children and should be recommended as standard clinical practice.

Discurso psicológico e população LGBTI: endereçamentos de uma ação clínica e política / Psychological discourse and the LGBTQ+ population: directions of a clinical and political action / Le discours psychologique et la population LGBTQ+: orientations d'une action clinique et politique / El discurso psicológico y la población LGBTI: un camino hacia una acción clínica y política

Resumo A clínica psicológica, acompanhando entrelaces e experiências diversas no campo da saúde e da educação, é entendida como espaço de recolhimento de questões que tematizam a existência humana. Por meio de leitura bibliográfica, pretendemos dialogar com fenômenos humanos que, sob o caos cotidiano, reverberam compreensões para a clínica psicológica como campo político de ação. Partimos de apontamentos de Hannah Arendt para abordar uma possível ação clínica que faz interface com a política. Buscamos evidenciar as identidades de gênero e orientações sexuais como constructos que permeiam e são permeados por forças que ora direcionam, ora excluem, dadas as confusões em torno do poder e da violência que desde tenra história revelam a sua não-conformidade com a ciência psicológica. Questionamos o lugar do fazer e do saber da psicologia, salientando que sua atitude deveria caminhar numa direção ética e dialogar com uma ação clínica e política.

Abstract The psychological clinic, involving different experiences and interrelations between health and education, is mainly understood as a space of recollection of questions that characterize human existence. By means of a bibliographical reading, this study investigates human phenomena that, understood under the everyday chaos, echoes understandings for the psychological clinic as a political arena. Based on Hannah Arendt, the text begins by discussing a possible clinical action interfacing with politics. It highlights gender identities and sexual orientations as constructs that permeate and are permeated by forces that sometimes direct and sometimes exclude, given the confusions regarding power and violence that from antiquity reveals their non-conformity with psychological science. It calls into question the place of psychology, as knowledge and praxis, pointing out that the psychologist's attitude should move towards ethics and dialogue with a clinical and political action.

Résumé La clinique psychologique, impliquants différents expériences et entrelacements entre la santé et l'éducation, est largement comprise comme un espace de recueillement des questions qui caractérisent l'existence humaine. Par le biais d'une lecture bibliographique, cette étude examine des phénomènes humains qui, compris dans le chaos quotidien, font échos à la compréhension de la clinique psychologique en tant que champ politique d'action. En se basant sur Hannah Arendt, le texte commence par discuter d'une possible action clinique en interface avec la politique. Il souligne les identités de genre et les orientations sexuelles comme des constructions qui imprègnent et sont imprégnées par des forces qui parfois dirigent et parfois excluent, étant donné la confusion concernant le pouvoir et la violence qui, depuis l'antiquité, révèlent leur non-conformité avec la science psychologique. Il remet en question la place de la psychologie, en tant que savoir et praxis, en soulignant que l'attitude du psychologue devrait s'orienter vers une éthique et le dialogue avec une action clinique et politique.

Resumen La clínica psicológica al seguir entrelaces y experiencias diversas, sobre todo, en el campo de la salud y la educación se entiende como un espacio de recogida de cuestiones que tematizan la existencia humana. Por medio de una lectura bibliográfica, pretendemos dialogar con fenómenos humanos que, al caos cotidiano, reflejan conocimientos para la clínica psicológica como un campo político de acción. Partimos de apuntes de Hannah Arendt para tematizar una posible acción clínica que hace interfaz con la política. Buscamos evidenciar las identidades de género y orientaciones sexuales como constructos que permean y están impregnados por fuerzas que ora dirigen, ora excluyen, dadas las confusiones en torno al poder y la violencia, que desde tiempos remotos revela la no conformidad de tales existencias con la ciencia psicológica. Cuestionamos el lugar del hacer y del saber de la psicología, demarcando que una actitud del psicólogo debería caminar hacia la ética y dialogar con una acción clínica y política.

Perspective: plasticity, the enemy of the good.

Plasticity is an important feature of modern cancer research. However, the level at which we should consider it remains an open question. Such debate is not new in the field of cancer and can be exemplified by the different models explaining carcinogenesis. Those models mostly explain cell transformation through the deregulation of the internal circuitry. In the last years, those models dramatically increased our knowledge and led to a series of short-term successes in terms of therapeutics. However, cancer drug resistance inevitably arises. Recently, studies on the so-called tumor microenvironment enriched the cell-centered perspective but it also enlarged the complexity of cancer etiology in particular for advanced diseases. Here, we suggest that the plastic and multi-sites specific nature of cancer combined with our incapacity to promise cure should push towards a new perspective where early clinical actions, instead of late ones, should be heralded as the priority of cancer research and care.

Clinical Action Curves: Measuring the Magnitude of Physician Response to Abnormal Laboratory Results.

OBJECTIVES: While reference limits are foundational to interpreting clinical laboratory tests, they may not correspond to the actual values triggering clinical response. We propose to measure this using clinical action curves, which plot test values against an indicator of clinical action. METHODS: We selected repeat test ordering as a quantifiable, objective, useful measure that is readily calculable using available laboratory data. Using all results in Calgary in 2010-2011 for eight analytes, clinical action curves for each analyte were plotted as the relationship between index test value and retesting hazard, modeled using Cox proportional hazards with restricted cubic splines. Clinical action limits were defined where retesting hazard rose 38% above baseline (25%-50% considered). RESULTS: In general, clinical action increased before the reference limits, and clinical action limits were narrower than reference limits. However, some reference limits showed no increased clinical action and may thus be ignored in practice. CONCLUSIONS: Clinical action curves and limits provide practical, objective tools for describing physician responses to test values. Results suggest that many normal results are treated as abnormal and vice versa; such discrepancies require further scrutiny and ultimately reconciliation via altered reference ranges or altered practice patterns.

Clinical action measures improve the reliability of feedback on quality of care in diabetes centres: a retrospective cohort study.

BACKGROUND: Assessment of quality of care using classical threshold measures (TM) is open to debate. Measures that take into account the clinician's actions and the longitudinal nature of chronic care are more reliable, although their major limitation is that they require more sophisticated electronic health records. We created a clinical action measure (CAM) for the control of LDL and non-HDL cholesterol from low-complexity data, and investigated how quality of care in individual diabetes centres based on the CAM is related to that based on the classical TM. METHODS: Data was used from 3421 diabetes patients treated in 95 centres, collected in two consecutive retrospective data collections. Patients met the TM when their index value was below target. Patients met the CAM when their index value was below target or above target but for whom treatment initiation or intensification, or possible contraindication, was indicated. RESULTS: Based on the TM, 60-70 % of the patients received good care. This percentage increased significantly using the CAM (+5 %, p < 0.001). At the centre level, the CAM was associated with a higher median score, and a change in position among centres ('poor', 'good' or 'excellent' performer) for 5-10 % of the centres. CONCLUSIONS: Judging quality of diabetes care of a centre based on a TM may be misleading. Low-complexity data available from a quality improvement initiative can be used to construct a more fair and feasible measure of quality of care.

Phapmacological and Clinical Actions of Tetrodotoxin / 中国海洋药物

This report indroduces the characterization of tetrodotoxin (TTX),and its pharmacological and clinical actions.