Surgical Aspects of Peritoneal Dialysis

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Author :
Publisher : Springer
ISBN 13 : 3319528211
Total Pages : 170 pages
Book Rating : 4.3/5 (195 download)

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Book Synopsis Surgical Aspects of Peritoneal Dialysis by : Stephen Haggerty

Download or read book Surgical Aspects of Peritoneal Dialysis written by Stephen Haggerty and published by Springer. This book was released on 2017-04-06 with total page 170 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book aims to educate general and vascular surgeons on all pertinent aspects of peritoneal dialysis (PD). Most surgeons get very little training in residency on this topic, and the use of PD is growing around the world. Much of the book will focus on implantation techniques, especially laparoscopic insertions. The authors will describe the known adjunct procedures that have been shown to decrease dysfunction rates. The aim is to provide greater patient autonomy, a better quality of life, preservation of residual renal function and a higher survival advantage.

Continuous Ambulatory Peritoneal Dialysis

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Author :
Publisher : Springer Science & Business Media
ISBN 13 : 9401178283
Total Pages : 137 pages
Book Rating : 4.4/5 (11 download)

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Book Synopsis Continuous Ambulatory Peritoneal Dialysis by : G.R. Catto

Download or read book Continuous Ambulatory Peritoneal Dialysis written by G.R. Catto and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 137 pages. Available in PDF, EPUB and Kindle. Book excerpt: For more than a generation haemodialysis has been the principal method of treating patients with both acute and chronic renal failure. Initially, developments and improvements in the system were highly technical and relevant to only a relatively small number of specialists in nephrology. More recently, as advances in therapy have dem onstrated the value of haemofiltration in the intensive therapy unit and haemoperfusion for certain types of poisoning, the basic principles of haemodialysis have been perceived as important in many areas of clinical practice. In this volume, the potential advantages of bicarbonate haemo dialysis are objectively assessed, the technical and clinical aspects of both haemofiltration and haemoperfusion discussed and the con tinuing problems associated with such extra corporeal circuits analysed. All the chapters have been written by recognized experts in their field. The increasing availability of highly technical facilities for appropriately selected patients should ensure that the information contained in the book is relevant not only to nephrologists but to all practising clinicians. ABOUT THE EDITOR Dr Graeme R. D. Catto is Professor in Medicine and Therapeutics at the University of Aberdeen and Honorary Consultant Phy sician/Nephrologist to the Grampian Health Board. His current inter est in transplant immunology was stimulated as a Harkness Fellow at Harvard Medical School and the Peter Bent Brighton Hospital, Boston, USA. He is a member of many medical societies including the Association of Physicians of Great Britain and Ireland, the Renal Association and the Transplantation Society.

The Textbook of Peritoneal Dialysis

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Author :
Publisher : Springer Science & Business Media
ISBN 13 :
Total Pages : 828 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis The Textbook of Peritoneal Dialysis by : R. Gokal

Download or read book The Textbook of Peritoneal Dialysis written by R. Gokal and published by Springer Science & Business Media. This book was released on 1994 with total page 828 pages. Available in PDF, EPUB and Kindle. Book excerpt: Foreword; B.H. Scribner. Preface; R. Gokal, K.D. Nolph. 1. Historical Development and Overview of Peritoneal Dialysis; R. Gokal, K.D. Nolph. 2. Peritoneal Ultrastructure; J. Dobbie. 3. Peritoneal Circulation; R. White, D.N. Granger, R. Korthius. 4. Peritoneal Physiology -- Transport of Solutes; R.T. Krediet, B. Rippe. 5. Peritoneal Lymphatics; R. Khanna, R.A. Mactier. 6. Ultrafiltration with Colloid Osmosis; J.K. Leypoldt, C. Mistry. 7. Peritoneal Pharmacokinetics and Pharmacological Alterations of Peritoneal Transport; P. Hirszel, N. Lameire, M. Bogaert. 8. Solutions and Systems; J. Winchester, G. LaGreca, M. Ferriani. 9. Peritoneal Dialysis Access and Exit Site Care; Z.J. Twardowski. 10. Placement Procedures for Peritoneal Access; S. Ash, W.K. Nichols. 11. Organization of a Peritoneal Dialysis Program -- Nurses' Role; B. Prowant, L. Uttley. 12. Continuous Ambulatory Peritoneal Dialysis; G.E. Digenis, N.V. Dombros, J.W. Moncrief, D.G. Oreopoulos, R.P. Popovich. 13. Automated Peritoneal Dialysis; J.A. Diaz-Buxo, W. Suki. 14. Adequacy of Peritoneal Dialysis; P. Keshaviah, K. D. Nolph. 15. Nutritional Management of Patients on Peritoneal Dialysis; J. Bergstrom, J. Kopple, B. Lindholm. 16. Peritonitis; W. Keane, S.I. Vas. 17. Host Defence and Effects of Solutions on Peritoneal Cells; G. Coles, S. Lewis, J.D. Williams. 18. Calcium Phosphate and Renal Osteodystrophy; R. Gokal, A. Hutchison. 19. Other Complications of Peritoneal Dialysis; J.M. Bargman. 20. Pediatric Peritoneal Dialysis; S.R. Alexander, J.W. Balfe, E. Harvey. 21. Peritoneal Dialysis in Diabetics; R. Khanna. 22. Peritoneal Dialysis in the Elderly; A. Nissenson. 23. Quality of Life and Cost Effectiveness; R. Gokal. 24. Outcome of Peritoneal Dialysis -- Comparative Studies; R. Maiorca, G. Cancarini. 25. Registry Results; K.D. Nolph. 26. Use of Peritoneal Dialysis in Special Situations; S. Prichard, J.M. Bargurar. 27. Intraperitoneal Chemotherapy; R. Dedrick, M.F. Flessner. Index of Subjects.

Automated Peritoneal Dialysis

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Author :
Publisher : Karger Medical and Scientific Publishers
ISBN 13 : 3805569343
Total Pages : 284 pages
Book Rating : 4.8/5 (55 download)

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Book Synopsis Automated Peritoneal Dialysis by : Claudio Ronco

Download or read book Automated Peritoneal Dialysis written by Claudio Ronco and published by Karger Medical and Scientific Publishers. This book was released on 1999-01-01 with total page 284 pages. Available in PDF, EPUB and Kindle. Book excerpt: While continuous ambulatory peritoneal dialysis (CAPD) has been the standard peritoneal procedure since the seventies, different schedules of automated peritoneal dialysis (APD) have emerged during the eighties. Today, APD is considered a valuable tool in the management of ESRD patients, together with CAPD and hemodialysis. However, despite its frequent use, APD has not yet been well assessed, and most pathophysiological and clinical studies on PD refer to CAPD. In this book, major experts in the field therefore discuss and evaluate the insights gained on APD up to now, presenting a comprehensive review of all experimental, technical and clinical aspects related to the various treatments grouped under the definition of APD. The recent developments presented are divided into four sections: membrane permeability, transport mechanisms and kinetic modeling applied to APD; prescription and adequacy of different APD treatment schedules; dialysis machines and solutions for APD, and, lastly, different clinical aspects such as the possibility to maintain APD program and residual renal function. Physicians involved in ESRD care, renal fellows and scientists both in the academic world and in the hospital setting will undoubtedly profit from this timely publication.

Diagnosis and Management of Complications of Peritoneal Dialysis related Peritonitis

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Author :
Publisher : Springer Nature
ISBN 13 : 9819922755
Total Pages : 177 pages
Book Rating : 4.8/5 (199 download)

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Book Synopsis Diagnosis and Management of Complications of Peritoneal Dialysis related Peritonitis by : Georgi Abraham

Download or read book Diagnosis and Management of Complications of Peritoneal Dialysis related Peritonitis written by Georgi Abraham and published by Springer Nature. This book was released on 2023-08-23 with total page 177 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book is unique in addressing the management and complications of PD-related peritonitis to reduce morbidity and mortality. It addresses the measures to prevent peritonitis, types of tools used for diagnosis, including molecular techniques, the focus of microbiologists for educating peers, catheter-related issues such as catheter care, exit site, and tunnel infection, catheter removal, reimplantation techniques, nurses' role, nutrition aspects, surgical methods and pediatric peritoneal dialysis, peritonitis with its uniqueness in detail. Each chapter starts with a case scenario and pictures related to the branch by the contributors' experience.This book is helpful for physicians, nurses, technicians, microbiologists, ID trainees and consultants, nephrology trainees, nephrologists, and surgeons involved in PD care.

Applied Peritoneal Dialysis

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Author :
Publisher : Springer Nature
ISBN 13 : 3030708977
Total Pages : 473 pages
Book Rating : 4.0/5 (37 download)

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Book Synopsis Applied Peritoneal Dialysis by : Anjay Rastogi

Download or read book Applied Peritoneal Dialysis written by Anjay Rastogi and published by Springer Nature. This book was released on 2021-07-24 with total page 473 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book offers a comprehensive guide to peritoneal dialysis (PD). Home dialysis, and more specifically PD, is growing in popularity in the US. By conservative estimates, experts suggest that 45 percent of dialysis patients in the US can be on home dialysis. However, the current penetration rate is only 10 percent. This is changing with an expected major increase in the next 5 years. One of the reasons for the low uptake is that many nephrologists lack comfort and confidence in using PD as a dialysis modality. This book addresses those concerns by covering all aspects of PD. Chapters include its history, patient selection, implementation options, comorbidities, quality of life concerns, and developing approaches to treatment. This comprehensive resource fills the unmet need for a practical, hands-on book that is both detailed and can work as a quick reference. This is an ideal guide for academic nephrologists, private practice nephrologists, NPs, PAs, nurses, fellows, and residents.

Evolving Strategies in Peritoneal Dialysis

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Author :
Publisher : BoD – Books on Demand
ISBN 13 : 1789235324
Total Pages : 116 pages
Book Rating : 4.7/5 (892 download)

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Book Synopsis Evolving Strategies in Peritoneal Dialysis by : Edward T. Zawada Jr.

Download or read book Evolving Strategies in Peritoneal Dialysis written by Edward T. Zawada Jr. and published by BoD – Books on Demand. This book was released on 2018-08-01 with total page 116 pages. Available in PDF, EPUB and Kindle. Book excerpt: Evolving Strategies in Peritoneal Dialysis is intended as a concise compilation of articles designed to understand the basics of the current practice of the most cost-effective form of life support for patients with end-stage renal disease who require dialysis. Current strategies are understood best with a review of the historical development of catheter materials, solution packaging, and simplified machinery, which allow safe and effective nocturnal treatments. Quantitation of the efficacy of peritoneal dialysis is also reviewed because such calculations were also developed by the pioneers of nephrology to ensure adequacy of dialysis and daily fluid balance, which are responsible for the best chance for long-term patient survival. Comparison of methods for catheter placement is presented as well as the role that a dialysis center plays in the health and success of this form of end-stage renal disease patient care. The novel concept of assisted peritoneal dialysis for the infirm or institutionalized patients is probably the next direction needed to make available this treatment to many more patients than are currently eligible to receive it. This concept is explored in a separate chapter. Finally, professional dialysis staff must monthly assess individuals' nutritional status, bone health, and infection prevention and treatment to ensure the greatest functional status for these patients. This book concludes with a review of each of these topics to expand the mandatory monthly surveillance performed by dialysis centers for each patient who receives home peritoneal dialysis therapy.

Vascular and Peritoneal Access for Dialysis

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Publisher : Springer Science & Business Media
ISBN 13 : 1461315891
Total Pages : 379 pages
Book Rating : 4.4/5 (613 download)

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Book Synopsis Vascular and Peritoneal Access for Dialysis by : V.E. Andreucci

Download or read book Vascular and Peritoneal Access for Dialysis written by V.E. Andreucci and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 379 pages. Available in PDF, EPUB and Kindle. Book excerpt: When the external Quinton-Scribner arteriovenous shunt was developed in 1960, and, a little later, the internal Brescia-Cimino arteriovenous fistula was developed as a vascular access for hemodialysis, thereby making possible regular dialysis therapy of chronic uremic patients, many nephrologists became surgeons, having learned the type of vascular surgery related to hemodialysis quite well. The same series of events occurred with regards to peritoneal dialysis with the introduction of the Tenckhoff catheter and the need for gaining a permanent access to the peritoneum for chronic ambulatory peritoneal dialysis (CAPD) therapy. With time, however, problems relating to vascular and peritoneal access have forced many nephrologists to give up their surgery; meanwhile, many surgeons have become quite expert in some sophisticated techniques relating to dial ysis (e. g., vessel grafting, prosthesis implantation, etc.). Today, whether or not involved in this type of surgery, both nephrologists and surgeons remain interested in knowing all available access devices for dialysis as well as the surgical techniques involved. However, all nephrologists involved in dialysis must know how to prevent or treat complications related to dialysis access. Thus, it appeared to me to be quite advisable to have a book in my series, Topics in Renal Medicine, dealing with vascular and peritoneal access for dialysis.

Textbook of Peritoneal Dialysis

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Author :
Publisher : Springer Science & Business Media
ISBN 13 : 9401732256
Total Pages : 852 pages
Book Rating : 4.4/5 (17 download)

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Book Synopsis Textbook of Peritoneal Dialysis by : R. Gokal

Download or read book Textbook of Peritoneal Dialysis written by R. Gokal and published by Springer Science & Business Media. This book was released on 2013-11-27 with total page 852 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 1994, the expert knowledge of Ram Gokal and Karl D. Nolph, the two foremost figures in the field of peritoneal dialysis, was combined to produce the first edition of the Textbook of Peritoneal Dialysis. The work quickly became recognised as the `gold standard' for those working in the field. Since its conception, however, our understanding of peritoneal dialysis related physiology, kinetics and clinical outcomes, as well as the concepts of intraperitoneal chemotherapy, has increased sufficiently to make an updated and completely revised edition of the work necessary. An expansion of the editorial team by fellow-experts Ramesh Khanna and Raymond Krediet enabled an even more comprehensive approach to be taken. This second edition reasserts the book's uniqueness in its detailed discussion of the topic, making it required reading for all those working within the field of peritoneal dialysis.

Interventional Nephrology

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Publisher : McGraw Hill Professional
ISBN 13 : 0071769331
Total Pages : 745 pages
Book Rating : 4.0/5 (717 download)

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Book Synopsis Interventional Nephrology by : Arif Asif

Download or read book Interventional Nephrology written by Arif Asif and published by McGraw Hill Professional. This book was released on 2012-08-24 with total page 745 pages. Available in PDF, EPUB and Kindle. Book excerpt: A complete guide to every aspect of interventional nephrology—an essential text for students, residents, fellows, and clinicians This timely resource examines all relevant aspects of interventional nephrology, from the history of nephrology to the principles governing the latest vascular access techniques. Heavily illustrated with full-color procedural drawings and featuring an easy-to-follow design, the book includes contributions from many leading authorities in the field whose insights combine to form an unprecedented, clinically rigorous survey of interventional nephrology. Interventional Nephrology opens with an instructive look at the origins of hemodialysis access; an overview of the history of interventional nephrology in the U.S. and abroad; and clinically relevant coverage of vascular access outcomes. The high-yield coverage continues with a probing assessment of ethics, public policy, and practice guidelines, illuminating such pivotal topics as industry partnerships and conflicts of interest. The principles that support interventional nephrology techniques are also extensively reviewed, encompassing everything from vascular mapping to peritoneal dialysis catheter removal, while the following section delves into the key surgical aspects of vascular access. Finally, the book provides useful perspectives on how political and policy affairs impact current practice. FEATURES Illustrated with precise full-color drawings and radiographs that highlight both normal and vascular anatomy and clarify the management of vascular access problems Streamlined design and helpful pedagogy, including chapter-opening learning objectives, numerous tables, and concept-clarifying figures Complete overview of the core principles underlying interventional nephrology practice and techniques, covering vascular mapping, monitoring and surveillance of arteriovenous access, venous angioplasty, tunneled catheters, renal ultrasonography, and much more Discussion of vascular access in special populations and the role of pharmacologic agents in preserving vascular access provides evidence-based insights that are pertinent to the everyday practice of interventional nephrology In-depth emphasis on the surgical aspects of vascular access reviews sites, types, and creation of arteriovenous fistulae; secondary arteriovenous fistula; and surgical options for vascular anomalies Forward-thinking coverage of basic and translational science considers future directions in vascular access science; flow dynamics, maturity, and access failure; neointimal hyperplasia; pharmacologic prevention of access dysfunction; and device innovation

Peritoneal Dialysis

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Publisher : Divadi LLC
ISBN 13 : 9780984546329
Total Pages : 216 pages
Book Rating : 4.5/5 (463 download)

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Book Synopsis Peritoneal Dialysis by : Ingemar Davidson

Download or read book Peritoneal Dialysis written by Ingemar Davidson and published by Divadi LLC. This book was released on 2012-08-31 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Davidson Medical Series is a comprehensive guide to current common diagnostic, operative, and percutaneous techniques used in creating and maintaining vascular access for dialysis in patients with end-stage renal disease or cancer. When writing the text, the authors have focused on surgeons in training, interventional radiologists, nephrologists and fellows, dialysis nurses, and technicians. Health care professionals involved in the care of patients with end-stage renal disease or cancer and the patients themselves will also benefit from these handbooks. Volume I, appropriately, covers peritoneal dialysis. The concept of "Peritoneal Dialysis First" states that whenever feasible peritoneal dialysis should be the first dialysis modality considered for patients in need of a lifelong access strategy. Peritoneal dialysis offers a survival benefit for several years after dialysis initiation. Patients who receive a transplant while on peritoneal dialysis have better outcomes compared to patients who are on hemodialysis. As all dialysis access modalities have a high failure rate over time, proactively planning and placing access for hemodialysis in patients on peritoneal dialysis serves as "life insurance," should the peritoneal dialysis modality later fail. Peritoneal dialysis and hemodialysis must not be seen as competitive therapies but rather complementary, where over time both dialysis access options are considered as integral parts of thoughtful long-term planning.

The Essentials of Peritoneal Dialysis

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Author :
Publisher : Springer
ISBN 13 : 9401127557
Total Pages : 119 pages
Book Rating : 4.4/5 (11 download)

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Book Synopsis The Essentials of Peritoneal Dialysis by : R. Khanna

Download or read book The Essentials of Peritoneal Dialysis written by R. Khanna and published by Springer. This book was released on 2012-12-06 with total page 119 pages. Available in PDF, EPUB and Kindle. Book excerpt: Designed for daily use by professionals responsible for caring for patients with renal disease, this long-awaited primer provides a simplified, up-to-date review of peritoneal dialysis. Dealing concisely with all aspects of PD, it is written in such a style that even beginners with elementary knowledge of the subject could benefit from its use, and thus it is the perfect text for trainees or new and junior staff members. It is also an ideal text for nurses, a virtual how-to guide on PD. A book like this one, crafted specifically as a bench text and a learning tool, is hard to find. Emphasis is placed on the plentiful illustrations and tables that immediately clarify and expand upon the text. The illustrations, many in full color, are deftly drawn by one of the foremost medical artists in the world, Bernard Tardieu. Few texts can boast such a cast of distinguished authors. Ramesh Khanna, Karl Nolph, and Dimitrios Oreopoulos are among the most respected practitioners of dialysis.

Peritoneal Carcinomatosis: Principles of Management

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Publisher : Springer Science & Business Media
ISBN 13 : 1461312477
Total Pages : 434 pages
Book Rating : 4.4/5 (613 download)

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Book Synopsis Peritoneal Carcinomatosis: Principles of Management by : Paul H. Sugarbaker

Download or read book Peritoneal Carcinomatosis: Principles of Management written by Paul H. Sugarbaker and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 434 pages. Available in PDF, EPUB and Kindle. Book excerpt: Paul Sugarbaker and his colleagues have persevered in the study and treat ment of peritoneal carcinomatosis. The peritoneal cavity has many unique and incompletely appreciated properties. These properties, coupled with the biologic behavior of many cancers, results in the seeding and growth of these cancers on the peritoneum. Many of these cancers remain localized to the peritoneum only, never metastasizing to other sites. One possible reason for this may be the obstruction of the afferent lymphatics on the undersurface of the diaphragm. The mucopolysaccharides produced by many of these neoplasma are probably viscous enough to obstruct these lymphatics, leading to the syndrome of pseudomyxoma peritonei. Many of the neoplasms taking residence on the peritoneum have extremely long cell-cycle times and are resistant to radiotherapy and many chemotherapeutic agents. How ever, much can be done for these patients - resection of primary cancers, omentectomies to reduce ascites formation, management of recurrent ascites, management of intestinal obstruction, nutritional care, and, hopefully, intraperitoneal chemotherapy. We have reviewed many of these problems in the past [1-7]. Dr. Sugarbaker and his colleagues have organized the current state of knowledge and technology for continuing use. The book provides a basis for thoughtful, prospective research planning. John S. Spratt, M. D. , F. A. C. S. Professor of Surgery The James Graham Brown Cancer Center University of Louisville Louisville, Kentucky References 1. Long RTL, Spratt JS, Dowling E.

Some Special Problems in Peritoneal Dialysis

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Author :
Publisher : BoD – Books on Demand
ISBN 13 : 9535125982
Total Pages : 164 pages
Book Rating : 4.5/5 (351 download)

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Book Synopsis Some Special Problems in Peritoneal Dialysis by : Robert Ekart

Download or read book Some Special Problems in Peritoneal Dialysis written by Robert Ekart and published by BoD – Books on Demand. This book was released on 2016-09-07 with total page 164 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book covers some special issues relevant to peritoneal dialysis and is a guide to the clinical practice of peritoneal dialysis. A team of international experts presents the latest information about novel peritoneal solutions, pharmacological preservation of peritoneal membrane, peritoneal dialysis catheters, assessment of volume status in PD patients, management of exit-site infection, microbiology of PD peritonitis, peritoneal dialysis in acute renal failure, and peritoneal dialysis and pregnancy.

Clinical Practice Guidelines for Vascular Access

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Publisher :
ISBN 13 : 9780962972164
Total Pages : 170 pages
Book Rating : 4.9/5 (721 download)

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Book Synopsis Clinical Practice Guidelines for Vascular Access by : National Kidney Foundation

Download or read book Clinical Practice Guidelines for Vascular Access written by National Kidney Foundation and published by . This book was released on 1997 with total page 170 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Remote Patient Management in Peritoneal Dialysis

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Publisher :
ISBN 13 : 9783318064766
Total Pages : 0 pages
Book Rating : 4.0/5 (647 download)

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Book Synopsis Remote Patient Management in Peritoneal Dialysis by : Claudio Ronco

Download or read book Remote Patient Management in Peritoneal Dialysis written by Claudio Ronco and published by . This book was released on 2019 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Telemedicine and remote patient monitoring are innovative tools to provide remote transmission, interpretation, and storage of data for review by the care team. These tools allow for accurate home monitoring of patients enabling the team to improve care through prevention and early identification of problems. This book is structured into four main parts. The first describes the evolution of peritoneal dialysis and related technology. The second part summarizes current unmet clinical needs reported by patients and care teams, the need for innovation in the field, and the technical and clinical issues involved with the modern management of peritoneal dialysis. The third section presents the operational characteristics of the new information communication technology system and, in detail, the features of the Sharesource platform. Finally, a series of field experiences by expert users are reported to describe the benefits and the potential applications of remote patient monitoring in the future. Telemedicine and remote patient monitoring have proven to be useful in the care of patients on peritoneal dialysis. The scope of this publication, therefore, is to present the experiences of clinical key opinion leaders who have been using the application.

Access for Dialysis

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Author :
Publisher : CRC Press
ISBN 13 : 1498712991
Total Pages : 446 pages
Book Rating : 4.4/5 (987 download)

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Book Synopsis Access for Dialysis by : Ingemar J.A. Davidson

Download or read book Access for Dialysis written by Ingemar J.A. Davidson and published by CRC Press. This book was released on 2002-01-01 with total page 446 pages. Available in PDF, EPUB and Kindle. Book excerpt: This publication is intended as a guide to common diagnostic, operative and percutaneous techniques used in creating and maintaining vascular access for hemodialysis. When writing the text, the authors have focused on surgeons in training, fellows, interventional radiologists and clinically active nephrologists. Dialysis nurses and other clinicians