Global Trends in Clinical Practice and Healthcare Delivery: Opportunities for Growth and Innovation

ObjectiveGestational diabetes is the most common metabolic disorder of pregnancy, and it is important that well-written clinical practice guidelines (CPGs) are used to optimise healthcare delivery and improve patient outcomes. The aim of the study was to assess the methodological quality of hospital-based CPGs on the identification and management of gestational diabetes.DesignWe conducted an assessment of local clinical guidelines in English for gestational diabetes using the Appraisal of Guidelines for Research and Evaluation (AGREE II) to assess and validate methodological quality.Data sources and eligibility criteriaWe sought a representative selection of local CPGs accessible by the internet. Criteria for inclusion were (1) identified as a guideline, (2) written in English, (3) produced by or for the hospital in a Western country, (4) included diagnostic criteria and recommendations concerning gestational diabetes, (5) grounded on evidence-based medicine and (6) accessible over the internet. No more than two CPGs were selected from any single country.ResultsOf the 56 CPGs identified, 7 were evaluated in detail by five reviewers using the standard AGREE II instrument. Interrater variance was calculated, with strong agreement observed for those protocols considered by reviewers as the highest and lowest scoring based on the instrument. CPG results for each of the six AGREE II domains are presented categorically using a 5-point Likert scale. Only one CPG scored above average in five or more of the domains. Overall scores ranged from 91.6 (the strongest) to 50 (the weakest). Significant variation existed in the methodological quality of CPGs, even though they followed the guideline of an advising body. Specifically, appropriate identification of the evidence relied on to inform clinical decision making in CPGs was poor, as was evidence of user involvement in the development of the guideline, resource implications, documentation of competing interests of the guideline development group and evidence of external review.ConclusionsThe limitations described are important considerations for updating current and new CPGs.

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WhatsApp guidelines – what guidelines? A literature review

Journal of Telemedicine and Telecare ◽

10.1177/1357633x19873233 ◽

2019 ◽

Vol 25 (9) ◽

pp. 524-529 ◽

Cited By ~ 6

Author(s):

Maurice Mars ◽

Christopher Morris ◽

Richard E Scott

Keyword(s):

Clinical Practice ◽

Ethical Issues ◽

Instant Messaging ◽

Healthcare Delivery ◽

Modern Society ◽

Professional Communication ◽

Sensitive Information ◽

Inclusion Criteria ◽

National Guidelines ◽

Record Keeping

Introduction Instant messaging (IM) is pervasive in modern society, including healthcare. WhatsApp, the most cited IM application in healthcare, is used to share sensitive patient information between clinicians. Its use raises legal, regulatory and ethical concerns. Are there guidelines for the clinical use of WhatsApp? Can generic guidelines be developed for the use of IM, for one-to-one and one-to-many healthcare professional communication using WhatsApp as an example? Aim We aimed to investigate if there are guidelines for using WhatsApp in clinical practice. Method Nine electronic databases were searched in January 2019 for articles on WhatsApp in clinical service. Inclusion criteria: paper was in English, reported on WhatsApp use or potential use in clinical practice, addressed legal, regulatory or ethical issues and presented some form of guideline or guidance for WhatsApp use. Results In total, 590 unique articles were found and 167 titles and abstracts met the inclusion criteria. Twenty-one articles identified the need for general guidelines. Twelve articles provided some form of guidance for using WhatsApp. Issues addressed were confidentiality, identification and privacy (eight articles), security (seven), record keeping (four) and storage (three). Mandatory national guidelines for the use of IM for patient-sensitive information do not appear to exist, only advisories that counsel against its use. Conclusion The literature showed clinicians use IM because of its simplicity, timeliness and cost effectiveness. No suitable guidelines exist. Generic guidelines are required for the use of IM for healthcare delivery which can be adapted to local circumstance and messaging service used.

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Longitudinal impact of Welsh clinical leadership fellowship

Leadership in Health Services ◽

10.1108/lhs-06-2019-0033 ◽

2020 ◽

Vol 33 (1) ◽

pp. 1-11

Author(s):

Suzanne Phillips ◽

Alison Bullock

Keyword(s):

Clinical Practice ◽

Medical Training ◽

Healthcare Delivery ◽

The Body ◽

Longitudinal Impact ◽

Structured Interviews ◽

Clinical Leadership ◽

Content Type ◽

Training Programmes ◽

The Impact

Purpose This paper aims to evaluate the longer-term impact of the 12-month Welsh clinical leadership fellowship. Design/methodology/approach Semi-structured interviews with 10 out of 14 trainee doctors who were fellows between 2013-2016, exploring how leadership knowledge and skills were used in clinical practice, impact on patient care and influence on careers. Data, gathered in 2017 when participants had completed the fellowship between 1-3 years, were analysed thematically. Findings All found the fellowship rewarding. The experience was felt to advantage them in consultant interviews. They gained insight into the wider influence on organisations and the complexity of issues facing senior clinicians. Although subtle, the impact was significant, equipping fellows with negotiation skills, enabling them to better influence change. Indirect impact on clinical practice was evidenced by enhanced confidence, teamworking skills and progression of improvement projects. However, the use of skills was limited by lack of seniority within teams, demands of medical training and examinations. The negativity of others towards management and leadership was also noted by some. Research limitations/implications Small participant numbers limit generalisability. Practical implications The fellowship is designed to equip participants with skills to lead improvements in healthcare delivery. Those more advanced in their medical training had greater opportunity and seniority to lead change and were better placed to apply the learning. This has implications for whom the training should be targeted. Originality/value A rare study exploring the longer-term impact of a leadership programme on later clinical practice, which adds to the body of knowledge of impact and efficacy of leadership training programmes in healthcare environments.

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Cost-effectiveness of point-of-care C-Reactive Protein test compared to current clinical practice as an intervention to improve antibiotic prescription in malaria-negative patients in Afghanistan

PLoS ONE ◽

10.1371/journal.pone.0258299 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0258299

Author(s):

Simon Dickinson ◽

Huey Yi Chong ◽

Toby Leslie ◽

Mark Rowland ◽

Kristian Schultz Hansen ◽

...

Keyword(s):

Clinical Practice ◽

Cost Effectiveness ◽

Antibiotic Prescription ◽

Point Of Care ◽

Healthcare Delivery ◽

Antibiotic Prescribing ◽

Current Clinical Practice ◽

C Reactive Protein ◽

Negative Patient ◽

Reactive Protein

Background Antimicrobial resistance (AMR) is a global health problem requiring a reduction in inappropriate antibiotic prescribing. Point-of-Care C-Reactive Protein (POCCRP) tests could distinguish between bacterial and non-bacterial causes of fever in malaria-negative patients and thus reduce inappropriate antibiotic prescribing. However, the cost-effectiveness of POCCRP testing is unclear in low-income settings. Methods A decision tree model was used to estimate cost-effectiveness of POCCRP versus current clinical practice at primary healthcare facilities in Afghanistan. Data were analysed from healthcare delivery and societal perspectives. Costs were reported in 2019 USD. Effectiveness was measured as correctly treated febrile malaria-negative patient. Cost, effectiveness and diagnostic accuracy parameters were obtained from primary data from a cost-effectiveness study on malaria rapid diagnostic tests in Afghanistan and supplemented with POCCRP-specific data sourced from the literature. Incremental cost-effectiveness ratios (ICERs) reported the additional cost per additional correctly treated febrile malaria-negative patient over a 28-day time horizon. Univariate and probabilistic sensitivity analyses examined the impact of uncertainty of parameter inputs. Scenario analysis included economic cost of AMR per antibiotic prescription. Results The model predicts that POCCRP intervention would result in 137 fewer antibiotic prescriptions (6%) with a 12% reduction (279 prescriptions) in inappropriate prescriptions compared to current clinical practice. ICERs were $14.33 (healthcare delivery), $11.40 (societal), and $9.78 (scenario analysis) per additional correctly treated case. Conclusions POCCRP tests could improve antibiotic prescribing among malaria-negative patients in Afghanistan. Cost-effectiveness depends in part on willingness to pay for reductions in inappropriate antibiotic prescribing that will only have modest impact on immediate clinical outcomes but may have long-term benefits in reducing overuse of antibiotics. A reduction in the overuse of antibiotics is needed and POCCRP tests may add to other interventions in achieving this aim. Assessment of willingness to pay among policy makers and donors and undertaking operational trials will help determine cost-effectiveness and assist decision making.

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Stroke Rehabilitation and Patients with Multimorbidity: A Scoping Review Protocol

Journal of Comorbidity ◽

10.15256/joc.2015.5.47 ◽

2015 ◽

Vol 5 (1) ◽

pp. 1-10 ◽

Cited By ~ 6

Author(s):

Michelle L.A. Nelson ◽

Linda Kelloway ◽

Deirdre Dawson ◽

J. Andrew McClure ◽

Kaileah A. McKellar ◽

...

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Stroke Rehabilitation ◽

Mixed Methods Research ◽

Best Practice ◽

Healthcare Delivery ◽

Stroke Care ◽

Current Evidence ◽

Medical Diagnoses

Stroke care presents unique challenges for clinicians, as most strokes occur in the context of other medical diagnoses. An assessment of capacity for implementing “best practice” stroke care found clinicians reporting a strong need for training specific to patient/system complexity and multimorbidity. With mounting patient complexity, there is pressure to implement new models of healthcare delivery for both quality and financial sustainability. Policy makers and administrators are turning to clinical practice guidelines to support decision-making and resource allocation. Stroke rehabilitation programs across Canada are being transformed to better align with the Canadian Stroke Strategy's Stroke Best Practice Recommendations. The recommendations provide a framework to facilitate the adoption of evidence-based best practices in stroke across the continuum of care. However, given the increasing and emerging complexity of patients with stroke in terms of multimorbidity, the evidence supporting clinical practice guidelines may not align with the current patient population. To evaluate this, electronic databases and gray literature will be searched, including published or unpublished studies of quantitative, qualitative or mixed-methods research designs. Team members will screen the literature and abstract the data. Results will present a numerical account of the amount, type, and distribution of the studies included and a thematic analysis and concept map of the results. This review represents the first attempt to map the available literature on stroke rehabilitation and multimorbidity, and identify gaps in the existing research. The results will be relevant for knowledge users concerned with stroke rehabilitation by expanding the understanding of the current evidence.

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Patient, family and provider views of measurement-based care in an early-psychosis intervention programme

BJPsych Open ◽

10.1192/bjo.2021.1005 ◽

2021 ◽

Vol 7 (5) ◽

Author(s):

Ari B. Cuperfain ◽

Katrina Hui ◽

Suze G. Berkhout ◽

George Foussias ◽

David Gratzer ◽

...

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Shared Decision Making ◽

Healthcare Delivery ◽

Early Psychosis ◽

Shared Decision ◽

Structured Interviews ◽

National Guidelines ◽

Intervention Programme ◽

Measurement Based Care

Background Measurement-based care (MBC) in mental health improves patient outcomes and is a component of many national guidelines for mental healthcare delivery. Nevertheless, MBC is not routinely integrated into clinical practice. Several known reasons for the lack of integration exist but one lesser explored variable is the subjective perspectives of providers and patients about MBC. Such perspectives are critical to understand facilitators and barriers to improve the integration of MBC into routine clinical practice. Aims This study aimed to uncover the perspectives of various stakeholders towards MBC within a single treatment centre. Method Researchers conducted qualitative semi-structured interviews with patients (n = 15), family members (n = 7), case managers (n = 8) and psychiatrists (n = 6) engaged in an early-psychosis intervention programme. Data were analysed using thematic analysis, informed by critical realist theory. Results Analysis converged on several themes. These include (a) implicit negative assumptions; (b) relevance and utility to practice; (c) equity versus flexibility; and (d) shared decision-making. Providers assumed patients’ perspectives of MBC were negative. Patients’ perspectives of MBC were actually favourable, particularly if MBC was used as an instrument to engage patients in shared decision-making and communication rather than as a dogmatic and rigid clinical decision tool. Conclusions This qualitative study presents the views of various stakeholders towards MBC, providing an in-depth examination of the barriers and facilitators to MBC through qualitative investigation. The findings from this study should be used to address the challenges organisations have experienced in implementing MBC.

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Telemedicine: A New Frontier in Clinical Practice

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.2.3592 ◽

2021 ◽

Vol 37 (2) ◽

Author(s):

Munazza Asad ◽

Nooresahar . ◽

Saniya R. Sabzwari

Keyword(s):

Clinical Practice ◽

Original Work ◽

Healthcare Delivery ◽

Creative Commons ◽

New Frontier ◽

Teaching Learning ◽

Effective Use ◽

Developed World ◽

Open Access Article

The COVID-19 pandemic has highlighted the important role of telemedicine as a tool for safe healthcare delivery across the world. While its use was more common in the developed world, the developing world has also adopted this strategy. It is important to develop a clear process and contextual guidance for effective use of this strategy for better patient-doctor interaction and its role in teaching/learning of trainees. doi: https://doi.org/10.12669/pjms.37.2.3592 How to cite this:Asad M, Nooresahar, Sabzwari SR. Telemedicine: A New Frontier in Clinical Practice. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.3592 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Modern Approaches to the Diagnosis and Management of Children With Primary Ciliary Dyskinesia

Педиатрическая фармакология ◽

10.15690/pf.v14i1.1700 ◽

2017 ◽

Vol 14 (1) ◽

pp. 43-48

Author(s):

A. A. Baranov ◽

L. S. Namazova-Baranova ◽

E. A. Vishneva ◽

L. R. Selimzyanova ◽

O. I. Simonova ◽

...

Keyword(s):

Clinical Practice ◽

Respiratory Tract ◽

Genetic Heterogeneity ◽

Lower Respiratory Tract ◽

Primary Ciliary Dyskinesia ◽

Inflammatory Diseases ◽

Healthcare Delivery ◽

Common Disease ◽

Disease Manifestation ◽

Ciliary Dyskinesia

The article presents the most modern positions of healthcare delivery for children with primary ciliary dyskinesia. Symptoms of this pathology in clinical practice vary that is conditioned by genetic heterogeneity of the disease. The most common disease manifestation in children is frequent inflammatory diseases of the upper and lower respiratory tract. They are recorded in most patients, especially in young children, and the diagnosis is often determined untimely due to a low awareness of specialists about this nosology. Differential diagnostic approach is described in detail, peculiarities of treatment and management of children with this nosology are specified. The material is based on clinical guidelines developed and approved by the professional association «Union of Pediatricians of Russia».

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