Structured clinical decision making: Is it different ?

2011 ◽  
Vol 26 (S2) ◽  
pp. 788-788
Author(s):  
R. Travers ◽  
A. Kumar
Keyword(s):  
Decision Making ◽  
Sex Offenders ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Base ◽  
Professional Judgment ◽  
Evidence Based ◽  
Patient Assessments ◽  
The Difference ◽  
Level Of Risk

IntroductionThe Psychiatrists are called to assess the level of risk in violent and sex offenders’ population. There are differing perceptions about formalising the severity and management of risk. The proponents of actuarial decision making propose that it is scientific and evidence based approach. The advocates of professional judgment however think that actuarial tools usually miss out on the interplay of compounding factors and can under or over estimate the level of risk.ObjectivesTo review consecutive patient assessments and qualitatively compare it with HCR-20 and RSVP tools for violent and sex offending patients.AimsTo report the difference in outcome in the domains of overall severity of risk, risk formulation and clinical decision making for management of the risk in these patient groups.MethodsWe aim to compare twenty consecutive patients where professional judgment of the clinician determined the severity of the risk, risk formulation and management. We then aim to use the information available to check for any differences in these areas when HCR-20 and RSVP are employed.ResultsThe comparison and benefits of professional judgment and actuarial decision making are reported.ConclusionsThe professionals (providers) are being increasingly compelled by commissioners(purchasers) to evidence base their clinical decision making. The professional judgments are more likely to be challenged in the courts. People are easily impressed by decisions which are evidence based though they may have limited understanding of research environment and population studied.

Integrating research and evidence-based guidance into prescribing practice

2021 ◽  
Vol 3 (3) ◽  
pp. 120-123
Author(s):  
Adam Bedson
Keyword(s):  
Decision Making ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Primary Source ◽  
Clinical Decision ◽  
Evidence Base ◽  
Evidence Based ◽  
Multiple Sources ◽  
Prescribing Practice ◽  
Critical Appraisal Skills

The College of Paramedics and the Royal Pharmaceutical Society are clear that they require advanced paramedics, as non-medical prescribers, to review and critically appraise the evidence base underpinning their prescribing practice. Evidence-based clinical guidance such as that published by the National Institute for Health and Care Excellence (NICE) is recommended as the primary source of evidence on which paramedics should base their prescribing decisions. NICE guidance reflects the best available evidence on which to base clinical decision-making. However, paramedics still need to critically appraise the evidence underpinning their prescribing, applying expertise and decision-making skills to inform their clinical reasoning. This is achieved by synthesising information from multiple sources to make appropriate, evidence-based judgments and diagnoses. This first article in the prescribing paramedic pharmacology series considers the importance of evidence-based paramedic prescribing, alongside a range of tools that can be used to develop and apply critical appraisal skills to support prescribing decision-making. These include critical appraisal check lists and research reporting tools

Integrating research and evidence-based guidance into prescribing practice

2021 ◽  
Vol 13 (1) ◽  
pp. 10-13
Author(s):  
Adam Bedson
Keyword(s):  
Decision Making ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Primary Source ◽  
Clinical Decision ◽  
Evidence Base ◽  
Evidence Based ◽  
Multiple Sources ◽  
Prescribing Practice ◽  
Critical Appraisal Skills

The College of Paramedics and the Royal Pharmaceutical Society are clear that they require advanced paramedics, as non-medical prescribers, to review and critically appraise the evidence base underpinning their prescribing practice. Evidence-based clinical guidance such as that published by the National Institute for Health and Care Excellence (NICE) is recommended as the primary source of evidence on which paramedics should base their prescribing decisions. NICE guidance reflects the best available evidence on which to base clinical decision-making. However, paramedics still need to critically appraise the evidence underpinning their prescribing, applying expertise and decision-making skills to inform their clinical reasoning. This is achieved by synthesising information from multiple sources to make appropriate, evidence-based judgments and diagnoses. This first article in the prescribing paramedic pharmacology series considers the importance of evidence-based paramedic prescribing, alongside a range of tools that can be used to develop and apply critical appraisal skills to support prescribing decision-making. These include critical appraisal checklists and research reporting tools.

Person-centred clinical reasoning and evidence-based healthcare

2020 ◽  
Vol 8 (2) ◽  
pp. 215
Author(s):  
Roger Kerry ◽  
Matthew Low ◽  
Peter O'Sullivan
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Population Data ◽  
Clinical Decision ◽  
Evidence Base ◽  
Evidence Based ◽  
Evidence Based Healthcare ◽  
Causal Theories

Purpose: Clinical practice, and in particular decision-making, are dependent on data and knowledge which are relevant to the context at hand. Numerous frameworks have existed which aim to facilitate best clinical decision-making for healthcare professionals and their patients, for example clinical reasoning and the evidence-based healthcare models. The purpose of this paper is to provide some reconciliation between apparently conflicting models of healthcare practice with regards to best practice.Methods: We provide a theoretical narrative account of clinical practice with regards to clinical reasoning and best decision-making. We problematise the practice frameworks of clinical reasoning and evidence base healthcare by suggesting they are conflicting and contradictory to each other. We frame the arguments available with philosophical views of causation, making the assumption that causation lies central to all aspects of knowledge. We use the narrative to expose causal theories behind different practice models and illustrate our account with a case study.Results: Clinical reasoning and evidence-based healthcare are characterised by different causal theories which do not readily align with each other. By reconceptualising causation as a dispositional phenomenon, reconciliation between individualised person-centred care and the population data which are the core interest of evidence-based healthcare, can be found, thus preserving the most valuable aspects of each practice framework.Conclusion: Reconceptualising causation in dispositionalist terms facilitates a more person-centred, multi-dimensional clinical reasoning process. This in-turn allows for the integration of data from prioritised methods of evidence-based healthcare into complex and context-sensitive individualised clinical situations.

scholarly journals Evidence-based Laboratory Medicine: Supporting Decision-Making

2000 ◽  
Vol 46 (8) ◽  
pp. 1041-1050 ◽  
Author(s):  
Christopher P Price
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Base ◽  
Laboratory Medicine ◽  
Experimental Methodology ◽  
Evidence Based ◽  
Test Procedures ◽  
Specific Test ◽  
Explicit Statement

Abstract There is an implicit acceptance that an evidence-based culture underpins the practice of laboratory medicine, in part because it is perceived as the scientific foundation of medicine. However, several reviews of specific test procedures or technologies have shown that the evidence base is limited and in many cases flawed. One of the key deficiencies in the scientific literature on diagnostic tests often is the absence of an explicit statement of the clinical need, i.e., the clinical or operational question that the use of the test is seeking to answer. Several reviews of the literature on specific procedures have also demonstrated that the experimental methodology used is flawed with, in some cases, significant bias being introduced. Despite these limitations it is recognized that a more evidence-based approach will help in the education and training of health professionals, in the creation of a research agenda, in the production of guidelines, in the support of clinical decision-making, and in resource allocation. Furthermore, as knowledge and technologies continue to be developed, an evidence-based strategy will be critical to harnessing these developments.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

HEALTH TECHNOLOGY ASSESSMENT AND CLINICAL DECISION MAKING:

1999 ◽  
Vol 15 (3) ◽  
pp. 585-592 ◽  
Author(s):  
Alicia Granados
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Technology Assessment ◽  
Case Studies ◽  
Technology Assessment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Health Technology ◽  
Evidence Based ◽  
Systematic Process

This paper examines the rationality of the concepts underlying evidence—based medicineand health technology assessment (HTA), which are part of a new current aimed at promoting the use of the results of scientific studies for decision making in health care. It describes the different approaches and purposes of this worldwide movement, in relation to clinical decision making, through a summarized set of specific HTA case studies from Catalonia, Spain. The examples illustrate how the systematic process of HTA can help in several types of uncertainties related to clinical decision making.

scholarly journals The PICO strategy for the research question construction and evidence search

2007 ◽  
Vol 15 (3) ◽  
pp. 508-511 ◽  
Author(s):  
Cristina Mamédio da Costa Santos ◽  
Cibele Andrucioli de Mattos Pimenta ◽  
Moacyr Roberto Cuce Nobre
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Scientific Evidence ◽  
Research Question ◽  
Clinical Decision ◽  
Evidence Based ◽  
Review Of The Literature

Evidence based practice is the use of the best scientific evidence to support the clinical decision making. The identification of the best evidence requires the construction of an appropriate research question and review of the literature. This article describes the use of the PICO strategy for the construction of the research question and bibliographical search.

Oxytocin versus carbetocin administered to cows after uncomplicated calvings and subsequent fertility

2016 ◽  
Vol 179 (7) ◽  
pp. 175-176
Author(s):  
Natalie Robinson ◽  
Marnie Brennan
Keyword(s):  
Decision Making ◽  
Veterinary Medicine ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Subsequent Fertility ◽  
The University

BestBETs for Vets are generated by the Centre for Evidence-based Veterinary Medicine at the University of Nottingham to help answer specific questions and assist in clinical decision making. Although evidence is often limited, they aim to find, present and draw conclusions from the best available evidence, using a standardised framework. A more detailed description of how BestBETs for Vets are produced was published in VR, April 4, 2015, vol 176, pp 354-356.

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