Evidence-based Guidelines for Anxiety Disorders: Can They Improve Clinical Outcomes?

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S12) ◽  
pp. 34-39 ◽  
Author(s):  
David S. Baldwin
Keyword(s):  
Decision Making ◽  
Anxiety Disorders ◽  
Clinical Outcomes ◽  
Clinical Guidelines ◽  
Clinical Decision Making ◽  
Treatment Guidelines ◽  
Clinical Decision ◽  
Evidence Based ◽  
Mental Health Programs ◽  
Evidence Based Guidelines

AbstractEvidence-based medicine (EBM) enables clinicians to justify decision making, enhances the quality of medical practice, identifies unanswered research questions, and ensures the efficient practice of medicine. Implementation of evidence-based mental health programs requires education, time, and improved effort by administration, regulatory, and clinical professionals. Essential to these efforts are consistent incentives for change, effective training materials, and clear clinical guidelines. Guidelines exist within the framework of EBM. Good guidelines are simple, specific, and user friendly, focus on key clinical decisions, are based on research evidence, and present evidence and recommendations in a concise and accessible format. Potential limitations of guidelines to improve clinical outcomes in anxiety disorders are the widespread distribution of anxiety symptoms in primary care, health inequalities across patient groups, persistent misconceptions regarding psychotropic drugs, and low confidence in using simple psychological treatments. Clinical guidelines generally specify therapeutic areas covered and not covered, but often there is no mention of cost or cost effectiveness of treatment. Guidelines can inform clinical decision making, but administrators of drug formularies may regard themselves as being primarily responsible for limiting costs and access to certain medications, even if these decisions are at odds with guideline recommendations.

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.

Evaluating the Effects of an Evidence-Based Hemostasis and Thrombosis Treatment Algorithm Tool on Medical Practitioner and Trainee Clinical Decision Making

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4736-4736
Author(s):  
Joseph Shatzel ◽  
Derrick Tao ◽  
Sven R Olson ◽  
Edward Kim ◽  
Molly Daughety ◽  
...  
Keyword(s):  
Decision Making ◽  
Medical Students ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Mean Difference ◽  
Current Evidence ◽  
Evidence Based ◽  
Clinical Vignettes ◽  
Evidence Based Guidelines ◽  
Attending Physicians

Abstract INTRODUCTION There are many interventions in the disciplines of hemostasis and thrombosis that have been shown to be effective by high quality evidence, leading to the development of evidence-based guidelines by several professional groups. The extent to which providers and medical trainees make use of these guidelines in real-time clinical decision making is not known. Current hemostasis and thrombosis guidelines also lack an easy to navigate algorithmic design such as what is used by the National Comprehensive Cancer Network (NCCN) which may limit their utilization. Using several evidence based guidelines and consensus expert opinion we created an algorithmic tool designed to easily answer clinical questions in thrombosis and hemostasis, and conducted a prospective study assessing provider understanding of current evidence based recommendations and the effects of the algorithmic tool on clinical decision making. METHODS We implemented a prospective survey study of health care providers and medical students from the Oregon Health & Science University during July of 2016. Practitioners who care for patients with thrombotic or hemostatic issues were eligible; including internists, hematologist and oncologists, family medicine practitioners, nurse practitioners & physician assistants, hematology and oncology fellows, internal medicine and family medicine residents, and medical students. The survey included demographic questions, 11 clinical vignettes with multiple-choice questions asking participants for the most evidence-based treatment decision and to rate their confidence in the answer, and post-assessment feedback. Participants were encouraged to use the resources they would typically use in a clinical setting to make these decisions. Included subjects were randomly assigned access to our evidence-based algorithmic tool, (available online at http://tinyurl.com/Hemostasis-ThrombosisGuideline) available as downloadable PDF. The 11 clinical questions were scored, and an unpaired t-test was performed to determine if any significant difference existed in scores between participants with and without the evidence-based algorithmic tool. RESULTS During the study period, 101 individuals participated: 48 medical students, 23 medicine residents, 17 attending physicians, 9 fellows, and 4 NP/PAs. Across all participants, those with access to the algorithms on average answered 3.84 (34%) more questions correctly (95% CI 3.08 - 4.60, P < 0.0001) (Table 1). Participants randomized to receive the algorithm were significantly more confident in their treatment decisions than participants without the algorithm (P < 0.0001). Significantly higher scores were found among individual groups including medical students, (mean difference 4.73, 95% CI 3.64 - 5.82, P < 0.0001), attending physicians (mean difference 2.58, 95% CI 0.63 - 4.53, P = 0.0131), and residents & fellows (mean difference 3.81, 95% CI 2.66 - 4.96, P < 0.0001). There was insufficient data to find a difference in score among NP/PAs who did and did not receive the algorithm. Participant reported confidence in their answers was significantly higher in those who were randomized to receive the algorithm (mean difference of0.95 on a 5-point confidence scale, 95% CI0.50 to 1.39, P < 0.0001). CONCLUSION Our study found that at baseline, there were limitations in provider and trainee understanding of the current evidence based management of clinical issues relevant to hemostasis and thrombosis, and that the use of an easy to navigate algorithmic tool significantly altered treatment decisions in commonly encountered clinical vignettes. Our findings suggest that utilization and decision-making may benefit from a more streamlined, algorithmic display of guidelines. Future prospective studies are needed to determine if such a tool improves management and outcomes in practice. Disclosures No relevant conflicts of interest to declare.

scholarly journals A scoping review protocol of evidence-based guidance and guidelines published by general practitioner professional organisations

2021 ◽  
Vol 4 ◽  
pp. 53
Author(s):  
Emer O'Brien ◽  
Barbara Clyne ◽  
Susan M. Smith ◽  
Noirin O'Herlihy ◽  
Velma Harkins ◽  
...  
Keyword(s):  
Decision Making ◽  
General Practice ◽  
General Practitioner ◽  
General Practitioners ◽  
Scoping Review ◽  
Clinical Guidelines ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based

Introduction: General practitioners (GPs) strive to use a patient centered approach to achieve shared decision making by integrating clinical evidence, clinical judgement, and patient priorities. In order to achieve this standard of care, GPs require relevant, up to date and high quality evidence. Currently there is a gap in the literature regarding the role of GP professional organisations internationally in producing and publishing evidence based guidance and clinical guidelines for GPs. This protocol outlines a scoping review to identify what evidence-based guidance is produced by general practitioner professional organisations internationally in terms of topic content, the structure and methods used to develop guidance and ways of disseminating this guidance, to support general practice clinical decision making. Methods: This scoping review will be conducted using the framework proposed by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR), will be used to guide the reporting. Two researchers will search electronic databases (Medline, Embase, Cochrane Library and Scopus), grey literature sources and contact international GP professional organisations directly to identify appropriate studies for inclusion. Key information will be categorised and classified to generate a summary of the methods used internationally to develop and implement evidence-based guides for general practitioners and a narrative synthesis will be conducted. Conclusions: This scoping review will examine current practice internationally regarding the role of General Practice professional organisations in producing and publishing clinical guidelines and evidence based guidance to support general practitioner’s clinical decision making to benefit patient care.

DB01-01 - Is EBM killing the art of treatment in psychiatry?

2011 ◽  
Vol 26 (S2) ◽  
pp. 1790-1790
Author(s):  
W. Gaebel
Keyword(s):  
Clinical Decision Making ◽  
Treatment Guidelines ◽  
Psychiatric Treatment ◽  
Clinical Decision ◽  
Work Capacity ◽  
Systematic Research ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Therapeutic Decisions ◽  
Evidence Based Guidelines

Evidence based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Applied to treatment in psychiatry, somatic, pharmacological and psychotherapeutic therapy as well as prevention and rehabilitation are to be assessed systematically. Evidence-based practice guidelines for the treatment of mental disorders are available in many countries and were developed based on the principles of EBM. This includes literature reviews, which are time-consuming and beyond the scope of everyday clinical psychiatrists' work capacity. Thus, evidence-based guidelines support the art of treatment in psychiatry by providing expertise.Treatment algorithms published in treatment guidelines are often misunderstood as strict rules. In fact, guidelines cannot provide non-exceptional regulations. They imply the option to deviate from guideline recommendations. Guidelines and EBM will only be able to support clinical decision making. The “art” of making therapeutic decisions remains an essential competence of the practising psychiatrist.Adhering to guideline recommendations in psychiatric treatment leads to optimized patient outcomes. EBM thus provides a firm basis for often complicated treatment decisions in psychiatry and critically supports the art of treatment in psychiatry. It will never kill this art but rather help it to survive as a highly specialized, scientifically based medical competence.

Decision-making under pressure: medical errors in uncertain and dynamic environments

2018 ◽  
Vol 42 (4) ◽  
pp. 395 ◽  
Author(s):  
Alicia M. Zavala ◽  
Gary E. Day ◽  
David Plummer ◽  
Anita Bamford-Wade
Keyword(s):  
Decision Making ◽  
Human Factors ◽  
Clinical Outcomes ◽  
Medical Errors ◽  
Thematic Analysis ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Dynamic Environments ◽  
Emergency Situations ◽  
Case Complexity

Objective This paper provides a narrative overview of the literature concerning clinical decision-making processes when staff come under pressure, particularly in uncertain, dynamic and emergency situations. Methods Studies between 1980 and 2015 were analysed using a six-phase thematic analysis framework to achieve an in-depth understanding of the complex origins of medical errors that occur when people and systems are under pressure and how work pressure affects clinical performance and patient outcomes. Literature searches were conducted using a Summons Search Service platform; search criteria included a variety of methodologies, resulting in the identification of 95 papers relevant to the present review. Results Six themes emerged in the present narrative review using thematic analysis: organisational systems, workload, time pressure, teamwork, individual human factors and case complexity. This analysis highlights that clinical outcomes in emergency situations are the result of a variety of interconnecting factors. These factors may affect the ability of clinical staff in emergency situations to provide quality, safe care in a timely manner. Conclusions The challenge for researchers is to build the body of knowledge concerning the safe management of patients, particularly where clinicians are working under pressure. This understanding is important for developing pathways that optimise clinical decision making in uncertain and dynamic environments. What is known about the topic? Emergency departments (EDs) are characterised by high complexity, high throughput and greater uncertainty compared with routine hospital wards or out-patient situations, and the ED is therefore prone to unpredictable workflows and non-replicable conditions when presented with unique and complex cases. What does this paper add? Clinical decision making can be affected by pressures with complex origins, including organisational systems, workload, time constraints, teamwork, human factors and case complexity. Interactions between these factors at different levels of the decision-making process can increase the complexity of problems and the resulting decisions to be made. What are the implications for practitioners? The findings of the present study provide further evidence that consideration of medical errors should be seen primarily from a ‘whole-of-system’ perspective rather than as being primarily the responsibility of individuals. Although there are strategies in place in healthcare organisations to eliminate errors, they still occur. In order to achieve a better understanding of medical errors in clinical practice in times of uncertainty, it is necessary to identify how diverse pressures can affect clinical decisions, and how these interact to influence clinical outcomes.

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.

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