Use of Neuromuscular Electrical Stimulationfor Swallowing Habilitation in High-Risk Infants: A Survey of Clinical Practice

Purpose: The purpose of this clinical focus article was to identify clinical practice patterns of speech-language pathologists (SLPs) who use neuromuscular electrical stimulation (NMES) with the high-risk infants, specifically, the modality treatment parameters and physiological rationale. Method: An online survey was disseminated to query use of NMES by licensed SLPs who routinely address swallowing habilitation in high-risk infants. Results: Eleven of the 40 practicing SLPs who completed the survey indicated they have used NMES on neonates and infants. Most survey respondents reported not using NMES with infants. Of the SLPs who used this modality, over half reported they relied on clinical judgment for determination of NMES dose, frequency of treatments, electrode placement, and discharge determination. While SLPs acknowledged that little empirical evidence is available, those who used this modality indicated that the American Speech-Language-Hearing Association should support this modality in infants. Conclusions: Reliance on clinical judgment, as indicated by SLPs who use NMES on high-risk infants, is not consistent with the evidence-based practice triad, which encourages the use of high-quality peer-reviewed published evidence to inform clinical decision-making. Additional basic and applied research is needed to support use of NMES as a therapeutic modality in infants.

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AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS—2020 UPDATE EXECUTIVE SUMMARY

Endocrine Practice ◽

10.4158/gl-2019-0524 ◽

2020 ◽

Author(s):

Pauline M. Camacho ◽

Steven M. Petak ◽

Neil Binkley ◽

Dima L. Diab ◽

Leslie S. Eldeiry ◽

...

Keyword(s):

Clinical Practice ◽

High Risk ◽

Postmenopausal Osteoporosis ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Clinical Decision Making ◽

American Association ◽

Clinical Decision ◽

Evidence Base ◽

Executive Summary

Objective: The development of these guidelines is sponsored by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPG). Methods: Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols. Results: The Executive Summary of this 2020 updated guideline contains 52 recommendations: 21 Grade A (40%), 24 Grade B (46%), 7 Grade C (14%), and no Grade D (0%). These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world care of patients. The evidence base presented in the subsequent Appendix provides relevant supporting information for the Executive Summary recommendations. This update contains 368 citations: 123 (33.5%) EL 1 (highest), 132 (36%) EL 2 (intermediate), 20 (5.5%) EL 3 (weak), and 93 (25%) EL 4 (lowest). New or updated topics in this CPG include: clarification of the diagnosis of osteoporosis, stratification of the patient according to high-risk and very high-risk features, a new dual action therapy option, and transitions from therapeutic options. Conclusion: This guideline is a practical tool for endocrinologists, physicians in general, regulatory bodies, health-related organizations, and interested laypersons regarding the diagnosis, evaluation, and treatment of postmenopausal osteoporosis.

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Fear of Progression in Parents of Children with Cancer: Results of An Online Expert Survey in Pediatric Oncology

Klinische Pädiatrie ◽

10.1055/a-0586-8921 ◽

2018 ◽

Vol 230 (03) ◽

pp. 130-137 ◽

Cited By ~ 2

Author(s):

Katharina Clever ◽

Florian Schepper ◽

Luise Küpper ◽

Holger Christiansen ◽

Julia Martini

Keyword(s):

Clinical Practice ◽

Pediatric Oncology ◽

Clinical Judgment ◽

Online Survey ◽

Qualitative Content Analysis ◽

Relaxation Techniques ◽

Children With Cancer ◽

Expert Survey ◽

Fear Of Progression ◽

Treatment Indications

Abstract Background Fear of Progression (FoP) is a commonly reported psychological strain in parents of children with cancer. This expert survey investigates how professionals in pediatric oncology estimate the burden and consequences of FoP in parents and how they assess and treat parental FoP. Method N=77 professionals in pediatric oncology (members and associates of the Psychosocial Association in Paediatric Oncology and Haematology, PSAPOH) were examined in an online survey with a self-developed questionnaire. Data were analyzed via descriptive statistics and qualitative content analysis. Results Three of four experts in clinical practice were (very) often confronted with parental FoP which was associated with more negative (e. g., psychosomatic reactions, reduced family functioning) than positive (e. g., active illness processing) consequences. N=40 experts indicated that they mainly assess parents’ anxiety via clinical judgment (72.5%) and/or according to ICD-10/DSM-5 diagnostic criteria (37.5%), whereas standardized methods such as psycho-oncological questionnaires (12.5%) were applied less often. Only n=6 experts named a specific diagnostic approach to assess parental FoP. The most common treatment approaches for FoP were supportive counseling (74.0%), psychotherapy (59.7%) and/or relaxation techniques (55.8%). Discussion Parental FoP is frequently perceived by experts in clinical practice. A standardized diagnostic procedure would increase comparability of diagnostic judgments and harmonize treatment indications.

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Use of Urology-Based Clinical Practice Guidelines in International Settings

Société Internationale d’Urologie Journal ◽

10.48083/qvxe4949 ◽

2021 ◽

Vol 2 (1) ◽

pp. 10-17

Author(s):

German Patino ◽

Medina Ndoye ◽

Hannah S. Thomas ◽

Andrew J. Cohen ◽

Nnenaya A. Mmonu ◽

...

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Online Survey ◽

Clinical Decision Making ◽

Clinical Decision ◽

Medical Decision ◽

Local Health ◽

Cross Sectional

Objective Clinical practice guidelines (CPGs) serve as frameworks to unify diagnostic criteria and guide clinical decision-making. There is a paucity of literature surrounding the uptake of CPGs in urology practice settings with varied levels of resources worldwide. This study aims to evaluate reported use of CPGs within the context of international urology practice, identify local barriers to uptake, and evaluate the role of stakeholders in the CPG-development process. Methods This was an international, multi-center, cross-sectional study. An online survey collecting variables pertaining to the use of CPGs was distributed to attending/consultant urologists in Latin America, Africa, and China. Statistical analysis was conducted using R software. Result A total of 249 practicing urologists from 28 countries completed the survey. The majority of participants were males, aged 36 to 45, and practiced in a non-academic setting. Ninety-three percent of urologists used CPGs in their everyday clinical practice, and 43% believed CPGs were very important to medical decision-making. However, barriers such as the lack of adaptability or applicability of CPGs to local settings were mentioned by 29% and 24% of participants, respectively. Urologists believed scientific associations (81%), national urology boards (68%), and ministries of health (56%), were important stakeholders to consult to foster the development of local CPGs. Conclusions Globally, CPGs are widely used tools for clinical practice. However, there are concerns about the adaptability and applicability of CPGs to settings that may lack the resources to implement their recommendations. Efforts should be directed towards incorporating scientific and medical stakeholders into the review and adaptation of urology CPGs to suit the unique features of local health care systems.

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AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS— 2020 UPDATE EXECUTIVE SUMMARY

Endocrine Practice ◽

10.4158/gl-2020-0524 ◽

2020 ◽

Vol 26 (5) ◽

pp. 564-570 ◽

Cited By ~ 10

Author(s):

Pauline M. Camacho ◽

Steven M. Petak ◽

Neil Binkley ◽

Dima L. Diab ◽

Leslie S. Eldeiry ◽

...

Keyword(s):

Clinical Practice ◽

High Risk ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Clinical Decision Making ◽

American Association ◽

Clinical Decision ◽

Evidence Base ◽

Executive Summary ◽

Post Menopausal Osteoporosis

Objective: The development of these guidelines is sponsored by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). Methods: Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols. Results: The Executive Summary of this 2020 updated guideline contains 52 recommendations: 21 Grade A (40%), 24 Grade B (46%), 7 Grade C (14%), and no Grade D (0%). These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world care of patients. The evidence base presented in the subsequent Appendix provides relevant supporting information for the Executive Summary recommendations. This update contains 368 citations: 123 (33.5%) evidence level (EL) 1 (highest), 132 (36%) EL 2 (intermediate), 20 (5.5%) EL 3 (weak), and 93 (25%) EL 4 (lowest). New or updated topics in this CPG include: clarification of the diagnosis of osteoporosis, stratification of the patient according to high-risk and very-high-risk features, a new dual-action therapy option, and transitions from therapeutic options. Conclusion: This guideline is a practical tool for endocrinologists, physicians in general, regulatory bodies, health-related organizations, and interested laypersons regarding the diagnosis, evaluation, and treatment of post-menopausal osteoporosis.

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Athletic Training Student and Student Aide Clinical Task Allowance in the Secondary School Setting

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2019.1848 ◽

2019 ◽

Author(s):

Zachary Winkelmann ◽

Robert Huggins ◽

Lindsey Eberman

Keyword(s):

Clinical Practice ◽

Secondary School ◽

Athletic Training ◽

Best Practice ◽

Online Survey ◽

Clinical Decision Making ◽

Clinical Experiences ◽

Training Experience ◽

Athletic Training Student ◽

Official Statement

Purpose: Athletic training student aides (SA) are minors in high school that participate in an athletic training experience under the supervision of secondary school athletic trainers (SSAT). The NATA published an official statement on the proper supervision of SAs related to task allowance. As SSATs may also supervise athletic training students (ATSs), it is important to understand the differences in both. Therefore, the objective was to explore the training, task allowance, and perspectives of SAs and ATSs by SSATs during clinical experiences. Methods: We used a cross-sectional, web-based survey for this study. SSATs (n=3,567) from the ATLAS database were recruited and 614 participants (age=39±11years, years credentialed=12±9years) completed the study. An online survey was developed to reflect the NATA official statement for task allowance and supervision of SAs and ATSs. Dependent variables included requirements and task allowance of the SA and ATS based on supervision (direct, autonomous, and restricted), and the personal perceptions from SSATs. Results: 76.5% of SSATs reported having SAs involved in their clinical practice. Less than 50% of SSATs implemented recommended trainings related to emergency preparedness, first aid, and patient privacy. When exploring task allowance, most SSATs were following best practice guidelines for job-related tasks. Additionally, SSATs were allowing ATSs to perform more tasks autonomously as compared to SAs. Conclusions: SSATs are mostly following best practice recommendations for task allowance, whereby they are providing supervision to SAs in the appropriate areas and not allowing certain duties. However, 100% compliance was not met, thus increasing risks to patients and the profession. SSATs should improve training and preparedness for the SAs involved in their clinical practice Additionally, SSATs are allowing ATSs to perform job-related tasks autonomously or with directed supervision during clinical experiences with the exception to administrative tasks and autonomous clinical-decision making.

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

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd20.4.121 ◽

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.

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