Clinical decision making and outcome in routine care for people with severe mental illness (CEDAR): first results

2011 ◽  
Vol 38 (S 01) ◽  
Author(s):  
E Ay ◽  
M Frøkjær Krogsgaard Bording ◽  
T Ivánka ◽  
D Giacco ◽  
A Bär ◽  
...  
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Routine Care ◽  
First Results

scholarly journals Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness (CEDAR): Study protocol

2010 ◽  
Vol 10 (1) ◽  
Author(s):  
Bernd Puschner ◽  
Sabine Steffen ◽  
Mike Slade ◽  
Helena Kaliniecka ◽  
Mario Maj ◽  
...  
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Study Protocol ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Routine Care

scholarly journals Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR)

2015 ◽  
Vol 25 (1) ◽  
pp. 69-79 ◽  
Author(s):  
B. Puschner ◽  
T. Becker ◽  
B. Mayer ◽  
H. Jordan ◽  
M. Maj ◽  
...  
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Primary Outcome ◽  
Clinical Decision Making ◽  
Unmet Needs ◽  
Clinical Decision ◽  
Routine Care ◽  
Shared Decision ◽  
Over Time

Aims.Shared decision making has been advocated as a means to improve patient-orientation and quality of health care. There is a lack of knowledge on clinical decision making and its relation to outcome in the routine treatment of people with severe mental illness. This study examined preferred and experienced clinical decision making from the perspectives of patients and staff, and how these affect treatment outcome.Methods.“Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness” (CEDAR; ISRCTN75841675) is a naturalistic prospective observational study with bimonthly assessments during a 12-month observation period. Between November 2009 and December 2010, adults with severe mental illness were consecutively recruited from caseloads of community mental health services at the six study sites (Ulm, Germany; London, UK; Naples, Italy; Debrecen, Hungary; Aalborg, Denmark; and Zurich, Switzerland). Clinical decision making was assessed using two instruments which both have parallel patient and staff versions: (a) The Clinical Decision Making Style Scale (CDMS) measured preferences for decision making at baseline; and (b) the Clinical Decision Making Involvement and Satisfaction Scale (CDIS) measured involvement and satisfaction with a specific decision at all time points. Primary outcome was patient-rated unmet needs measured with the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS). Mixed-effects multinomial regression was used to examine differences and course over time in involvement in and satisfaction with actual decision making. The effect of clinical decision making on the primary outcome was examined using hierarchical linear modelling controlling for covariates (study centre, patient age, duration of illness, and diagnosis). Analysis were also controlled for nesting of patients within staff.Results.Of 708 individuals approached, 588 adults with severe mental illness (52% female, mean age = 41.7) gave informed consent. Paired staff participants (N = 213) were 61.8% female and 46.0 years old on average. Shared decision making was preferred by patients (χ2 = 135.08; p < 0.001) and staff (χ2 = 368.17; p < 0.001). Decision making style of staff significantly affected unmet needs over time, with unmet needs decreasing more in patients whose clinicians preferred active to passive (−0.406 unmet needs per two months, p = 0.007) or shared (−0.303 unmet needs per two months, p = 0.015) decision making.Conclusions.Decision making style of staff is a prime candidate for the development of targeted intervention. If proven effective in future trials, this would pave the ground for a shift from shared to active involvement of patients including changes to professional socialization through training in principles of active decision making.

scholarly journals Storytelling, Safeguarding, Treatment, and Responsibility: attributes of recovery in psychiatric intensive care units

2014 ◽  
Vol 11 (02) ◽  
pp. 105-118 ◽  
Author(s):  
Karleen Gwinner ◽  
Louise Ward
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Illness ◽  
Intensive Care ◽  
Lived Experience ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Review Of Literature ◽  
Psychiatric Distress ◽  
Nurse Knowledge

AbstractBackground and aimIn recent years, policy in Australia has endorsed recovery-oriented mental health services underpinned by the needs, rights and values of people with lived experience of mental illness. This paper critically reviews the idea of recovery as understood by nurses at the frontline of services for people experiencing acute psychiatric distress.MethodData gathered from focus groups held with nurses from two hospitals were used to ascertain their use of terminology, understanding of attributes and current practices that support recovery for people experiencing acute psychiatric distress. A review of literature further examined current nurse-based evidence and nurse knowledge of recovery approaches specific to psychiatric intensive care settings.ResultsFour defining attributes of recovery based on nurses’ perspectives are shared to identify and describe strategies that may help underpin recovery specific to psychiatric intensive care settings.ConclusionThe four attributes described in this paper provide a pragmatic framework with which nurses can reinforce their clinical decision-making and negotiate the dynamic and often incongruous challenges they experience to embed recovery-oriented culture in acute psychiatric settings.

scholarly journals Hydroxychloroquine and COVID-19: critiquing the impact of disease public profile on policy and clinical decision-making

2020 ◽  
Vol 46 (9) ◽  
pp. 574-578 ◽  
Author(s):  
Yves S J Aquino ◽  
Nicolo Cabrera
Keyword(s):  
Decision Making ◽  
Media Coverage ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Routine Care ◽  
Concept Of Disease ◽  
Effective System ◽  
Randomised Controlled ◽  
Policy Problems ◽  
The Impact

The controversy surrounding the use of hydroxychloroquine (HCQ), an antimalarial drug, for COVID-19 has raised numerous ethical and policy problems. Since the suggestion that HCQ has potential for COVID-19, there have been varying responses from clinicians and healthcare institutions, ranging from adoption of protocols using HCQ for routine care to the conduct of randomised controlled trials to an effective system-wide prohibition on its use for COVID-19. In this article, we argue that the concept of ‘disease public profile’ has become a prominent, if not the sole, determinant in decision-making across various healthcare responses to the pandemic. In the case of COVID-19, the disease’s public profile is based on clinical and non-clinical factors that include contagiousness, clinical presentation and media coverage. In particular, we briefly examine the dangers of a heightened public profile in magnifying the inequality of diseases and undermining three key ethical concepts, namely (1) evidence-based practice, (2) sustainable allocation and (3) meaningful consent.

Outpatient treatment in mental health care

2011 ◽  
Vol 26 (S2) ◽  
pp. 373-373
Author(s):  
M.K. Bording ◽  
H.Ø. Sørensen ◽  
B. Puschner ◽  
P. Munk-Jørgensen
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Mental Health Care ◽  
Outpatient Treatment ◽  
Best Practice ◽  
Quantitative Methods ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Routine Care

IntroductionThere is a lack of knowledge on outpatient treatment in mental health and its outcome. The major reason for this is that research on clinical decision making in health care has primarily focused on well-defined situations in physical conditions, while there has not been any research in clinical decision making in people with schizophrenia with its high demands on patient's treatment adherence and establishing stable therapeutic relationships.ObjectiveThis study is about clinical decision making in outpatient mental health care with specific focus on patients diagnosed with schizophrenia.Aims of the studyTo identify the types of decision making between the patient and the therapist (paternalistic, shared and informed). Moreover, to investigate the patient's understanding of the decision making, involvement and analyse type of decision making as a possible predictor of adherence to treatment.MethodsThe study is an open, explorative study using a combination of both qualitative and quantitative methods. The study population consists of severe mentally ill outpatients diagnosed with schizophrenia. Data collection consists of both questionnaires, field observation and patient interviews.Expected resultsSpecifications of primary areas for further improvement in CDM is an expected result of the study. Recommendations will be extracted and formulated from the study data to implement elements of best practice in CDM in the routine care for people with schizophrenia in particular and severe mental illness in general. The explicit focus will contribute to the strengthening of patient perspective.

scholarly journals Real-World Use of Azathioprine Metabolites Changes Clinical Management of Inflammatory Bowel Disease

2020 ◽  
Author(s):  
Laura Wilson ◽  
Stephanie Tuson ◽  
Lufang Yang ◽  
Dustin Loomes
Keyword(s):  
Decision Making ◽  
Clinical Management ◽  
Chart Review ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Routine Care ◽  
Therapeutic Drug ◽  
Toxicity Monitoring ◽  
Inflammatory Bowel ◽  
Poor Efficacy

Abstract Background Thiopurines such as 6-mercaptopurine and azathioprine have complex metabolism, resulting in significant inter-individual differences in clinical efficacy and risk of drug toxicity, making conventional weight-based dosing inaccurate and potentially unsafe. Therapeutic drug monitoring (TDM) of thiopurine metabolites improves clinical outcomes through dose optimization and toxicity monitoring. Despite evidence for TDM, use is limited, due in part to test availability and awareness. The objectives of this study were twofold: (1) to investigate how thiopurine TDM impacts clinical management of IBD patients and (2) to evaluate proportion of patients outside therapeutic 6TGN levels or exhibiting signs of toxicity Methods Patients who received thiopurine TDM as part of routine care underwent chart review of demographics, disease activity, medication dosing, metabolite levels, and adverse events. Changes in clinical management following TDM were measured. Additionally, we conducted a retrospective review of clinical decision making blinded and unblinded to TDM result. Results A total of 92 IBD patients were included. Levels of 6TGN were therapeutic in 29% of patients. 6TGN levels correlated weakly with weight-based dosing (r2 = 0.057, P = 0.02). Adverse reactions were observed in 6.5%. TDM informed clinical management in 64%. Significantly more changes to clinical management occurred in those with active disease than in remission (73% versus 48%; P = 0.02) and in those on mono- versus combination therapy (48% versus 27.5%; P = 0.03). Conclusions TDM informs clinical decision making in over two-thirds of patients. The demonstrated poor efficacy of weight-based dosing and impact of TDM on clinical management contributes to the evidence supporting the need for greater availability and uptake of thiopurine TDM.

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