scholarly journals Understanding unwarranted variation in clinical practice: a focus on network effects, reflective medicine and learning health systems

2020 ◽  
Vol 32 (4) ◽  
pp. 271-274
Author(s):  
Femke Atsma ◽  
Glyn Elwyn ◽  
Gert Westert
Keyword(s):  
Clinical Practice ◽  
Network Effects ◽  
Practice Variation ◽  
Future Research ◽  
Patient Beliefs ◽  
The Past ◽  
Variation Patterns ◽  
Alternative Research ◽  
Clinical Variation ◽  
Unwarranted Variation

Abstract In the past decades, extensive research has been performed on the phenomenon of unwarranted clinical variation in clinical practice. Many studies have been performed on signaling, describing and visualizing clinical variation. We argue that it is time for next steps in practice variation research. In addition to describing and signaling variation patterns, we argue that a better understanding of causes of variation should be gained. Moreover, target points for improving and decreasing clinical variation should be created. Key elements in this new focus should be research on the complex interaction of networks, reflective medicine, patient beliefs and objective criteria for treatment choices. By combining these different concepts, alternative research objectives and new targets for improving and reducing unwarranted variation may be defined. In this perspective, we reflect on these concepts and propose target points for future research.

scholarly journals Patient Selection and Timing of Continuous Renal Replacement Therapy

2016 ◽  
Vol 42 (3) ◽  
pp. 224-237 ◽  
Author(s):  
Marlies Ostermann ◽  
Michael Joannidis ◽  
Antonello Pani ◽  
Matteo Floris ◽  
Silvia De Rosa ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Patient Selection ◽  
Kidney Injury ◽  
Practice Variation ◽  
Standards Of Care ◽  
Future Research ◽  
Controversial Topic

When and in whom to initiate continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) remains a highly controversial topic with large practice variation around the world. Even within countries, practice variation exists and recommendations for clinical practice are not specific. In this article, we report the consensus recommendations for timing and patient selection for CRRT - the results of the 2016 Acute Disease Quality Initiative XVII conference on ‘precision CRRT'. We suggest that these recommendations could serve to develop the best clinical practice and standards of care for use of CRRT in patients with AKI. Finally, we identify and highlight the areas of ongoing uncertainty and propose an agenda for future research.

scholarly journals Practice Variation Research in Degenerative Lumbar Disc Surgery: A Literature Review on Design Characteristics and Outcomes

2021 ◽  
pp. 219256822110648
Author(s):  
Juliëtte J. C. M. Van Munster ◽  
Vera de Weerdt ◽  
Ilan J. Y. Halperin ◽  
Amir H. Zamanipoor Najafabadi ◽  
Peter Paul G. van Benthem ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Literature Review ◽  
Degenerative Disc Disease ◽  
Practice Variation ◽  
Case Mix ◽  
Disc Disease ◽  
Explanatory Variables ◽  
Unwarranted Variation ◽  
Over Time

Study Design Literature review. Objective To describe whether practice variation studies on surgery in patients with lumbar degenerative disc disease used adequate study methodology to identify unwarranted variation, and to inform quality improvement in clinical practice. Secondary aim was to describe whether variation changed over time. Methods Literature databases were searched up to May 4th, 2021. To define whether study design was appropriate to identify unwarranted variation, we extracted data on level of aggregation, study population, and case-mix correction. To define whether studies were appropriate to achieve quality improvement, data were extracted on outcomes, explanatory variables, description of scientific basis, and given recommendations. Spearman’s rho was used to determine the association between the Extreme Quotient (EQ) and year of publication. Results We identified 34 articles published between 1990 and 2020. Twenty-six articles (76%) defined the diagnosis. Prior surgery cases were excluded or adjusted for in 5 articles (15%). Twenty-three articles (68%) adjusted for case-mix. Variation in outcomes was analyzed in 7 articles (21%). Fourteen articles (41%) identified explanatory variables. Twenty-six articles (76%) described the evidence on effectiveness. Recommendations for clinical practice were given in 9 articles (26%). Extreme Quotients ranged between 1-fold and 15-fold variation and did not show a significant change over time (rho= −.33, P= .09). Conclusions Practice variation research on surgery in patients with degenerative disc disease showed important limitations to identify unwarranted variation and to achieve quality improvement by public reporting. Despite the availability of new evidence, we could not observe a significant decrease in variation over time.

scholarly journals WEB PLOT DIGITIZER SOFTWARE: CAN IT BE USED TO MEASURE NECK POSTURE IN CLINICAL PRACTICE?

2018 ◽  
Vol 11 (14) ◽  
pp. 86 ◽  
Author(s):  
Suresh Mani ◽  
Shobha Sharma ◽  
Devinder Kaur Ajit Singh
Keyword(s):  
Clinical Practice ◽  
Neck Pain ◽  
Head Tilt ◽  
Future Research ◽  
Clinical Settings ◽  
Digital Photogrammetry ◽  
Validity And Reliability ◽  
The Past ◽  
History Of ◽  
Larger Sample

Objective : The aim of this study was to examine the use of WPD software to evaluate FHP using digital photogrammetry method.Method: A total of 15 adults with no history of neck pain for the past 6 months were recruited for the study. Using digital photogrammetry and sagittal head tilt, craniocervical and shoulder angles (SAs) were measured using a WPD, which is an open resource of web or Windows-based software.Result: Fifteen participants aged 17–40 years (mean 24.7±6.3 years) were examined. Sagittal head tilt and craniocervical angles were 16.35°±8.33° and 47.43°±7.97°, respectively. SA was 52.28°±12.46°.Conclusion: WPD may be used to evaluate FHP in the clinical settings. However, future research is required to determine the validity and reliability of WPD among patients with neck-related musculoskeletal disorders with a larger sample.

Seeking Forgiveness: Theoretical Context and an Initial Empirical Study

2000 ◽  
Vol 28 (1) ◽  
pp. 21-35 ◽  
Author(s):  
Steven J. Sandage ◽  
Everett L. Worthington ◽  
Terry L. Hight ◽  
Jack W. Berry
Keyword(s):  
Clinical Practice ◽  
Potential Role ◽  
Initial Study ◽  
Future Research ◽  
Developmental Level ◽  
Theoretical Base ◽  
Self Monitoring ◽  
The Past ◽  
Developmental Factors

While research on granting forgiveness has exploded recently, no theoretical or empirical attention has been directed at seeking forgiveness. We lay a theoretical base for the study of seeking forgiveness and report our initial study bearing on the concept. We investigate the potential role of some personality and developmental factors that might promote seeking forgiveness. Students ( N = 232) who indicated having transgressed against a partner in the past year completed questionnaires on religiosity, age, developmental level of reasoning about forgiveness, narcissism, self-monitoring, and the level to which they had sought forgiveness. Neither religiosity nor age significantly predicted seeking forgiveness. Developmental level of reasoning about forgiveness predicted seeking forgiveness beyond religiosity and age. Narcissism and self-monitoring significantly predicted seeking forgiveness. We outline limitations of the study and implications for future research, clinical practice, and integration.

‘Why are You doing That?’ A Project to Look for Evidence of Efficacy within Occupational Therapy

1997 ◽  
Vol 60 (11) ◽  
pp. 487-490 ◽  
Author(s):  
M Catherine Conroy
Keyword(s):  
Clinical Practice ◽  
Occupational Therapy ◽  
Special Needs ◽  
Occupational Therapists ◽  
Future Research ◽  
Emotional And Behavioural Problems ◽  
Related Activity ◽  
The Past ◽  
Research Findings ◽  
Therapy Service

Nine occupational therapists working with children agreed to participate in a project designed to extend their awareness of evidence of efficacy in their clinical practice. Successful procedures would be developed for use in other areas of the occupational therapy service in Southampton. The occupational therapists divided themselves into three groups – those working with children whose needs were primarily physical, those working with children with emotional and behavioural problems and those working in mainstream schools with children with special needs – and used the following process to develop the project. They devised a statement related to their clinical practice. Electronic databases were used to search for relevant articles. Papers published during the past 10 years and available locally were distributed to the participating therapists. They reviewed the articles, using an agreed format. The articles were discussed by the therapists at regular meetings, culminating in a summary of the research findings, how they related to clinical practice and priorities for future research. There is evidence of increased research-related activity beyond that required by the project. Requests have been made by occupational therapists in other clinical areas to be included in this process.

Revisiting Weber's charismatic leadership: learning from the past and looking to the future

2014 ◽  
Vol 20 (2) ◽  
pp. 224-240 ◽  
Author(s):  
Ivana Milosevic ◽  
A. Erin Bass
Keyword(s):  
Design Methodology ◽  
Charismatic Leadership ◽  
Future Research ◽  
Content Type ◽  
The Past ◽  
Leaders And Followers ◽  
Alternative Research ◽  
Contemporary Study ◽  
Informal Structure ◽  
Leadership Research

Purpose – Weber emphasized the informal structure, followers' power, and time in charismatic leadership; yet the extant literature either overlooks or underplays the significance of each of these facets. The aim of this paper is to revisit Weber's conceptualizations of charisma and illuminate these facets, thus creating new avenues for the contemporary charismatic leadership research. Design/methodology/approach – The focus of this research is on analysis of Weber's conceptualization of charisma. The analysis of selected quotes is grounded within contemporary discourse in order to illustrate how three overlooked facets may propel future research on charismatic leadership. Findings – By revisiting Weber's seminal work, the paper illustrates several historical findings and identifies research opportunities that are yet to be addressed by contemporary study in charismatic leadership. In doing so, the paper generates a set of propositions as an impetus for future exploration. Research limitations/implications – To address the three proposed questions, researchers should focus their attention on the exploration of charisma outside of the formal bureaucracy, the dynamic power relations between leaders and followers, and the temporally bound nature of charisma. Given the nature of these questions, researchers may also consider alternative research methods such as in-depth case studies and narratives in order to more fully capture the dynamic and unpredictable nature of charisma in complex contexts. Originality/value – Contemporary research largely overlooks or underplays the issues of time, the informal structure, and followers in the study of charisma. Through analysis of Weber's writings, this paper brings to the forefront these issues, and thus provide rich opportunities for future research on charismatic leadership.

scholarly journals Iodine

2011 ◽  
Vol 16 (3) ◽  
pp. 190-194 ◽  
Author(s):  
Chris D. Meletis
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Human Body ◽  
The United States ◽  
Cellular Level ◽  
Future Research ◽  
The Past

Iodine levels in the United States have dropped precipitously over the past few decades, whereas antagonists such as bromine, perchlorate, and fluoride have become more ubiquitous. These changes have placed a nutritional burden on the human body and increased the potential for pathophysiological change at the cellular level. This review examines the clinical and peer-reviewed literature and provides perspective related to health-compromising trends that warrant close scrutiny in clinical practice and future research mandates.

Women And Depression: Future Research, Clinical Practice, And Public Policy

2002 ◽  
Author(s):  
Carolyn M. Mazure ◽  
Laura J. Bierut ◽  
Steven D. Hollon ◽  
Susan G. Kornstein ◽  
Charlotte Brown
Keyword(s):  
Public Policy ◽  
Clinical Practice ◽  
Future Research

Old-growth forest reserves in Slovenia: the past, present, and future

2012 ◽  
Vol 163 (6) ◽  
pp. 240-246 ◽  
Author(s):  
Thomas A. Nagel ◽  
Jurij Diaci ◽  
Dusan Rozenbergar ◽  
Tihomir Rugani ◽  
Dejan Firm
Keyword(s):  
Stand Structure ◽  
Growth Conditions ◽  
Ecosystem Functions ◽  
Future Research ◽  
Old Growth ◽  
Forest Reserves ◽  
The Past ◽  
Old Growth Forest ◽  
Forest Remnants ◽  
Basic Characteristics

Old-growth forest reserves in Slovenia: the past, present, and future Slovenia has a small number of old-growth forest remnants, as well as many forest reserves approaching old-growth conditions. In this paper, we describe some of the basic characteristics of these old-growth remnants and the history of their protection in Slovenia. We then trace the long-term development of research in these old-growth remnants, with a focus on methodological changes. We also review some of the recent findings from old-growth research in Slovenia and discuss future research needs. The conceptual understanding of how these forests work has slowly evolved, from thinking of them in terms of stable systems to more dynamic and unpredictable ones due to the influence of natural disturbances and indirect human influences. In accordance with this thinking, the methods used to study old-growth forests have changed from descriptions of stand structure to studies that address natural processes and ecosystem functions.

Chinese Medicine Protein and Peptide in Gene and Cell Therapy

2019 ◽  
Vol 20 (3) ◽  
pp. 251-264 ◽  
Author(s):  
Yinlu Feng ◽  
Zifei Yin ◽  
Daniel Zhang ◽  
Arun Srivastava ◽  
Chen Ling
Keyword(s):  
Chinese Medicine ◽  
Cell Therapy ◽  
Future Research ◽  
The Past ◽  
Promising Strategy ◽  
Wide Range ◽  
New Directions ◽  
Gene And Cell Therapy ◽  
Proteins And Peptides

The success of gene and cell therapy in clinic during the past two decades as well as our expanding ability to manipulate these biomaterials are leading to new therapeutic options for a wide range of inherited and acquired diseases. Combining conventional therapies with this emerging field is a promising strategy to treat those previously-thought untreatable diseases. Traditional Chinese medicine (TCM) has evolved for thousands of years in China and still plays an important role in human health. As part of the active ingredients of TCM, proteins and peptides have attracted long-term enthusiasm of researchers. More recently, they have been utilized in gene and cell therapy, resulting in promising novel strategies to treat both cancer and non-cancer diseases. This manuscript presents a critical review on this field, accompanied with perspectives on the challenges and new directions for future research in this emerging frontier.

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