Oxford Handbook of Clinical and Healthcare Research

This handbook is written for clinical and healthcare research students as well as graduates who wish to work in clinical and healthcare research. It provides simple instructions on the legislative requirements as well as the practical requirements of commissioning, conducting, analysing and reporting research for those in clinical or healthcare practice, and education/training. The handbook outlines the underpinning concepts governing each topic. It takes the researcher through the steps from general good clinical practice in healthcare research, through the process and management of research in a practical yet evidence based manner. There is wide coverage of topics pertaining to several areas of healthcare research, not commonly found in a single text.

2018 ◽  
Vol 29 (4) ◽  
pp. 395-399
Author(s):  
Wendy Thompson ◽  
Leonardo Essado Rios ◽  
Zbys Fedorowicz ◽  
Yvonne Dailey ◽  
Gail Douglas

Abstract Antibiotics do not cure toothache. This headline message of the United Kingdom’s (UK) Dental Antimicrobial Stewardship (AMS) toolkit’s posters and leaflets is aimed at patients; clinicians are expected to know this already. Evidence based clinical guidelines exist to set clear standards for good clinical practice yet there are barriers to compliance. The national AMS audit tool is designed for clinicians to review their management of acute dental conditions, including but not limited to the prescription of antibiotics. In this article we aim to help dental teams protect their patients and themselves from adverse events related to antibiotic prescription. It explores the emergent problem of Clostridium difficile, antibiotic resistance and severe sepsis, and considers some of the barriers, which clinicians have suggested, contribute to the unjustified prescription of antibiotics. Dentists must weigh the risks against the benefits before prescribing any antibiotic.


Author(s):  
J. David Kinzie

In setting treatment goals, the patient’s cultural values and goals, as well as diagnosis, need to be considered by the clinician. Psychiatrists are urged to use the Cultural Formulation Interview of the DSM-5 to aide in assessing patients. With the impacts of globalization and ubiquitous television viewing influencing the culture of the refugees and immigrants, clearly their cultures are in flux and not static, after they arrive in the new country. Doctors and medical approaches are well known to refugees and immigrants. However, they may experience resistance and fear on referral to psychiatrists for reasons of stigma. A sensitive medical approach can help reduce the resistance and fear on the part of the refugee. When a relationship forms, psychosocial issues can be addressed. Treatment guidelines for evidence-based treatments for Western patients exist, but these should be individualized for refugees with individual goals. Good clinical practice and cultural understanding must meet the patient’s personal goals.


2019 ◽  
Vol 28 (4) ◽  
pp. 877-894
Author(s):  
Nur Azyani Amri ◽  
Tian Kar Quar ◽  
Foong Yen Chong

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.


2020 ◽  
Vol 29 (2) ◽  
pp. 688-704
Author(s):  
Katrina Fulcher-Rood ◽  
Anny Castilla-Earls ◽  
Jeff Higginbotham

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.


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