Outcome-Informed Clinical Work

2005 ◽  
pp. 84-102 ◽  
Author(s):  
Scott D. Miller ◽  
Barry L. Duncan ◽  
Mark A. Hubble
Keyword(s):  
Clinical Practice ◽  
Clinical Work ◽  
Methods Of Treatment

For a field as intent on identifying and codifying the methods of treatment as psychotherapy is, abandoning process in favor of outcome may seem radical indeed. Nevertheless, an entire tradition of using outcome to inform process exists. We begin by exploring the empirical antecedents of an outcome-informed approach to clinical practice. After this review, the development our own work and perspective is presented.

scholarly journals Assessing competence in cognitive-behavioural therapy

2008 ◽  
Vol 193 (1) ◽  
pp. 60-64 ◽  
Author(s):  
Andrew J. A. Keen ◽  
Mark H. Freeston
Keyword(s):  
Clinical Practice ◽  
Case Studies ◽  
Cognitive Behavioural Therapy ◽  
Clinical Work ◽  
Behavioural Therapy ◽  
High Stakes ◽  
Cognitive Behavioural ◽  
Reliable Assessment

BackgroundPostgraduate courses on cognitive-behavioural therapy (CBT) assess various competencies using essays, case studies and audiotapes or videotapes of clinical workAimsTo evaluate how reliably a well-established postgraduate course assesses CBT competenciesMethodData were collected on two cohorts of trainees (n=52). Two examiners marked trainees on: (a) two videotapes of clinical practice; (b) two case studies; and (c) three essaysResultsEssay examinations were more reliable than case studies, which in turn were more reliable than videotaped assessments. The reliability of the latter two assessments was considerably lower than that commonly expected of high-stakes examinations. To assess reliably standard CBT competencies, postgraduate courses would need to examine about 5 essays, 12 case studies and 19 videotapesConclusionsReliable assessment of standard competencies is complex and resource intensive. There would need to be a marked increase in the number of samples of clinical work assessed to be able to make reliable judgements about proficiency

scholarly journals Working on dreams, from neuroscience to psychotherapy

2021 ◽  
Vol 24 (2) ◽  
Author(s):  
Giorgio Caviglia
Keyword(s):  
Clinical Practice ◽  
Recent Literature ◽  
Clinical Work ◽  
The Self ◽  
Current Clinical Practice ◽  
The Unconscious ◽  
Psychoanalytic Approach ◽  
The Relationship ◽  
Aggressive Drive ◽  
Cultural Openness

Within the current clinical practice, the debate on the use of dream is still very topical. In this article, the author suggests to address this question with a notable scientific and cultural openness that embraces either the psychoanalytic approach (classical, modern and intersubjective), and the neurophysiological assumptions and both clinical research and cognitive hypotheses. The utility of dream - in the clinical work with patients - is supported by the author with extensive bibliographic references and personal clinical insights, drawn from his experience as a psychotherapist. Results: From an analysis of recent literature on this topic, the dream assumes a very different function and position in the clinical practice: from ‘via regia to the unconscious’ of Freudian theories - an expression of repressed infantile wishes of libidinal or aggressive drive nature - it becomes the very fulcrum of the analysis, a fundamental capacity to be developed, a necessary and decisive element for the patient’s transformation. The dream can also be use with the function of thinking and mentalization, of problem solving, of adaptation, as well as an indicator of the relationship with the therapist in the analytic dialogue or of dissociated aspects of the self. Finally, the author proposes a challenging reading of the clinical relevance of dream: through listening to the dream, the clinician can help the patient to stand in the spaces of his own self in a more open and fluid way and therefore to know himself better, to regulate his affects, to think and to integrate oneself.

Enabling visibility of the clinician-scientists’ knowledge broker role in linking research with clinical practice: A participatory design research in the Dutch nursing-home sector

2020 ◽  
Author(s):  
Margot Barry ◽  
Wietske Kuijer ◽  
Anke Persoon ◽  
Loek Nieuwenhuis ◽  
Nynke Scherpbier
Keyword(s):  
Clinical Practice ◽  
Performance Appraisal ◽  
Participatory Design ◽  
Design Research ◽  
Clinical Work ◽  
Role Expectations ◽  
Knowledge Broker ◽  
Academic Network ◽  
Knowledge Intensive ◽  
Definition Of

Abstract Background: Twelve clinician-scientists were employed in a Dutch academic network, which is a collaboration between fifteen nursing-homes and an academic medical research institute. The clinician-scientists were tasked with linking research and clinical practice by catalysing both care-informed research and evidence-informed implementation initiatives. The clinician-scientists and their manager experienced difficulties in clearly defining the knowledge broker role of the clinician-scientists, a difficulty also reported in literature. They found no tools and methods suitable for make their knowledge broker role visible. Clarifying role expectations and accountability for funding these knowledge broker positions was difficult. They aimed to design a theory-informed performance appraisal tool that allowed clinician-scientists to explicate and develop their knowledge broker role in collaboration with management.Methods: A participatory design research was conducted over a 21 month period with a design group consisting of an external independent researcher, clinician-scientists and their managers from within the academic network. Results: A tool (the SP-tool) was developed in MS Excel. This allowed clinician-scientists to log their knowledge broker activities as distinct from their clinical work and research related activities. The tool contributed to their ability to make their knowledge broker role visible to themselves and their stakeholders. The theoretic contribution of the design research is a conceptual model of professionalisation of the clinician scientists knowledge broker role. This model presents the relationship between work visibility and the clarification of functions of the clinician-scientist’s knowledge broker role. In the professionalisation of knowledge-intensive work, visibility contributes to the definition of CS broker functions, which is an element necessary for the professionalisation of an occupation.Conclusions: The CSs knowledge broker role is a knowledge-intensive role and work-tasks associated with this role are not automatically visible. The SP-tool contributes to creating work visibility of the clinician-scientists’ knowledge broker role. This in turn could contribute to the professionalisation of this role, which is not well described in literature at the day-to-day professional level.

Managing cancer care through service delivery networks: The role of professional collaboration in two European cancer networks

2017 ◽  
Vol 31 (3) ◽  
pp. 120-129 ◽  
Author(s):  
Joan Prades ◽  
Verdiana Morando ◽  
Valeria D Tozzi ◽  
Didier Verhoeven ◽  
Jose R Germà ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Work ◽  
Network Governance ◽  
Governance Structures ◽  
Medical Specialties ◽  
Strategic Networks ◽  
Services Delivery ◽  
Four Levels ◽  
Cancer Networks ◽  
European Cancer

Background The study examines two meso-strategic cancer networks, exploring to what extent collaboration can strengthen or hamper network effectiveness. Unlike macro-strategic networks, meso-strategic networks have no hierarchical governance structures nor are they institutionalised within healthcare services’ delivery systems. This study aims to analyse the models of professional cooperation and the tools developed for managing clinical practice within two meso-strategic, European cancer networks. Methods Multiple case study design based on the comparative analysis of two cancer networks: Iridium, in Antwerp, Belgium and the Institut Català d’Oncologia in Catalonia, Spain. The case studies applied mixed methods, with qualitative research based on semi-structured interviews ( n = 35) together with case-site observation and material collection. Results The analysis identified four levels of collaborative intensity within medical specialties as well as in multidisciplinary settings, which became both platforms for crosscutting clinical work between hubs’ experts and local care teams and the levers for network-based tools development. The organisation of clinical practice relied on professional-based cooperative processes and tiers, lacking vertical integration mechanisms. Conclusions The intensity of professional linkages largely shaped the potential of meso-strategic cancer networks to influence clinical practice organisation. Conversely, the introduction of managerial techniques or network governance structures, without introducing vertical hierarchies, was found to be critical solutions.

scholarly journals Gender Differences and Work-Family Conflicts among Emergency Physicians with Intention to Leave

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Yi-Fang Wu ◽  
Po-Chang Wang ◽  
Yi-Chuan Chen
Keyword(s):  
Gender Differences ◽  
Clinical Practice ◽  
Night Shift ◽  
Clinical Work ◽  
Intention To Leave ◽  
Work Hours ◽  
Emergency Physicians ◽  
Family Conflicts ◽  
And Gender ◽  
Work Family

Backgrounds. The objective of this study was to investigate the relationships among intention to leave, emergency physician clinical activities, work-family conflicts, and gender differences in emergency physicians (EPs). Methods. The survey instrument was a self-administered questionnaire containing basic demographic information and characteristics of clinical activities. The work-family conflicts were assessed by the Chinese version of the work-family conflict (WIF) scale. The questionnaires were mailed to board-certified EPs between January 2014 and August 2014. Student’s t-test, Chi-square test, and one-way analysis of variance (ANOVA) were used to test the difference between subgroups. Logistic regression analysis was performed to determine the factors associated with intention to leave and gender differences. Results. The study included 222 respondents for analysis after exclusions. Compared with physicians not planning to leave, those planning to leave ED practice showed higher dissatisfaction with their clinical work hours (50.0% versus 31.4%, p = 0.035) and night/day shift ratio (52.9% versus 31.0%, p = 0.013) and tended to work with night/day shift ratio exceeding 40% (67.6% versus 45.7%, p = 0.019). Female physicians were more likely to leave ED practice (females versus males, 26.5% versus 10.1%, p = 0.008). A significantly higher level of WIF scale was noted in the group with intention to leave ED practice (3.7 ± 0.6 versus 3.3 ± 0.7, p = 0.001). Conclusions. Females and EPs with higher level of WIF scale were more likely to leave emergency clinical practice. Instead of the number of clinical practice hours, the satisfaction with the clinical work hours and night shift frequency were significantly associated with the intention to leave.

scholarly journals The place of intervention methods of treatment of patients with resistant hypertension in clinical practice

2018 ◽  
Vol 15 (1) ◽  
pp. 21-22
Author(s):  
R A Agaeva ◽  
N M Danilov ◽  
O V Sagaydak ◽  
I E Chazova
Keyword(s):  
Clinical Practice ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
High Technology ◽  
Scientific Interest ◽  
Arteriovenous Anastomosis ◽  
Baroreflex Activation Therapy ◽  
Activation Therapy ◽  
Methods Of Treatment

Every year scientific interest in studying of interventional methods of treatment of resistant hypertension steadily increases. Row of high technology device are created for performance of such procedures as well as techniques of their management are also developed. Non-pharmacological ways of treatment are described in this article, which are widely used in clinical practice: baroreflex activation therapy, radiofrequency renal denervation, and central iliac arteriovenous anastomosis.

scholarly journals Non-saccular aneurysms: pathogenesis, clinic and methods of treatment (review)

2020 ◽  
Vol 22 (3) ◽  
pp. 76-83
Author(s):  
L. Ya. Kravets ◽  
A. D. Pogosyan
Keyword(s):  
Clinical Practice ◽  
Scientific Literature ◽  
Clinical Course ◽  
Fusiform Aneurysm ◽  
Local Expansion ◽  
Treatment Review ◽  
Generic Term ◽  
Methods Of Treatment ◽  
Saccular Aneurysms

In clinical practice, we use the term “fusiform aneurysm” for local expansion of artery. Under this generic term specialists understand heterogeneous arterial pathology, which is very important for diagnosis and choosing the treatment. We conducted an analysis of scientific literature published in 1987–2019, including 63 foreign and 4 Russian sources devoted to pathogenesis and types of non-saccular aneurysms. Among non-saccular aneurysms, dolichoectatic aneurysms are distinguished, rather of genetically or non-atherosclerotic origin and fusiform aneurysm acquired due to dissection processes. Features of mechanisms of their formation, variants of clinical course and methods of treatment are presented.

Anthropologies of Medicine, Religion, and Spirituality and Their Application to Clinical Practice

2017 ◽  
Author(s):  
Linda L. Barnes ◽  
Lance D. Laird
Keyword(s):  
Clinical Practice ◽  
Medical Anthropology ◽  
Clinical Work ◽  
Religious Studies ◽  
Cultural Humility ◽  
Religion And Spirituality ◽  
Anthropology Of Religion ◽  
Cultural System ◽  
Religious Traditions

This chapter reviews how medical anthropology has characterized and interpreted biomedicine as a cultural system in its own right. Because so much of the field has attended to how practitioners and patients experience their engagement in biomedicine and other systems of healing, we introduce related dimensions. Some medical anthropologists have also drawn from what is known as the Anthropology of Religion, as a way of exploring religious traditions related to healing. Their work adds useful dimensions to the topic at hand. Finally, we address applied dimensions, that include how biomedical professionals can introduce issues related to religion/spirituality in their clinical work. We advocate for a synthesis of the strengths of religious studies, medical anthropology, refined tools of spiritual inquiry that reflect the particularities of the different traditions, and a stance of cultural humility.

scholarly journals Assessing work capacity – reviewing the what and how of physicians’ clinical practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
P. Nordling ◽  
G. Priebe ◽  
C. Björkelund ◽  
G. Hensing
Keyword(s):  
Clinical Practice ◽  
Information Seeking ◽  
Clinical Work ◽  
Objective Evaluation ◽  
Work Capacity ◽  
Work Place ◽  
Main Task ◽  
Certification Process ◽  
Daily Work ◽  
Capacity Data

Abstract Background Although a main task in the sickness certification process, physicians’ clinical practice when assessing work capacity has not been thoroughly described. Increased knowledge on the matter is needed to better understand and support the certification process. In this review, we aimed to synthesise existing qualitative evidence to provide a clearer description of the assessment of work capacity as practiced by physicians. Method Seven electronic databases were searched systematically for qualitative studies examining what and how physicians do when they assess work capacity. Data was analysed and integrated using thematic synthesis. Results Twelve articles were included. Results show that physicians seek to form a knowledge base including understanding the condition, the patient and the patient’s workplace. They consider both medical and non-medical aspects to affect work capacity. To acquire and process the information they use various skills, methods and resources. Medical competence is an important basis, but not enough. Time, trust, intuition and reasoning are also used to assess the patient’s claims and to translate the findings into a final assessment. The depth and focus of the information seeking and processing vary depending on several factors. Conclusion The assessment of work capacity is a complex task where physicians rely on their non-medical skills to a higher degree than in ordinary clinical work. These skills are highly relevant but need to be complemented with access to appropriate resources such as understanding of the associations between health, work and social security, enough time in daily work for the assessment and ways to better understand the patient’s work place. Also, the notion of an “objective” evaluation is questioned, calling for a greater appreciation of the complexity of the assessment and the role of professional judgement.

Safe chemotherapy: Clinicians driving technology and not the other way around.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 183-183
Author(s):  
Vishal Kukreti ◽  
Roxanne Cosby ◽  
Annie Cheung ◽  
Marie Hamasoor ◽  
Sherrie Hertz ◽  
...  
Keyword(s):  
Clinical Practice ◽  
System Integration ◽  
Quality Care ◽  
Management Strategies ◽  
User Involvement ◽  
Clinical Work ◽  
Future Research ◽  
Evidence Based ◽  
Unanticipated Consequences ◽  
Evidence Based Guideline

183 Background: Although information technology (IT) has the potential to improve the quality and safety of patient care, introduction into the clinical work flow may create unanticipated consequences. IT solutions such as computerized physician order entry (CPOE) are often designed and executed without end-user involvement. An evidence based guideline for systemic treatment (ST) CPOE was developed. The guideline looks at the features, functionalities and components of a ST CPOE system required to ensure safe and high-quality care. Methods: The guideline was developed by an interdisciplinary panel of physicians, nurses, pharmacists, methodologists, IT specialists, and human factors experts. A systematic review was conducted of the available clinical and technology literature and key informant interviews were conducted. Role-specific CPOE functionalities were process mapped for physicians, nurses and pharmacists. Two expert panels (i.e., clinical and supporting tools) were convened to review the information and provide feedback on guideline content. The guideline was also reviewed externally by content experts from provincial, national and international organizations. Results: The resulting evidence-based guideline focused on two distinct yet interconnected parts: clinical practice (e.g., error prevention, unanticipated consequences, impact on practice, clinical decision support), and technology requirements (e.g., usability features, system integration, effective alerts, audit logs, regimen building). The recommendations also highlight the importance of change management strategies and clinician engagement. Conclusions: This innovative guideline provides an approach to technology evaluation focusing on clinical practice needs driving IT solutions. Future research to help standardize design and usability of such systems is necessary. The non-vendor specific recommendations can be used as the foundation for evaluation of ST CPOE systems to reduce errors, improve safety, and support clinical practice. The application of the recommendations as an assessment of ST CPOE system guideline concordance will also be valuable.

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