Case formulation in forensic practice: challenges and opportunities

2016 ◽  
Vol 18 (3) ◽  
pp. 240-250 ◽  
Author(s):  
Vanessa Delle-Vergini ◽  
Andrew Day
Keyword(s):  
Clinical Decision Making ◽  
Ethical Issues ◽  
Core Competency ◽  
Clinical Decision ◽  
Case Formulation ◽  
Content Type ◽  
Forensic Practice ◽  
Challenges And Opportunities ◽  
Forensic Case ◽  
Narrative Literature Review

Purpose – The purpose of this paper is to provide an overview of current practice in forensic case formulation, describing different approaches and discussing some of the practical and ethical issues that routinely arise. The paper further identifies areas where future practice and research might be strengthened. Design/methodology/approach – There is only a very small literature to draw upon in reviewing this topic. Therefore a narrative literature review was undertaken, synthesising findings from published, peer-reviewed studies, and papers that addressed case formulation in psychological practice. Findings – Despite case formation being considered by many to be a core competency of evidence-based forensic practice, it is not currently possible to describe a typical forensic case formulation or advocate for a particular approach to practice. Practical implications – A number of practical and ethical issues routinely arise in the process of conducting a forensic case formulation. Ultimately, the absence of a consistent approach can lead to lead to poor clinical decision-making and the delivery of inadequate or inappropriate intervention. Originality/value – This is one of the few discussions of case formulation that have been prepared for forensic practitioners. It is likely to be of interest to readers of the journal given the importance of the formulation process in contemporary forensic practice.

Combined data mining techniques based patient data outlier detection for healthcare safety

2016 ◽  
Vol 9 (1) ◽  
pp. 42-68 ◽  
Author(s):  
Gebeyehu Belay Gebremeskel ◽  
Chai Yi ◽  
Zhongshi He ◽  
Dawit Haile
Keyword(s):  
Data Mining ◽  
Decision Making ◽  
Patient Safety ◽  
Outlier Detection ◽  
Clinical Data ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Healthcare Services ◽  
Content Type ◽  
Outliers Detection

Purpose – Among the growing number of data mining (DM) techniques, outlier detection has gained importance in many applications and also attracted much attention in recent times. In the past, outlier detection researched papers appeared in a safety care that can view as searching for the needles in the haystack. However, outliers are not always erroneous. Therefore, the purpose of this paper is to investigate the role of outliers in healthcare services in general and patient safety care, in particular. Design/methodology/approach – It is a combined DM (clustering and the nearest neighbor) technique for outliers’ detection, which provides a clear understanding and meaningful insights to visualize the data behaviors for healthcare safety. The outcomes or the knowledge implicit is vitally essential to a proper clinical decision-making process. The method is important to the semantic, and the novel tactic of patients’ events and situations prove that play a significant role in the process of patient care safety and medications. Findings – The outcomes of the paper is discussing a novel and integrated methodology, which can be inferring for different biological data analysis. It is discussed as integrated DM techniques to optimize its performance in the field of health and medical science. It is an integrated method of outliers detection that can be extending for searching valuable information and knowledge implicit based on selected patient factors. Based on these facts, outliers are detected as clusters and point events, and novel ideas proposed to empower clinical services in consideration of customers’ satisfactions. It is also essential to be a baseline for further healthcare strategic development and research works. Research limitations/implications – This paper mainly focussed on outliers detections. Outlier isolation that are essential to investigate the reason how it happened and communications how to mitigate it did not touch. Therefore, the research can be extended more about the hierarchy of patient problems. Originality/value – DM is a dynamic and successful gateway for discovering useful knowledge for enhancing healthcare performances and patient safety. Clinical data based outlier detection is a basic task to achieve healthcare strategy. Therefore, in this paper, the authors focussed on combined DM techniques for a deep analysis of clinical data, which provide an optimal level of clinical decision-making processes. Proper clinical decisions can obtain in terms of attributes selections that important to know the influential factors or parameters of healthcare services. Therefore, using integrated clustering and nearest neighbors techniques give more acceptable searched such complex data outliers, which could be fundamental to further analysis of healthcare and patient safety situational analysis.

scholarly journals Qualitative exploration of the medical learner’s journey into correctional health care at an academic medical center and its implications for medical education

2020 ◽  
Author(s):  
Ahmar H. Hashmi ◽  
Alina M. Bennett ◽  
Nadeem N. Tajuddin ◽  
Rebecca J. Hester ◽  
Jason E. Glenn
Keyword(s):  
Learning Environment ◽  
Clinical Decision Making ◽  
Ethical Issues ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Decision ◽  
Diagnostic Laboratory ◽  
Lower Priority ◽  
Academic Medical ◽  
Qualitative Exploration

Abstract Correctional systems in several U.S. states have entered into partnerships with academic medical centers (AMCs) to provide healthcare for persons who are incarcerated. One AMC specializing in the care of incarcerated patients is the University of Texas Medical Branch at Galveston (UTMB), which hosts the only dedicated prison hospital in the U.S. and supplies 80% of the medical care for the entire Texas Department of Criminal Justice (TDCJ). Nearly all medical students and residents at UTMB take part in the care of the incarcerated. This research, through qualitative exploration using focus group discussions, sets out to characterize the correctional care learning environment medical trainees enter. Participants outlined an institutional culture of low prioritization and neglect that dominated the learning environment in the prison hospital, resulting in treatment of the incarcerated as second-class patients. Medical learners pointed to delays in care, both within the prison hospital and within the TDCJ system, where diagnostic, laboratory, and medical procedures were delivered to incarcerated patients at a lower priority compared to free-world patients. Medical learners elaborated further on ethical issues that included the moral judgment of those who are incarcerated, bias in clinical decision making, and concerns for patient autonomy. Medical learners were left to grapple with complex challenges like the problem of dual loyalties without opportunities to critically reflect upon what they experienced. This study finds that, without specific vulnerable populations training for both trainees and correctional care faculty to address these institutional dynamics, AMCs risk replicating a system of exploitation and neglect of incarcerated patients and thereby exacerbating health inequities.

scholarly journals Toward data-based clinical decision making for adults with challenging behavior using the Behavior Problems Inventory-Short Form (BPI-S)

2018 ◽  
Vol 23 (2) ◽  
pp. 103-110 ◽  
Author(s):  
Darren L. Bowring ◽  
Vasiliki Totsika ◽  
Richard P. Hastings ◽  
Sandy Toogood
Keyword(s):  
Behavior Problems ◽  
Behavior Change ◽  
Challenging Behavior ◽  
Clinical Decision Making ◽  
Short Form ◽  
Challenging Behaviors ◽  
Clinical Decision ◽  
Service Evaluation ◽  
Content Type ◽  
Clinically Significant

Purpose The Behavior Problems Inventory-Short Form (BPI-S) is a shorter version of the Behavior Problems Inventory-01. In this paper, BPI-S population norms are reported from a total administrative population of adults with intellectual disability (ID). To facilitate the use of the BPI-S in clinical services to assess behavior change, the purpose of this paper is to describe how to use BPI-S clinically significant and reliable change (RC) scores. Design/methodology/approach Data were gathered on 265 adults with ID known to services. Proxy informants completed the BPI-S on challenging behaviors over the previous six months. Clinically significant cut-off values and RC scores were calculated using the Jacobson and Truax’s (1991) method. Findings BPI-S clinical reference data are presented to provide benchmarks for individual and group comparisons regarding challenging behavior. Examples demonstrate how to use clinical norms to determine change. Practical implications Behavior change is a major goal of researchers and practitioners. Data from the present study can make the BPI-S a valuable tool for determining change in challenging behavior following service input or intervention. Originality/value Whilst well used in research, the BPI-S may be less extensively used in practice. This present study provides data to enable researchers and practitioners to use the BPI-S more widely in assessing clinical outcomes, such as intervention research and service evaluation.

scholarly journals The experiences of family members witnessing the diminishing drinking of a dying relative: An adapted meta-narrative literature review

2019 ◽  
Vol 33 (9) ◽  
pp. 1146-1157 ◽  
Author(s):  
Annie Pettifer ◽  
Katherine Froggatt ◽  
Sean Hughes
Keyword(s):  
Oral Fluid ◽  
Cancer Cachexia ◽  
Clinical Decision Making ◽  
Family Members ◽  
Clinical Decision ◽  
Future Research ◽  
Inclusion Criteria ◽  
Relevant Research ◽  
Narrative Literature ◽  
Narrative Literature Review

Background:Addressing the concerns of family members is an important aspect of palliative and end-of-life care. One aspect that commonly causes family caregivers concern is the decline of patients’ oral fluid intake in the last few days of life.Aim:To map the narratives in which family members’ experiences of witnessing the diminishing drinking of a dying relative have been researched, review the findings within each narrative and consider directions for future research.Design:An adapted meta-narrative review approach.Data Sources:The Cumulative Index of Nursing and Applied Health Literature, Medline, PsycINFO, Psycharticles and Scopus databases were searched for relevant research published between January 1982 and December 2017. Quality was assessed using the Quality Assessment and Review Instrument.Results:A total of 22 papers met the inclusion criteria. No study focused specifically on the experiences of family members when witnessing the diminishing drinking of dying relatives. However, research about diminishing drinking was identified within studies broadly focusing on cancer cachexia, clinical decision-making about hydration and/or nutrition and support in a hospice context. The research indicates that family members’ experiences of diminishing drinking vary with their views about the significance of drinking, dying well and their expectations of themselves and healthcare professionals.Conclusion:While some understanding of the topic can be inferred from research in related areas, there is a paucity of information specifically about family members’ experiences when witnessing the diminishing drinking of a dying relative.

Evaluation of offending behaviour programme selection: the PNA

2019 ◽  
Vol 21 (4) ◽  
pp. 264-277
Author(s):  
Laura Ramsay ◽  
Jamie S. Walton ◽  
Gavin Frost ◽  
Chloe Rewaj ◽  
Gemma Westley ◽  
...  
Keyword(s):  
Decision Making ◽  
High Intensity ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Policy Makers ◽  
Content Type ◽  
Maximum Security ◽  
Research Findings ◽  
Probation Service ◽  
Offending Behaviour

Purpose The purpose of this paper is to outline the qualitative research findings of the effectiveness of Her Majesty’s Prison and Probation Service Programme Needs Assessment (PNA) in supporting decision making regarding selection onto high-intensity offending behaviour programmes. Design/methodology/approach Qualitative data analysis was used through the application of thematic analysis. Results were pooled using principles from meta-synthesis in order to draw conclusions as to whether the PNA was operating as designed. Findings Four overarching themes were identified, which have meaning in guiding decision making into, or out of high-intensity programmes. These were risk, need and responsivity, the importance of attitudes, motivation and formulation and planning. Research limitations/implications The majority of data were collected from category C prisons. Generalisability of findings to high-intensity programmes delivered in maximum security prisons and prisons for younger people aged 18–21 years is limited. The research team had prior knowledge of the PNA, whether through design or application. Procedures were put in place to minimise researcher biases. Practical implications Findings suggest that the PNA is effective in guiding clinical decision making. Practitioners and policy makers can be assured that the processes in place to select into high-intensity programmes are effective, and aligned with the What Works in reducing re-offending. Originality/value This is the first evaluation into the effectiveness of the PNA designed to support clinical decision making regarding participant selection onto accredited offending behaviour programmes. Implications for practice have been discussed.

scholarly journals Qualitative Study of Oncologists’ Views on the CancerLinQ Rapid Learning System

2017 ◽  
Vol 13 (3) ◽  
pp. e176-e184 ◽  
Author(s):  
Rachel M. Mayo ◽  
Julie F. Summey ◽  
Joel E. Williams ◽  
Rebecca A. Spence ◽  
Shally Kim ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Ethical Issues ◽  
Health Care Systems ◽  
Clinical Decision ◽  
Learning System ◽  
Patient Identification ◽  
Rapid Learning ◽  
Ethical Implications ◽  
Patient Consent ◽  
The Impact

Introduction: ASCO is actively developing CancerLinQ (CLQ), a rapid learning system for oncology care. The purpose of this study was to explore providers’ opinions and concerns related to implementation of CLQ, including ethical issues. Methods: Twenty key informant oncologists were recruited for individual in-depth interviews through ASCO contacts, purposively selected to represent a wide variety of cancer specialties as well as different levels of familiarity with CLQ (familiar v unfamiliar). Qualitative data analysis was completed by a three-member team using an inductive narrative approach. Themes were examined by participants familiar and unfamiliar with CLQ, and quotations exemplifying each theme are provided. Results: Participants’ opinions centered on three main themes: (1) general attitudes regarding learning health care systems, (2) optimal approach to patient consent, and (3) appropriateness of data use. There was clear support for the use of big data in clinical decision making for patients and in research. Unfamiliar participants expressed concerns regarding system protections against patient identification, and both familiar and unfamiliar participants discussed the dilemma of including genetic information. Respondents were in agreement with notifying patients early; however, there was debate over whether patients should opt in or opt out. Overall, there was great concern regarding sharing data with drug companies and insurers. Conclusion: Understanding oncologists’ perspectives regarding the ethical implications of CLQ implementation is critical to its success. More research is needed on the impact of rapid learning systems on providers, patients, health systems, and the ultimate effect on cancer care.

Ethical Issues for Neonatal Nurses

1998 ◽  
Vol 5 (3) ◽  
pp. 206-217 ◽  
Author(s):  
Kaye Spence
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Ethical Decision ◽  
Clinical Decision Making ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Response Rate ◽  
Clinical Decision ◽  
Neonatal Nurses ◽  
Ethical Decisions

This article examines the involvement of neonatal nurses in ethical issues, achieved through a survey of Australian neonatal nurses. The aim was to discover if nurses were involved in ethical decisions, to examine various categories of neonates and the concerns that nurses felt about them, and to determine the extent to which nurses saw themselves as advocates. A response rate of 65% was achieved from nurses in two states who worked in intensive care and special care nurseries. The findings show that nurses were more likely to be involved in clinical decision making than in ethical decision making, showed the greatest concern for infants who had an uncertain prognosis, and saw themselves as advocates for their patients. The issues surrounding these findings are examined.

Understanding critical care nurses’ autonomy in Jordan

2017 ◽  
Vol 30 (4) ◽  
pp. 432-442 ◽  
Author(s):  
Mahmoud Maharmeh
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Critical Care Nurses ◽  
Cross Sectional Survey ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Content Type

Purpose The aim of this study was to describe Jordanian critical care nurses’ experiences of autonomy in their clinical practice. Design/methodology/approach A descriptive correlational design was applied using a self-reported cross-sectional survey. A total of 110 registered nurses who met the eligibility criteria participated in this study. The data were collected by a structured questionnaire. Findings A majority of critical care nurses were autonomous in their decision-making and participation in decisions to take action in their clinical settings. Also, they were independent to develop their own knowledge. The study identified that their autonomy in action and acquired knowledge were influenced by a number of factors such as gender and area of practice. Practical implications Nurse’s autonomy could be increased if nurses are made aware of the current level of autonomy and explore new ways to increase empowerment. This could be offered through classroom lectures that concentrate on the concept of autonomy and its implication in practice. Nurses should demonstrate autonomous nursing care at the same time in the clinical practice. This could be done through collaboration between educators and clinical practice to help merge theory to practice. Originality/value Critical care nurses were more autonomous in action and knowledge base. This may negatively affect the quality of patient care and nurses’ job satisfaction. Therefore, improving nurses’ clinical decision-making autonomy could be done by the support of both hospital administrators and nurses themselves.

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