scholarly journals Incidence and impact of incivility in paramedicine: a qualitative study

2021 ◽  
pp. emermed-2020-209961
Author(s):  
Nicola Jane Credland ◽  
Clare Whitfield
Keyword(s):  
Decision Making ◽  
General Public ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Cumulative Effect ◽  
Well Being ◽  
Clinical Decision ◽  
Interpersonal Aggression ◽  
Professional Groups ◽  
Semistructured Interviews

BackgroundIncivility or rudeness is a form of interpersonal aggression. Studies suggest that up to 90% of healthcare staff encounter incivility at work with it being considered ‘part of the job’.MethodsQualitative, in-depth, semistructured interviews (n=14) undertaken between June and December 2019. Purposive sampling was used to identify front-line paramedics working for one NHS Ambulance Trust. Interviews lasted between 16 and 45 min, were audiorecorded, verbatim transcribed and analysed using thematic analysis.ResultsFour themes were identified: paramedics reported a lack of respect displayed both verbally and non-verbally from other professional groups. The general public and interdisciplinary colleagues alike have unrealistic expectations of the role of a paramedic. In order to deal with incivility paramedics often reported taking the path of least resistance which impacts on ways of working and shapes subsequent clinical decision-making, potentially threatening best practice. Finally paramedics report using coping strategies to support well-being at work. They report that a single episode of incivility is easier to deal with but subsequent episodes compound the first.ConclusionsThis study highlights the effect incivility can have on operational paramedics. Incivility from the general public and other health professionals alike can have a cumulative effect impacting on well-being and clinical decision-making.

Music Therapy Pre-internship Education and Training: Support for a Methods-Based Approach

2021 ◽  
Author(s):  
Susan C Gardstrom ◽  
James Hiller ◽  
Annie Heiderscheit ◽  
Nancy L Jackson
Keyword(s):  
Music Therapy ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Well Being ◽  
Clinical Decision ◽  
Education And Training ◽  
Population Based ◽  
Music Therapists ◽  
Training Support ◽  
And Training

Abstract As music therapists, music is our primary realm of understanding and action and our distinctive way of joining with a client to help them attain optimal health and well-being. As such, we have adopted and advocate for a music-focused, methods-based (M-B) approach to music therapy pre-internship education and training. In an M-B approach, students’ learning is centered on the 4 music therapy methods of composing, improvising, re-creating, and listening to music and how these music experiences can be designed and implemented to address the health needs of the diverse clientele whom they will eventually encounter as practicing clinicians. Learning is highly experiential, with students authentically participating in each of the methods and reflecting on these self-experiences as a basis for their own clinical decision-making. This is differentiated from a population based (P-B) approach, wherein students’ attention is directed at acquiring knowledge about the non-musical problems of specific “clinical populations” and the “best practice” music interventions that are presumed to address these problems. Herein, we discuss both approaches, identifying the limitations of a P-B perspective and outlining the benefits of an M-B curriculum and its relevance to 21st-century music therapy practice.

No incentives, no innovation

2009 ◽  
Vol 91 (1) ◽  
pp. 10-12
Author(s):  
Jon Hackett
Keyword(s):  
Decision Making ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Bottom Up ◽  
High Profile ◽  
No Innovation

While the NHS has expressed a commitment to innovation with a succession of dedicated 'arms length bodies,' there are numerous high-profile cases in which advances on the ground have not received as much support as they might. In his recent Next Stage Review report, Lord Darzi has emphasised a commitment to clinical decision-making at all levels of the NHS but whether this will involve embracing best practice from the bottom up remains to be seen. For this article I spoke to two surgeons, whose sometimes controversial innovations were admired by many, about the obstacles they faced.

scholarly journals Novel Neurotechnological Interventions for Pediatric Drug-Resistant Epilepsy: Physician Perspectives

2020 ◽  
pp. 088307382096693
Author(s):  
Patrick J. McDonald ◽  
Viorica Hrincu ◽  
Mary B. Connolly ◽  
Mark J. Harrison ◽  
George M. Ibrahim ◽  
...  
Keyword(s):  
Decision Making ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Qualitative Content Analysis ◽  
Scientific Evidence ◽  
Clinical Decision ◽  
Drug Resistant ◽  
Ethical Considerations ◽  
Pediatric Drug ◽  
Drug Resistant Epilepsy

This qualitative study investigated factors that guide physicians’ choices for minimally invasive and neuromodulatory interventions as alternatives to conventional surgery or medical management for pediatric drug-resistant epilepsy. North American physicians were recruited to one of 4 focus groups at national conferences. Discussions were analyzed using qualitative content analysis. A pragmatic neuroethics framework was applied to interpret results. Discussions revealed 2 major thematic branches: (1) clinical decision making and (2) ethical considerations. Under clinical decision making, physicians emphasized scientific evidence and patient candidacy when assessing neurotechnologies for patients. Ongoing seizures without intervention was important for safety and neurodevelopment. Under ethical considerations, resource allocation, among other financial considerations for technology adoption, were considerable sources of pressure on decision making. Access to neurotechnology was a salient theme differentiating Canadian and American contexts. When assessing novel neurotechnological interventions for pediatric drug-resistant epilepsy, physicians balance clinical and ethical factors to guide decision making and best practice.

scholarly journals Cronic Kidney Disease, Life Quality Assessment Of Patients

2016 ◽  
Vol 12 (6) ◽  
pp. 103
Author(s):  
Marsida Duli ◽  
Qamil Dika ◽  
Matilda Bushati
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Clinical Decision Making ◽  
Well Being ◽  
Clinical Decision ◽  
Healthy Population ◽  
Important Indicator

Assessing quality of life in patients with varying degrees of chronic kidney disease is an important issue because of its impact on clinical decision-making as increasing the efficiency of resources in the health system. Through this survey provided an attempt to assess the quality of life of patients with chronic kidney disease undergoing dialysis. Commitment to maximize their functioning and well-being constitutes the essence of the purpose of health care. In recent decades elaborate SF 36 is cut by a gauge derive so simple and basic that helps to evaluate the function of the target of researchers, a certain age group, a disease or a treatment group. Short questionnaire forms SF36 instrument gauge is used to determine the level of quality of life in patients with chronic renal failure under the different stages of treatment with dialysis. The study involved 206 people, 112 from patients to Tirana and Shkodra and 94 healthy persons, who collaborated consensually for completing the questionnaires. Based on the results, the quality of life of dialysis patients is significantly worse than that of the healthy population and patients with other injuries less severe of renal function. Survey indicates that a more holistic approach to be used in the treatment of patients with chronic kidney disease including clinical decision making and patient perception. Precisely for this it is recommended to enter the practice of clinical interest that a set of questionnaires that provide information on patients' perception of health as an important indicator that facilitates the physician-patient collaboration in order to better treatment of the disease and increase the quality the life of the patient.

scholarly journals Best practice guidelines for management of spinal disorders in skeletal dysplasia

2020 ◽  
Author(s):  
Klane White ◽  
Michael B Bober ◽  
Tae-Joon Cho ◽  
Michael J Goldberg ◽  
Julie Hoover-Fong ◽  
...  
Keyword(s):  
Decision Making ◽  
Practice Guidelines ◽  
Skeletal Dysplasia ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Case Series ◽  
Clinical Decision ◽  
Spinal Disorders ◽  
Best Practice Guidelines ◽  
Group A

Abstract Background: Disorders of the spine present a common and difficult management concern in patients with skeletal dysplasia. Due to the rarity of these conditions however, the literature, largely consisting of small, single institution case series, is sparse in regard to well-designed studies to support clinical decision making in these situations. Methods: Using the Delphi method, an international, multi-disciplinary group of individuals, with significant experience in the care of patients with skeletal dysplasia, convened to develop multi-disciplinary, “best practice” guidelines in the care of spinal disorders in patients with skeletal dysplasia. Results: Starting with 33 statements, the group a developed a list of 31 “best practice” guidelines. Conclusions: The guidelines are presented and discussed to provide context for clinicians in their decision making in this often-challenging realm of care.

scholarly journals Vectors of Best Practice: An Introduction to Part III, Practice

2020 ◽  
pp. 129-138
Author(s):  
Bill Fulford
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Cultural Values ◽  
Multidisciplinary Team ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Personal Narratives ◽  
Clinical Decision ◽  
Bottom Line

AbstractThis chapter introduces Part III of the book. Contributing chapters illustrate the role of a culturally enriched form of values-based practice in building best practice in the design and delivery of contemporary mental health services. Topics covered from the model of values-based practice set out in chapter ‘Surprised by Values: An Introduction to Values-Based Practice and the Use of Personal Narratives in this Book’ include, person-values-centred care, the extended multidisciplinary team, shared clinical decision-making supported by dissensus within frameworks of shared values, and recovery practice. The bottom-line message is that incorporated into values-based practice, cultural values cease to operate as barriers to, and instead become effective vectors of, best practice in mental health.

scholarly journals Understanding Neonatal Ventilation: Strategies for Decision Making in the NICU

2013 ◽  
Vol 32 (4) ◽  
pp. 246-261 ◽  
Author(s):  
Julia Petty
Keyword(s):  
Decision Making ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Current Evidence ◽  
Individual Level ◽  
Neonatal Ventilation ◽  
Ventilation Modes ◽  
Ventilation Strategies

AbstractNeonatal ventilation is an integral component of care delivered in the neonatal unit. The aim of any ventilation strategy is to support the neonate’s respiratory system during compromise while limiting any long-term damage to the lungs. Understanding the principles behind neonatal ventilation is essential so that health professionals caring for sick neonates and families have the necessary knowledge to understand best practice. Given the range of existing ventilation modes and parameters available, these require explanation and clarification in the context of current evidence. Many factors can influence clinical decision making on both an individual level and within the wider perspective of neonatal care.

scholarly journals Does The Reformed Cancer Drug Fund Generate Evidence On Effectiveness? A Cross-sectional Analysis On Publicly Accessible Documentation

2020 ◽  
Author(s):  
Helen Macdonald ◽  
Ben Goldacre
Keyword(s):  
Decision Making ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Routine Data ◽  
Clinical Decision ◽  
New Drugs ◽  
Cancer Drug ◽  
Cross Sectional ◽  
Off Label

AbstractIntroductionThe Cancer Drugs Fund (CDF) was reformed in 2016 with an ambition to generate new evidence on effectiveness, and to review existing drugs in the fund. We set out to evaluate: whether drugs transitioning from the old CDF were re-reviewed as planned; whether new drugs have a “data collection arrangement” (DCA) as planned; and whether evidence generated under the DCA using routine data from the “Systemic Anti-Cancer Treatment” (SACT) database was of high quality.MethodsWe accessed documents from NHS England, Public Health England and NICE at August 2018. We calculated the proportion of old CDF drugs re-reviewed, and of new drugs and indications with a DCA. We described key features of the DCAs. For all SACT studies we set out to obtain a protocol in order to analyse the quality of the planned methods.Results47 old drugs and indications transitioned to the new CDF. For 14 there was no evidence of a re-review; 9 of these remain under CDF at August 2019 (all off-label uses). 33 had marketing authorisations: 22 of these had a review completed by September 2017 as planned (67%). 20 new drugs and indications entered the CDF by August 2018: 19 had a DCA; one (off-label) had no DCA or equivalent. All DCAs identify uncertainty about overall survival; all express an intent to conduct observational analysis using SACT data; SACT data was central to decision-making for 6 (32%). We were able to find 0 protocols of the 19 planned SACT studies (0). Following Freedom of Information requests we were told these protocols are prepared after the data are collected, and posted with the reappraisal: however we could not locate any protocol for either of the two published re-appraisals. We were therefore unable to assess the quality of the methods in any of the proposed SACT studies.ConclusionsThe revised CDF has not been implemented as planned. Reporting of observational analyses in SACT data fall substantially short of best practice, and the full methods used cannot be established. There is very little information in the public domain around evaluation of off-label uses. Lastly, SACT data itself does not appear to be able to support clinical decision-making in the manner suggested by the CDF policy documents. NHS England should review the conduct of the fund, but also the planning, as unrealistic commitments may have been made.

scholarly journals Best Practice Guidelines in Managing the Craniofacial Aspects of Skeletal Dysplasia

2020 ◽  
Author(s):  
Ravi Savarirayan ◽  
David E. Tunkel ◽  
Laura M. Sterni ◽  
Michael B. Bober ◽  
Tae-Joon Cho ◽  
...  
Keyword(s):  
Decision Making ◽  
Practice Guidelines ◽  
Delphi Method ◽  
Skeletal Dysplasia ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Subsequent Development ◽  
Clinical Decision ◽  
Best Practice Guidelines ◽  
Disciplinary Group

Abstract Background Recognition and appropriate management of the craniofacial manifestations of patients with skeletal dysplasia are challenging, due to the rarity of these conditions, and dearth of literature to support evidence-based clinical decision making. Methods Using the Delphi method, an international, multi-disciplinary group of individuals, with significant experience in the care of patients with skeletal dysplasia, convened to develop multi-disciplinary, best practice guidelines in the management of craniofacial aspects of these patients. Results After a comprehensive literature review, 23 initial statements were generated and critically discussed, with subsequent development of a list of 22 best practice guidelines after a second round voting. Conclusions The guidelines are presented and discussed to provide context and assistance for clinicians in their decision making in this important and challenging component of care for patients with skeletal dysplasia, in order standardize care and improve outcomes.

Sign in / Sign up

Export Citation Format

Share Document