scholarly journals Judgment and decision-making in clinical dentistry

2020 ◽  
Vol 48 (11) ◽  
pp. 030006052097287
Author(s):  
Liviu Feller ◽  
Johan Lemmer ◽  
Mbulaheni Simon Nemutandani ◽  
Raoul Ballyram ◽  
Razia Abdool Gafaar Khammissa
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Knowledge Base ◽  
Clinical Judgment ◽  
Judgment And Decision Making ◽  
Data Driven ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Statistical Approaches ◽  
Conferences And Congresses

The development of clinical judgment and decision-making skills is complex, requiring clinicians—whether students, novices, or experienced practitioners—to correlate information from their own experience; from discussions with colleagues; from attending professional meetings, conferences and congresses; and from studying the current literature. Feedback from treated cases will consolidate retention in memory of the complexities and management of past cases, and the conversion of this knowledge base into daily clinical practice. The purpose of this narrative review is to discuss factors related to clinical judgment and decision-making in clinical dentistry and how both narrative, intuitive, evidence-based data-driven information and statistical approaches contribute to the global process of gaining clinical expertise.

Clinical Guidelines and Clinical Judgment

2019 ◽  
pp. 8-26
Author(s):  
Charles F. Manski
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Patient Outcomes ◽  
Clinical Judgment ◽  
Evidence Based ◽  
Adherence To Guidelines ◽  
Limited Ability ◽  
Decentralized Decision Making ◽  
Welfare Comparison ◽  
Predict Treatment Response

This chapter reviews the continuing discourse in medicine regarding the circumstances in which clinicians should adhere to evidence-based practice guidelines or exercise their own judgment, sometimes called “expert opinion.” There are at least two broad reasons why patient care adhering to guidelines may differ from the care that clinicians provide. First, guideline developers and clinicians may differ in their ability to predict how decisions affect patient outcomes. Second, guideline developers and clinicians may differ in how they evaluate patient outcomes. Welfare comparison of adherence to guidelines and decentralized decision making requires consideration of both factors, and perhaps others as well. This chapter looks at how limited ability to assess patient risk of illness and to predict treatment response may affect the welfare achieved by adherence to guidelines and by decentralized clinical practice.

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

2020 ◽  
Vol 29 (2) ◽  
pp. 688-704
Author(s):  
Katrina Fulcher-Rood ◽  
Anny Castilla-Earls ◽  
Jeff Higginbotham
Keyword(s):  
Clinical Practice ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Speech Language Pathologists ◽  
School Based ◽  
Research Findings ◽  
Ebp Implementation

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.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

scholarly journals Applying evidence-based medicine in general practice: a video-stimulated interview study on workplace-based observation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisanne S. Welink ◽  
Kaatje Van Roy ◽  
Roger A. M. J. Damoiseaux ◽  
Hilde A. Suijker ◽  
Peter Pype ◽  
...  
Keyword(s):  
Decision Making ◽  
General Practice ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Stimulated Recall ◽  
Previous Discussion ◽  
Based Medicine ◽  
Stimulated Recall Interviews ◽  
Gp Training

Abstract Background Evidence-based medicine (EBM) in general practice involves applying a complex combination of best-available evidence, the patient’s preferences and the general practitioner’s (GP) clinical expertise in decision-making. GPs and GP trainees learn how to apply EBM informally by observing each other’s consultations, as well as through more deliberative forms of workplace-based learning. This study aims to gain insight into workplace-based EBM learning by investigating the extent to which GP supervisors and trainees recognise each other’s EBM behaviour through observation, and by identifying aspects that influence their recognition. Methods We conducted a qualitative multicentre study based on video-stimulated recall interviews (VSI) of paired GP supervisors and GP trainees affiliated with GP training institutes in Belgium and the Netherlands. The GP pairs (n = 22) were shown fragments of their own and their partner’s consultations and were asked to elucidate their own EBM considerations and the ones they recognised in their partner’s actions. The interview recordings were transcribed verbatim and analysed with NVivo. By comparing pairs who recognised each other’s considerations well with those who did not, we developed a model describing the aspects that influence the observer’s recognition of an actor’s EBM behaviour. Results Overall, there was moderate similarity between an actor’s EBM behaviour and the observer’s recognition of it. Aspects that negatively influence recognition are often observer-related. Observers tend to be judgemental, give unsolicited comments on how they would act themselves and are more concerned with the trainee-supervisor relationship than objective observation. There was less recognition when actors used implicit reasoning, such as mindlines (internalised, collectively reinforced tacit guidelines). Pair-related aspects also played a role: previous discussion of a specific topic or EBM decision-making generally enhanced recognition. Consultation-specific aspects played only a marginal role. Conclusions GP trainees and supervisors do not fully recognise EBM behaviour through observing each other’s consultations. To improve recognition of EBM behaviour and thus benefit from informal observational learning, observers need to be aware of automatic judgements that they make. Creating explicit learning moments in which EBM decision-making is discussed, can improve shared knowledge and can also be useful to unveil tacit knowledge derived from mindlines.

Evidence-Based Decision-Making (Part 1): Origins and Evolution in the Health Sciences

2009 ◽  
Vol 24 (4) ◽  
pp. 298-305 ◽  
Author(s):  
David A. Bradt
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Strategic Decision ◽  
Systematic Research ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Strength Of Evidence ◽  
Based Medicine ◽  
Evidence Based Decision Making

AbstractEvidence is defined as data on which a judgment or conclusion may be based. In the early 1990s, medical clinicians pioneered evidence-based decision-making. The discipline emerged as the use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine required the integration of individual clinical expertise with the best available, external clinical evidence from systematic research and the patient's unique values and circumstances. In this context, evidence acquired a hierarchy of strength based upon the method of data acquisition.Subsequently, evidence-based decision-making expanded throughout the allied health field. In public health, and particularly for populations in crisis, three major data-gathering tools now dominate: (1) rapid health assessments; (2) population based surveys; and (3) disease surveillance. Unfortunately, the strength of evidence obtained by these tools is not easily measured by the grading scales of evidence-based medicine. This is complicated by the many purposes for which evidence can be applied in public health—strategic decision-making, program implementation, monitoring, and evaluation. Different applications have different requirements for strength of evidence as well as different time frames for decision-making. Given the challenges of integrating data from multiple sources that are collected by different methods, public health experts have defined best available evidence as the use of all available sources used to provide relevant inputs for decision-making.

scholarly journals EBP e-Toolkit: Providing a Teaching and Learning Open and Innovative Toolkit for Evidence-Based Practice to Nursing European Curriculum – the second transnational project meeting in Warsaw

2019 ◽  
Vol 18 (3) ◽  
pp. 197-199
Author(s):  
Mariusz Panczyk ◽  
Joanna Gotlib
Keyword(s):  
Clinical Practice ◽  
Nursing Students ◽  
Teaching And Learning ◽  
Research Evidence ◽  
European Federation ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Clinical Decisions ◽  
Learning Tools ◽  
Efficient Option

AbstractIntroduction. Although European healthcare systems differ from country to country, almost all are currently going through profound changes and are becoming increasingly complex. New tasks and growing social expectations towards healthcare build high expectations of medical professionals regarding their competences. Knowledge and skills allowing for choosing the safest and most efficient option for patient care are particularly welcome. The idea of Evidence-based Nursing Practice (EBP) combines the best available research evidence on the one hand and clinical expertise and patients’ expectations on the other, allowing for solving problems in making clinical decisions. EBP is a tool used for making clinical decisions in nursing care that helps to reduce the cost of healthcare by increasing efficiency and safety. Under the Directive 2013/55/EU European Federation of Nurses Associations developed qualifications framework that provides requirements for nursing training, with the ability to apply research evidence in clinical practice being one of its key elements. Despite the aforementioned recommendations, the actual implementation of EBP into clinical practice is hindered by various obstacles. In addition, the existing European resources enhancing EBP teaching for nursing students are very limited.Summary. The EBP e-Toolkit Project is a response to high needs of the academic world and nursing practitioners, involving six institutions whose cooperation and expertise aim to ensure the development and implementation of high-quality learning tools tailored to the educational needs of modern nursing personnel. The six higher education institutions that jointly implement the aforementioned project involve: the University of Murcia (coordinating institution, Spain), Technological Educational Institute of Crete (Greece), University of Modena e Reggio Emilia (Italy), University of Ostrava (Czech Republic), Medical University of Warsaw (Poland), and Angela Boskin Faculty of Health Care (Slovenia).

The Contextual Nature of Critical Care Judgment

1994 ◽  
Vol 9 (2) ◽  
pp. 58-63 ◽  
Author(s):  
Gilbert M. Goldman ◽  
Thyyar M. Ravindranath
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Clinical Practice ◽  
Clinical Judgment ◽  
Retrospective Review ◽  
Medical Decision Making ◽  
Formal Analysis ◽  
Medical Decision ◽  
Time Constraints ◽  
Care Decision

Critical care decision-making involves principles common to all medical decision-making. However, critical care is a remarkably distinctive form of clinical practice and therefore it may be useful to distinguish those elements particularly important or unique to ICU decision-making. The peculiar contextuality of critical care decision-making may be the best example of these elements. If so, attempts to improve our understanding of ICU decision-making may benefit from a formal analysis of its remarkable contextual nature. Four key elements of the context of critical care decisions can be identified: (1) costs, (2) time constraints, (3) the uncertain status of much clinical data, and (4) the continually changing environment of the ICU setting. These 4 elements comprise the context for the practice of clinical judgment in the ICU. The fact that intensivists are severely constrained by teh context of each case has important ramifications both for practice and for retrospective review. During retrospective review, the contextual nature of ICU judgment may be unfairly neglected by ignoring one or more of the key elements. Such neglect can be avoided if intensivists demand empathetic evaluation from reviewers.

Investigating the Role of Data-Driven Decision-Making Within School Improvement Processes

2021 ◽  
pp. 1707-1725
Author(s):  
Venesser Fernandes
Keyword(s):  
Decision Making ◽  
Organizational Change ◽  
School Improvement ◽  
Critical Role ◽  
Data Driven ◽  
Evidence Based ◽  
Data Driven Decision Making ◽  
Continuous School Improvement ◽  
Decision Making Processes

This chapter provides a detailed literature review exploring the importance of data-driven decision-making processes in current Australian school improvement processes within a context of evidence-based organizational change and development. An investigation into the concept of decision-making and its effect on organizational culture is conducted as change and development are considered to be the new constants in the current discourse around continuous school improvement in schools. In a close examination of literature, this chapter investigates how key factors such as collaboration, communication, and organizational trust are achieved through data-driven decision-making within continuous school improvement processes. The critical role of leadership in sustaining data cultures is also examined for its direct impact on continuous school improvement processes based on evidence-based organizational change and development practices. Future implications of data-driven decision-making to sustain continuous school improvement and accountability processes in Australian schools are discussed.

Sign in / Sign up

Export Citation Format

Share Document