scholarly journals Transgender adolescents and genital-alignment surgery: Is age restriction justified?

2019 ◽  
Vol 14 (2) ◽  
pp. 94-103
Author(s):  
Edmund Horowicz
Keyword(s):  
Young People ◽  
Clinical Guidelines ◽  
Gender Dysphoria ◽  
Evidence Base ◽  
Cultural Norms ◽  
Evidence Based ◽  
Professional Issues ◽  
Standards Of Evidence ◽  
Current Concerns ◽  
Evidence Based Care

In the case of controversial interventions there is a need for clinical guidelines to be founded on ‘expert opinion’ and an evidence base, in order to minimise individual clinicians making subjective decisions influenced by bias or cultural norms. This paper considers international clinical guidelines that through recommendation effectively prohibit the provision of genital-alignment surgery for competent adolescents with gender dysphoria. I argue that although the rationale for this particular guideline is based on serious concerns, these need to be better understood to allow reconsideration of this unilateral prohibitive recommendation. I do not propose that genital-alignment surgery should be prima-facia provided for any adolescent with gender dysphoria. Instead I argue that by developing our understanding of the current concerns, we can allow guidelines to incorporate a margin of clinical discretion, to allow clinicians to provide genital-alignment surgery to some adolescents, where clinically appropriate. In facilitating this we can move towards establishing a solid evidence-base. The basis of this position is that clinical guidelines and medical practice should treat these young people with the same standards of evidence-based care as others who have less controversial conditions. Whilst this paper uses English law and UK professional regulation for context, many of the ethical, legal and professional issues highlighted are applicable to other jurisdictions.

scholarly journals Positive Choices: Addressing the evidence-practice gap in alcohol and other drug prevention

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Nepal ◽  
L Stapinski ◽  
N Newton ◽  
L Grummitt ◽  
S Lawler ◽  
...  
Keyword(s):  
Young People ◽  
Primary Source ◽  
Evidence Base ◽  
Drug Prevention ◽  
Evidence Based ◽  
Drug Education ◽  
Health Issues ◽  
Prevention Strategies ◽  
Response Strategies ◽  
Practice Gap

Abstract Issue Alcohol and other drug (AOD) use during adolescence puts young people at risk of juvenile offending, poor educational outcomes, school dropout, and mental health issues. Since parents and school teachers are the primary source of contact for adolescents, it is important that they are equipped with accurate and up-to-date response strategies. There are a number of effective drug prevention strategies, however, they are not widely implemented. Description of the practice To address this evidence-practice gap, the Positive Choices initiative was launched in 2015. Positive Choices supports implementation of evidence-based and prevention strategies through provision of training and a centralised information and resources portal for young people, their parents and teachers. The portal contains information factsheets and webinars and was developed in consultation with AOD experts and target users. Drug education resources and curriculum programs meeting pre-specified criteria for relevance, quality and evidence-base are listed in the resources database. Results Positive Choices has been accessed by one-million Australian and international users. The most popular resources are videos, factsheets, webinars. In 2019, 71% parents and 65% teachers said that they would continue using the website. Half (54%) of school staff were not currently implementing evidence-based prevention strategies, of these 89% intended to shift to evidence-based practice after using Positive Choices. The majority of the users have said they would recommend the website to their colleagues and friends. Lessons Positive Choices is effective in changing users' intentions to implement evidence-based strategies. Drug education programs need to engage parents and teachers if they are to be effective. Key messages Positive Choices has increased users’ awareness of evidence-based prevention strategies. Positive Choices has increased users’ intentions to implement evidence-based prevention strategies.

scholarly journals Alternative medicine under the Mental Health Care Act, 2017: Future implications and concerns

2022 ◽  
Vol 07 (01) ◽  
pp. 37-41
Author(s):  
Ramdas Ransing ◽  
Sujita Kumar Kar ◽  
Vikas Menon
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Alternative Medicine ◽  
Mental Healthcare ◽  
Evidence Base ◽  
Evidence Based ◽  
Insufficient Evidence ◽  
Indian Government ◽  
Evidence Based Care

In recent years, the Indian government has been promoting healthcare with an insufficient evidence base, or which is non-evidence-based, alongside delivery of evidence-based care by untrained practitioners, through supportive legislation and guidelines. The Mental Health Care Act, 2017, is a unique example of a law endorsing such practices. In this paper, we aim to highlight the positive and negative implications of such practices for the delivery of good quality mental healthcare in India.

scholarly journals Respiratory clinical guidelines inform ward-based nurses’ clinical skills and knowledge required for evidence-based care

Breathe ◽  
2016 ◽  
Vol 12 (3) ◽  
pp. 257-266 ◽  
Author(s):  
Alisha M. Johnson ◽  
Sheree M.S. Smith
Keyword(s):  
Common Core ◽  
Clinical Guidelines ◽  
Clinical Skills ◽  
Technical Skills ◽  
Evidence Based ◽  
Core Knowledge ◽  
Optimal Care ◽  
Knowledge And Skills ◽  
The Core ◽  
Evidence Based Care

Respiratory clinical guidelines provide clinicians with evidence-based guidance for practice. Clinical guidelines also provide an opportunity to identify the knowledge and technical and non-technical skills required by respiratory ward-based registered nurses. The aim of this review was to use a systematic process to establish the core technical and non-technical skills and knowledge identified in evidence-based clinical guidelines that enable the care of hospitalised adult respiratory patients.17 guidelines were identified in our systematic review. The quality assessment demonstrated variability in these guidelines. Common core knowledge and technical and non-technical skills were identified. These include pathophysiology, understanding of physiological measurements and monitoring, education, counselling, and ward and patient management.The knowledge and skills extracted from respiratory clinical guidelines may inform a curriculum for ward-based respiratory nursing to ensure optimal care of adult patients.

scholarly journals Management of obesity in Scotland: development of the latest evidence-based recommendations

2010 ◽  
Vol 69 (2) ◽  
pp. 195-198 ◽  
Author(s):  
J. Thompson
Keyword(s):  
Young People ◽  
Clinical Excellence ◽  
Evidence Base ◽  
Evidence Based ◽  
Healthy Weight ◽  
Guideline Adaptation ◽  
Lifestyle Measures ◽  
Scottish Government ◽  
Clinical Conditions ◽  
The Cost

The problem of obesity in Scotland has reached epidemic proportions and this reality is recognised at Scottish Government level. The financial impact of treating obesity and obesity-related disease is substantial and in Scotland the cost was estimated at £171×106 in 2001 but only a small proportion of this estimate included weight-loss interventions. The Scottish Intercollegiate Guidelines Network (SIGN) define clinical guidelines as ‘systematically developed statements to help practitioner and patient decisions’ that ‘provide recommendations for effective practice in the management of clinical conditions where variations in practice are known to occur and where effective care may be known not to occur’. The evidence base for successful interventions has progressed since the publication by SIGN of Obesity in Scotland: Integrating Prevention with Weight Management in 1996 and Management of Obesity in Children and Young People in 2003. In 2007 SIGN commissioned a review of these two publications. In 2006 the National Institute for Health and Clinical Excellence (NICE) published a comprehensive obesity guideline and to avoid duplication of effort SIGN used the ADAPTE guideline adaptation framework to utilise and update evidence tables produced by NICE (where appropriate) as a basis for considered judgement. The new SIGN guideline is due for publication in 2010 and addresses children, young people (<18 years old) and adults. It will provide evidence-based recommendations on primary prevention of obesity (defined as intervention when individuals are at a healthy weight and/or overweight to prevent or delay the onset of obesity) within the clinical setting and treatment by lifestyle measures, drugs and surgery.

scholarly journals Optimising real time clinical librarian support to enhance the evidence base in radiotherapy clinical protocols

2020 ◽  
Vol 43 (127) ◽  
Author(s):  
Carol-Ann Regan ◽  
Simon Goldsworthy ◽  
Jessica Pawley
Keyword(s):  
Real Time ◽  
Quality Function Deployment ◽  
Evidence Base ◽  
Evidence Based ◽  
Clinical Protocol ◽  
Optimal Outcomes ◽  
Percentage Difference ◽  
Novel Approach ◽  
Clinical Radiotherapy ◽  
Evidence Based Care

Clinical teams are professionally driven to adopt the latest evidence-based care ensuring optimal outcomes for patients. There can be delays in the latest evidence reaching practice. The radiotherapy multi-professional team in partnership with Clinical Librarians developed a lean process to undertake the real-time evidence-based live update of clinical radiotherapy protocols. Principles of Quality Function Deployment were deployed to create a lean process. The process was evaluated for the percentage difference to the radiotherapy protocol parameters over two years. Satisfaction of the live update was scored from 1: Very dissatisfied to 5: Very satisfied. Since 2014, 12 protocols have been through the process. The live update resulted in 80% of differences to the clinical protocol compared to the previous two years. Among 10 respondents, a mode of 5 was scored for satisfaction. This novel approach has been successful in providing a lean process ensuring that the latest evidence reaches radiotherapy practice.

scholarly journals Enabling practitioners working with young people who self-harm

2015 ◽  
Vol 10 (4) ◽  
pp. 268-280 ◽  
Author(s):  
Celeste Foster ◽  
Lynsey Birch ◽  
Shelly Allen ◽  
Gillian Rayner
Keyword(s):  
Mental Health ◽  
Higher Education ◽  
Young People ◽  
Workforce Development ◽  
Clinical Guidelines ◽  
Development Project ◽  
Evidence Based ◽  
Consultation Process ◽  
Content Type ◽  
Self Harm

Purpose – The purpose of this paper is to outline a UK-based interdisciplinary workforce development project that had the aim of improving service delivery for children and young people who self-harm or are feeling suicidal. Design/methodology/approach – This innovative practice-higher-education partnership utilised an iterative consultation process to establish the local workforce need and then facilitated the systematic synthesis and presentation of evidence-based clinical guidelines in a practical format, for staff working directly with young people who self-harm in non-mental health settings. Findings – The development, content and structure of this contextualised resource is presented, along with emerging outcomes and learning from the team. It is anticipated that this may also be a useful strategy and resource for other teams in other areas and is intended to provide a template that can be adapted by other localities to meet the specific needs of their own workforce. Practical implications – The paper demonstrates how higher education-practice partnerships can make clinical guidelines and research evidence in a field often thought of as highly specialist, accessible to all staff. It also shows a process of liaison and enhanced understanding across universal/specialist mental health service thresholds. Originality/value – This paper demonstrates how collaborative partnerships can work to bridge the gap between evidence-based guidelines and their implementation in practice, through innovative multi-agency initiatives.

scholarly journals Building the evidence base for waterpipe regulation and policy

2019 ◽  
Vol 29 (Suppl 2) ◽  
pp. s59-s61 ◽  
Author(s):  
Wasim Maziak ◽  
Eva Sharma
Keyword(s):  
Young People ◽  
Health Risks ◽  
Evidence Base ◽  
Evidence Based ◽  
Toxic Substances ◽  
Waterpipe Smoking ◽  
Special Issue ◽  
The Us ◽  
The Usa ◽  
Smoking Patterns

Waterpipe (hookah, shisha, narghileh) smoking is emerging as an epidemic, particularly among young people in the USA and globally. Unlike cigarettes, waterpipe smoking involves several components (eg, tobacco, charcoal, device and venues) and is characterised by unique smoking patterns that expose smokers to significant amounts of nicotine and other toxic substances. With the rising prevalence of use among young people and continuing misperceptions about waterpipe’s harmful nature, a better understanding of health risks associated with waterpipe smoking is warranted. In response to waterpipe’s rising trends, a Deeming Rule that extended the US Food and Drug Administration’s (FDA) regulatory authority to all tobacco products was issued in 2016. This rule includes waterpipe tobacco, components and parts. This development created the need for evidence to guide the FDA into best evidence-based strategies to limit waterpipe’s spread among young people and harm to public health. This special issue presents some of the studies that were funded under the ‘Chemistry, Toxicology, and Addiction Research on Waterpipe Tobacco’ programme to inform promising regulatory action on waterpipe products. In this preamble, we briefly summarise findings from these studies and discusses their policy and regulatory implications for different waterpipe products and components.

scholarly journals Informatics, evidence-based care, and research; implications for national policy: a report of an American Medical Informatics Association health policy conference

2010 ◽  
Vol 17 (2) ◽  
pp. 115-123 ◽  
Author(s):  
Meryl Bloomrosen ◽  
Don E Detmer
Keyword(s):  
Health Policy ◽  
American Medical ◽  
Medical Informatics ◽  
Health Informatics ◽  
National Policy ◽  
Evidence Base ◽  
Evidence Based ◽  
Health Records ◽  
American Medical Informatics Association ◽  
Evidence Based Care

Abstract There is an increased level of activity in the biomedical and health informatics world (e-prescribing, electronic health records, personal health records) that, in the near future, will yield a wealth of available data that we can exploit meaningfully to strengthen knowledge building and evidence creation, and ultimately improve clinical and preventive care. The American Medical Informatics Association (AMIA) 2008 Health Policy Conference was convened to focus and propel discussions about informatics-enabled evidence-based care, clinical research, and knowledge management. Conference participants explored the potential of informatics tools and technologies to improve the evidence base on which providers and patients can draw to diagnose and treat health problems. The paper presents a model of an evidence continuum that is dynamic, collaborative, and powered by health informatics technologies. The conference's findings are described, and recommendations on terminology harmonization, facilitation of the evidence continuum in a “wired” world, development and dissemination of clinical practice guidelines and other knowledge support strategies, and the role of diverse stakeholders in the generation and adoption of evidence are presented.

scholarly journals What are Specialist Mental Health Clinician Attitudes to Guideline Recommendations for the Treatment of Depression in Young People?

2011 ◽  
Vol 45 (11) ◽  
pp. 993-1001 ◽  
Author(s):  
Sarah E. Hetrick ◽  
Magenta Simmons ◽  
Andrew Thompson ◽  
Alexandra G. Parker
Keyword(s):  
Mental Health ◽  
Young People ◽  
Focus Groups ◽  
Clinical Excellence ◽  
Evidence Base ◽  
Service Level ◽  
Social Constructionist ◽  
Evidence Based ◽  
Complex Disorders ◽  
Individual Clinician

Objectives: We sought to examine potential barriers to the use of evidence-based guidelines for youth depression in a tertiary specialist mental health service, as part of an initiative to implement evidence based practice within the service. Methods: This was a qualitative study adopting a social constructionist perspective using focus groups. The focus groups, conducted with all clinicians (medical and allied health), were audiotaped, transcribed and thematic analysis was undertaken. Clinicians were asked about the barriers to implementing four key recommendations from the National Institute for Health and Clinical Excellence (NICE) guidelines. Results: Barriers existed at (i) the individual clinician level; (ii) the clinical level in terms of the presentation of young people; and (iii) the service level. The key individual clinician level barrier was a stated belief that the guidelines were not relevant to the young people presenting to the service, with little evidence to guide practice. Related, the main barrier with regard to the clinical presentation was the severity and complexity of this presentation, often making the delivery of interventions like cognitive behavioural therapy (CBT) difficult. At the service level, a lack of integration with primary and secondary level care meant sequencing interventions according to guideline recommendations was difficult. Conclusions: There is a clear imperative to develop the evidence base to ensure that effective treatments for young people aged up to 25 years with severe and complex disorders that include comorbid conditions, suicide risk and psychosocial difficulties are investigated and disseminated. Furthermore, this work has highlighted the need for greater investment in models of care that ensure integration between existing primary and secondary care and enhanced specialist early intervention mental health services for young people.

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