scholarly journals Consensus for a primary care clinical decision-making tool for assessing, diagnosing, and managing shoulder pain in Alberta, Canada

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Breda H. F. Eubank ◽  
Sebastian W. Lackey ◽  
Mel Slomp ◽  
Jason R. Werle ◽  
Colleen Kuntze ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shoulder Pain ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Rapid Review ◽  
Diagnosis And Management ◽  
Joint Health ◽  
Decision Making Tool

Abstract Background Shoulder pain is a highly prevalent condition and a significant cause of morbidity and functional disability. Current data suggests that many patients presenting with shoulder pain at the primary care level are not receiving high quality care. Primary care decision-making is complex and has the potential to influence the quality of care provided and patient outcomes. The aim of this study was to develop a clinical decision-making tool that standardizes care and minimizes uncertainty in assessment, diagnosis, and management. Methods First a rapid review was conducted to identify existing tools and evidence that could support a comprehensive clinical decision-making tool for shoulder pain. Secondly, provincial consensus was established for the assessment, diagnosis, and management of patients presenting to primary care with shoulder pain in Alberta, Canada using a three-step modified Delphi approach. This project was a highly collaborative effort between Alberta Health Services’ Bone and Joint Health Strategic Clinical Network (BJH SCN) and the Alberta Bone and Joint Health Institute (ABJHI). Results A clinical decision-making tool for shoulder pain was developed and reached consensus by a province-wide expert panel representing various health disciplines and geographical regions. This tool consists of a clinical examination algorithm for assessing, diagnosis, and managing shoulder pain; recommendations for history-taking and identification of red flags or additional concerns; recommendations for physical examination and neurological screening; recommendations for the differential diagnosis; and care pathways for managing patients presenting with rotator cuff disease, biceps pathology, superior labral tear, adhesive capsulitis, osteoarthritis, and instability. Conclusions This clinical decision-making tool will help to standardize care, provide guidance on the diagnosis and management of shoulder pain, and assist in clinical decision-making for primary care providers in both public and private sectors.

scholarly journals A Comparison of Physicians' and Nurse Practitioners' Use of Race in Clinical Decision-Making

2019 ◽  
Vol 29 (1) ◽  
pp. 1-8
Author(s):  
Khadijah E. Abdallah ◽  
Kathleen A. Calzone ◽  
Jean F. Jenkins ◽  
Melissa E. Moss ◽  
Sherrill L. Sellers ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Decision Making ◽  
Genetic Variation ◽  
Nurse Practitioners ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Care Providers ◽  
General Internal

Objective: The debate over use of race as a proxy for genetic risk of disease continues, but little is known about how primary care providers (nurse practitioners and general internal medicine physicians) currently use race in their clinical practice. Our study in­vestigates primary care providers’ use of race in clinical practice.Methods: Survey data from three cross-sectional parent studies were used. A total of 178 nurse practitioners (NPs) and 759 general internal medicine physicians were included. The outcome of interest was the Racial At­tributes in Clinical Evaluation (RACE) scale, which measures explicit use of race in clinical decision-making. Predictor variables included the Genetic Variation Knowledge Assessment Index (GKAI), which measures the providers’ knowledge of human genetic variation.Results: In the final multivariable model, NPs had an average RACE score that was 1.60 points higher than the physicians’ score (P=.03). The GKAI score was not significantly associated with the RACE outcome in the final model (P=.67).Conclusions: Physicians had more knowl­edge of genetic variation and used patients’ race less in the clinical decision-making process than NPs. We speculate that these differences may be related to differences in discipline-specific clinical training and approaches to clinical care. Further explora­tion of these differences is needed, including examination of physicians’ and NPs’ beliefs about race, how they use race in disease screening and treatment, and if the use of race is contributing to health care dispari­ties.Ethn Dis.2019;29(1):1-8; doi:10.18865/ ed.29.1.1.

scholarly journals A stepwise approach to implementing pharmacogenetic testing in the primary care setting

2019 ◽  
Vol 20 (15) ◽  
pp. 1103-1112 ◽  
Author(s):  
Kristin Wiisanen Weitzel ◽  
Benjamin Q Duong ◽  
Meghan J Arwood ◽  
Aniwaa Owusu-Obeng ◽  
Noura S Abul-Husn ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Test Results ◽  
Implementation Barriers ◽  
Pharmacogenetic Testing ◽  
Stepwise Approach ◽  
Test Ordering

Pharmacogenetic testing can help identify primary care patients at increased risk for medication toxicity, poor response or treatment failure and inform drug therapy. While testing availability is increasing, providers are unprepared to routinely use pharmacogenetic testing for clinical decision-making. Practice-based resources are needed to overcome implementation barriers for pharmacogenetic testing in primary care.The NHGRI’s IGNITE I Network (Implementing GeNomics In pracTicE; www.ignite-genomics.org ) explored practice models, challenges and implementation barriers for clinical pharmacogenomics. Based on these experiences, we present a stepwise approach pharmacogenetic testing in primary care: patient identification; pharmacogenetic test ordering; interpretation and application of test results, and patient education. We present clinical factors to consider, test-ordering processes and resources, and provide guidance to apply test results and counsel patients. Practice-based resources such as this stepwise approach to clinical decision-making are important resources to equip primary care providers to use pharmacogenetic testing.

scholarly journals Nottingham Prognostic Index Plus (NPI+): a modern clinical decision making tool in breast cancer

2014 ◽  
Vol 110 (7) ◽  
pp. 1688-1697 ◽  
Author(s):  
E A Rakha ◽  
D Soria ◽  
A R Green ◽  
C Lemetre ◽  
D G Powe ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Prognostic Index ◽  
Clinical Decision ◽  
Nottingham Prognostic Index ◽  
Decision Making Tool

Nuclear scans: A clinical decision making tool that reduces the need for cardiac catheterization

1987 ◽  
Vol 40 (5) ◽  
pp. 385-397 ◽  
Author(s):  
Sylvia Wassertheil-Smoller ◽  
Richard M. Steingart ◽  
John P. Wexler ◽  
Jonathan Tobin ◽  
Nancy Budner ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Catheterization ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Decision Making Tool

scholarly journals Clinical decision making in the provision of audiovisual care for upper limb trauma: a survey of UK experiences

Hand Therapy ◽  
2020 ◽  
pp. 175899832097213
Author(s):  
Emily McMullen ◽  
Megan Robson ◽  
Mark Paul Brewin ◽  
Poonam Valand ◽  
Leela Sayed ◽  
...  
Keyword(s):  
Decision Making ◽  
Upper Limb ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Service Planning ◽  
Cross Sectional Survey ◽  
Visual Technology ◽  
Limb Trauma ◽  
The Uk ◽  
Decision Making Tool

Introduction For many patients, audio-visual appointments have provided a timely and efficient way of seeking advice, assessment and treatment for their hand injuries during the NHS response to COVID-19. This study aimed to explore the experience of hand units across the UK in determining the safe and judicious use of audio-visual outpatient care for the management of acute upper limb trauma. Methods An online cross-sectional survey was sent to the therapy leads of hand units across the UK. Questions focused on the experience of using audio-visual technology in the management of upper limb trauma, and the relevant factors in determining its appropriate use. A deductive mixed methods analysis was used to identify both common themes and capture community experience and characteristics. Results A total of 51 out of 76 hand therapy units completed the survey; a response rate of 67%. Of these, 82% (42/51) reported using audio-visual technology to manage upper limb trauma during the UK COVID-19 lockdown. When determining patient suitability for audio-visual consultations, 73% (37/51) of respondents reported the use of COVID-19 guidelines, but only 35% (18/51) reported the use of a clinical decision-making tool. In agreement with our experience at Salisbury Hospital Foundation Trust, 92% (47/51) had concerns relating to the use of audio-visual care. Conclusion The choice of safely managed remote care or in-person consultation has, to date, largely relied on the discretion of the clinician. A carefully designed clinical decision-making tool for the management of upper limb trauma is needed for use both in clinical practice and in future service planning.

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