scholarly journals Informed consent, duty of disclosure and chiropractic: where are we?

2020 ◽  
Vol 28 (1) ◽  
Author(s):  
J. Keith Simpson ◽  
Stanley Innes
Keyword(s):  
Informed Consent ◽  
Clinical Decision Making ◽  
Spinal Manipulative Therapy ◽  
Continuing Professional Development ◽  
Professional Associations ◽  
Clinical Decision ◽  
Evidence Base ◽  
Best Interests ◽  
Health Practitioner ◽  
Vertebral Subluxation

Abstract Background The COVID-19 pandemic has seen the emergence of unsubstantiated claims by vertebral subluxation-based chiropractors that spinal manipulative therapy has a role to play in prevention by enhancing the body’s immune function. We contend that these claims are unprofessional and demonstrate a disturbing lack of insight into the doctrine of informed consent. As such it is timely to review how informed consent has evolved and continues to do so and also to discuss the attendant implications for contemporary health practitioner practice. We review the origins of informed consent and trace the duty of disclosure and materiality through landmark medical consent cases in four common law (case law) jurisdictions. The duty of disclosure has evolved from a patriarchal exercise to one in which patient autonomy in clinical decision making is paramount. Passing time has seen the duty of disclosure evolve to include non-medical aspects that may influence the delivery of care. We argue that a patient cannot provide valid informed consent for the removal of vertebral subluxation. Further, vertebral subluxation care cannot meet code of conduct standards because it lacks an evidence base and is practitioner-centered. The uptake of the expanded duty of disclosure has been slow and incomplete by practitioners and regulators. The expanded duty of disclosure has implications, both educative and punitive for regulators, chiropractic educators and professional associations. We discuss how practitioners and regulators can be informed by other sources such as consumer law. For regulators, reviewing and updating informed consent requirements is required. For practitioners it may necessitate disclosure of health status, conflict of interest when recommending “inhouse” products, recency of training after attending continuing professional development, practice patterns, personal interests and disciplinary findings. Conclusion Ultimately such matters are informed by the deliberations of the courts. It is our opinion that the duty of a mature profession to critically self-evaluate and respond in the best interests of the patient before these matters arrive in court.

scholarly journals Right Care, First Time: Developing a Theory-Based Automated Protocol to Help Clinically Stage Young People Based on Severity and Persistence of Mental Illness

2021 ◽  
Vol 9 ◽  
Author(s):  
Frank Iorfino ◽  
Vanessa Wan Sze Cheng ◽  
Shane P. Cross ◽  
Hannah F. Yee ◽  
Tracey A. Davenport ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Information Technologies ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Base ◽  
Clinical Staging ◽  
Health Information Technologies ◽  
Staging Model ◽  
Automated Protocol ◽  
First Time

Most mental disorders emerge before the age of 25 years and, if left untreated, have the potential to lead to considerable lifetime burden of disease. Many services struggle to manage high demand and have difficulty matching individuals to timely interventions due to the heterogeneity of disorders. The technological implementation of clinical staging for youth mental health may assist the early detection and treatment of mental disorders. We describe the development of a theory-based automated protocol to facilitate the initial clinical staging process, its intended use, and strategies for protocol validation and refinement. The automated clinical staging protocol leverages the clinical validation and evidence base of the staging model to improve its standardization, scalability, and utility by deploying it using Health Information Technologies (HIT). Its use has the potential to enhance clinical decision-making and transform existing care pathways, but further validation and evaluation of the tool in real-world settings is needed.

Integrating research and evidence-based guidance into prescribing practice

2021 ◽  
Vol 3 (3) ◽  
pp. 120-123
Author(s):  
Adam Bedson
Keyword(s):  
Decision Making ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Primary Source ◽  
Clinical Decision ◽  
Evidence Base ◽  
Evidence Based ◽  
Multiple Sources ◽  
Prescribing Practice ◽  
Critical Appraisal Skills

The College of Paramedics and the Royal Pharmaceutical Society are clear that they require advanced paramedics, as non-medical prescribers, to review and critically appraise the evidence base underpinning their prescribing practice. Evidence-based clinical guidance such as that published by the National Institute for Health and Care Excellence (NICE) is recommended as the primary source of evidence on which paramedics should base their prescribing decisions. NICE guidance reflects the best available evidence on which to base clinical decision-making. However, paramedics still need to critically appraise the evidence underpinning their prescribing, applying expertise and decision-making skills to inform their clinical reasoning. This is achieved by synthesising information from multiple sources to make appropriate, evidence-based judgments and diagnoses. This first article in the prescribing paramedic pharmacology series considers the importance of evidence-based paramedic prescribing, alongside a range of tools that can be used to develop and apply critical appraisal skills to support prescribing decision-making. These include critical appraisal check lists and research reporting tools

scholarly journals Green walking groups: A mixed-methods review of the mental health outcomes for adults with mental health problems

2019 ◽  
Vol 83 (3) ◽  
pp. 162-171
Author(s):  
Tom Swinson ◽  
Jennifer Wenborn ◽  
Paul Sugarhood
Keyword(s):  
Mental Health ◽  
Mixed Methods ◽  
Health Outcomes ◽  
Clinical Decision Making ◽  
Mental Health Problems ◽  
Clinical Decision ◽  
Evidence Base ◽  
Health Problems ◽  
Mental Health Outcomes ◽  
Natural Environments

Introduction Evidence suggests group walking in natural environments is more beneficial to the general population’s mental health than walking indoors, in urban environments, and alone. Such ‘green walking groups’ have been suggested as an occupational therapy intervention that could be suitable for adults with mental health problems. However, there have been no reviews of the mental health outcomes of participating in green walking groups for this population. Method A mixed-methods literature review was conducted. A range of databases was systematically searched electronically. Papers that met pre-defined inclusion criteria were selected, critically appraised, and qualitative and quantitative data were extracted. Thematic analysis was used to identify key qualitative outcomes. Findings Six papers were included and eight mental health outcomes identified. The evidence suggests participants can experience connections with other people, connections with nature, and a sense of freedom. There is some limited evidence to support improvements to mood, self-esteem, reflection on life tasks, and symptoms of depression, with mixed evidence for experiencing a sense of achievement. Conclusion This review can be used to build the evidence base for the link between occupation and mental health, and inform the clinical decision-making of occupational therapists, who are well-placed to design and implement green walking groups.

Management of severe stifle trauma: 2. Periarticular fractures

2019 ◽  
Vol 21 (7) ◽  
pp. 633-644
Author(s):  
Alessandro Conte ◽  
Elena Addison
Keyword(s):  
Clinical Decision Making ◽  
Proximal Tibia ◽  
Clinical Decision ◽  
Evidence Base ◽  
Deciduous Teeth ◽  
Published Data ◽  
Close Attention ◽  
Stifle Joint ◽  
Pin Fixation ◽  
Adult Cats

Practical relevance: Periarticular stifle fractures are uncommon but challenging injuries to treat. There may be concurrent damage to the ligaments and stabilising structures of the stifle joint itself, which should also be evaluated (see Part 1 of this article series). Improved knowledge of the fixation options and biomechanical challenges of these injuries will aid clinical decision-making and effective repair. Clinical challenges: Due to their nature, periarticular fractures may have small juxta-articular fragments, which require additional thought to address during stabilisation. In juvenile animals, these fractures typically involve the physis and often can be managed with cross pin fixation. In adult cats, locking fixation, specialised plates or external skeletal fixators can be utilised to address the juxta-articular fragments. Readers should also be aware of patellar fracture and dental anomaly syndrome (PADS), where cats develop insufficiency fractures affecting the patella and proximal tibia. A careful oral examination should be performed in affected patients, as these cats may have persistent deciduous teeth. Close attention should be paid to preoperative radiographs for evidence of chronicity of the injury including sclerosis of the patella, remodelling and blunting of the fracture lines. Aims: The aims of the article are to review the current literature surrounding periarticular fractures of the stifle joint and to summarise the diagnosis, treatment, outcome and complications of each fracture type. As well as discussing general fracture fixation and biomechanical principles applicable to both dogs and cats, information is provided on specific issues facing cats, such as PADS. Evidence base: Published data is limited, with reports including only a small number of cats. The information and recommendations in this article have therefore been drawn from a combination of the available literature and the authors’ clinical experience.

How to Decide Whether to Offer and Use “Nonstandard” Therapies in Patients with Advanced Sarcomas and Gastrointestinal Stromal Tumors: Global Variations in Clinical Practice, Assessment, and Access to Therapies in Diseases with Limited Incidence and Data

2012 ◽  
pp. 645-650 ◽  
Author(s):  
Stefan Sleijfer ◽  
Ian Judson ◽  
George D. Demetri
Keyword(s):  
Clinical Practice ◽  
Rare Diseases ◽  
Clinical Benefit ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Base ◽  
Stromal Tumors ◽  
Appropriate Care ◽  
Social Interests ◽  
Practice Assessment

Overview: As cancer is more generally recognized as a collection of various rare diseases rather than a homogeneous illness, sarcomas have become a model for the manner in which data can and cannot be used to drive clinical decision making. In this article, we explore the limitations of data generated in rare diseases such as sarcomas to provide an evidence base for clinical practice. How should patients be treated if there is no “standard” that offers “proof” of clinical benefit? By asking this question, we also raise the issue of what constitutes “clinical benefit”—and how to measure that—for patients with sarcomas and other rare diseases. As physicians become more accountable for decisions—and yet are always accountable to the patients and families who rely on them to provide the best and most appropriate care—oncologists must be cognizant of the limitations of data in rare diseases and be ready to justify actions that are in the best medical and social interests of patients.

Integrating research and evidence-based guidance into prescribing practice

2021 ◽  
Vol 13 (1) ◽  
pp. 10-13
Author(s):  
Adam Bedson
Keyword(s):  
Decision Making ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Primary Source ◽  
Clinical Decision ◽  
Evidence Base ◽  
Evidence Based ◽  
Multiple Sources ◽  
Prescribing Practice ◽  
Critical Appraisal Skills

The College of Paramedics and the Royal Pharmaceutical Society are clear that they require advanced paramedics, as non-medical prescribers, to review and critically appraise the evidence base underpinning their prescribing practice. Evidence-based clinical guidance such as that published by the National Institute for Health and Care Excellence (NICE) is recommended as the primary source of evidence on which paramedics should base their prescribing decisions. NICE guidance reflects the best available evidence on which to base clinical decision-making. However, paramedics still need to critically appraise the evidence underpinning their prescribing, applying expertise and decision-making skills to inform their clinical reasoning. This is achieved by synthesising information from multiple sources to make appropriate, evidence-based judgments and diagnoses. This first article in the prescribing paramedic pharmacology series considers the importance of evidence-based paramedic prescribing, alongside a range of tools that can be used to develop and apply critical appraisal skills to support prescribing decision-making. These include critical appraisal checklists and research reporting tools.

scholarly journals Developing supervisory competence: preliminary data on the impact of CBT supervision training

2012 ◽  
Vol 5 (4) ◽  
pp. 83-92 ◽  
Author(s):  
Katherine Newman Taylor ◽  
Kenneth Gordon ◽  
Simon Grist ◽  
Charlotte Olding
Keyword(s):  
Clinical Supervision ◽  
Repeated Measures ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Base ◽  
Preliminary Evaluation ◽  
Repeated Measures Design ◽  
Supervision Training ◽  
Psychological Therapies ◽  
The Impact

AbstractClinical supervision is key to the delivery and governance of effective psychological work. We place increasing emphasis on the evidence base in our clinical decision making, and yet there is no comparable body of information to inform our supervisory practice. This is a serious problem for psychological therapists; there is an urgent need for theoretically driven and empirically evaluated approaches to supervision, and the training of such skills. This preliminary evaluation examined the impact of a 5-day training designed for Improving Access to Psychological Therapies (IAPT) supervisors new to the role. A within-subject, repeated-measures design was used to compare self-assessed supervision competencies over the course of training. Twenty-eight IAPT supervisors completed 5 days’ training based on the Supervision Competencies Framework and IAPT Supervision Guidance. Significant improvements were found in ratings of generic, specific, applied and meta-supervision competencies, as well as overall competency. This evaluation gives preliminary support for the impact of training on supervisory competencies. There are clear limitations, particularly the lack of objective measures and comparison training. Nevertheless, in the context of a very limited evidence base to date, the study contributes to a more robust approach to developing supervisory competence in clinical practice.

Pharmacological management of acute severe behavioural disturbance: a survey of current protocols

2017 ◽  
Vol 25 (4) ◽  
pp. 395-398 ◽  
Author(s):  
Nick O’Connor ◽  
John Corish
Keyword(s):  
Clinical Decision Making ◽  
Relevant Literature ◽  
Clinical Decision ◽  
Evidence Base ◽  
Clinical Knowledge ◽  
Behavioural Disturbance ◽  
Treatment Protocols ◽  
Pharmacological Management ◽  
New Evidence ◽  
Careful Assessment

Objectives: The investigators reviewed protocols for the pharmacological management of acute severe behavioural disturbance (ASBD) used in Australasian psychiatric settings. Relevant literature was also examined, with a focus on Australian research. Methods: All Fellows of the RANZCP were emailed on two occasions in 2014 requesting a copy of the guidelines for pharmacological management of the ASBD patient used in their workplace. A literature search was also undertaken. Results: Thirty-six pharmacological management protocols for the ASBD patient were received. Twenty-six of these referred to patients aged 18–65 years and were selected for analysis. A number of recent publications provided new evidence in relation to the safe and effective management of patients with ASBD. Conclusions: ASBD is a heterogeneous, transnosological set of presentations requiring careful assessment and rational clinical decision making. Treatment protocols arising from an evolving evidence base provide safe and effective pathways for the majority of patients. However, sound clinical knowledge and a careful assessment of each presentation is required to enable the clinician to tailor treatment individually.

How Do Physical Therapists Approach Management of People With Early Knee Osteoarthritis? A Qualitative Study

2019 ◽  
Vol 100 (2) ◽  
pp. 295-306 ◽  
Author(s):  
Crystal MacKay ◽  
Gillian A Hawker ◽  
Susan B Jaglal
Keyword(s):  
Knee Osteoarthritis ◽  
Weight Management ◽  
Clinical Decision Making ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Continuing Professional Development ◽  
Clinical Decision ◽  
Therapeutic Interventions ◽  
Evidence Based ◽  
Knee Oa

Abstract Background Knee osteoarthritis (OA) is a leading cause of disability. There is increasing emphasis on initiating treatment earlier in the disease. Physical therapists are central to the management of OA through the delivery of exercise programs. There is a paucity of research on physical therapists’ perceptions and clinical behaviors related to early knee OA management. Objective The study aimed to explore how physical therapists approached management of early knee OA, with a focus on evidence-based strategies. This is an important first step to begin to optimize care by physical therapists for this population. Design We used a qualitative, descriptive research design. Methods Semistructured interviews were conducted with 33 physical therapists working with people with knee symptoms and/or diagnosed knee OA in community or outpatient settings in Canada. Data were analyzed using thematic analysis. Results Five main themes were constructed: (1) Physical therapists’ experience and training: clinical experiences and continuing professional development informed clinical decision-making. (2) Tailoring treatment from the physical therapist “toolbox:” participants described their toolbox of therapeutic interventions, highlighting the importance of tailoring treatments to people. (3) The central role of exercise and physical activity in management: exercise was consistently recommended by participants. (4) Variability in support for weight management: there was variation related to how participants addressed weight management. (5) Facilitating “buy-in” to management: physical therapists used a range of strategies to gain “buy-in.” Limitations Participants were recruited through a professional association specializing in orthopedic physical therapy and worked an average of 21 years. Conclusions Participants’ accounts emphasized tailoring of interventions, particularly exercises, which is an evidence-based strategy for OA. Findings illuminated variations in management that warrant further exploration to optimize early intervention (eg, weight management, behavior change techniques).

Sign in / Sign up

Export Citation Format

Share Document