Evidence-based best practice is more political than it looks: a case study of the 'Scottish Approach'

In 2011/2012 Cardiff Metropolitan University instigated a Student-Led Teaching Fellowship Scheme, which unlike other similar schemes sought to develop joint ownership between the University’s Learning and Teaching Development Unit (LTDU) and the Students’ Union (Cardiffmet SU), providing the opportunity for closer partnership working. Through establishing categories and criteria and developing an evidence-based nomination system the Fellowships have provided the opportunity to develop a shared understanding of both institutional drivers and pedagogic practice and have enabled a larger platform for the dissemination of best practice to both staff and students. In capturing the student voice it has been possible to recognise and evidence what students value and use this in a variety of ways to promote best practice. This case study seeks to demonstrate how the Student-led Teaching Fellowships have and can be used to instigate change within the institution together with identifying remaining challenges and opportunities for future development.

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Clinical audit as a tool to optimize contracted private healthcare provision: Testing the waters in resource-deprived Greece

SAGE Open Medicine ◽

10.1177/2050312119838736 ◽

2019 ◽

Vol 7 ◽

pp. 205031211983873

Author(s):

Kyriakos Souliotis ◽

Christina Golna ◽

Vasiliki Mantzana ◽

Sotirios Papaspyropoulos ◽

Anastasios Koutsovasilis ◽

...

Keyword(s):

Social Insurance ◽

Best Practice ◽

Clinical Audit ◽

Private Insurance ◽

Healthcare Services ◽

Evidence Based ◽

Care Organization ◽

Healthcare Provision ◽

Private Healthcare

Background and Aims: Clinical audit is applied to optimize clinical practice and quality of healthcare services while controlling for money spent, critically in resource-deprived settings. This case study reports on the outcomes of a retrospective clinical audit on private hospitalizations, for which reimbursement had been pending by the Health Care Organization for Public Servants (OPAD) in Greece. This case study is the first effort by a social insurance organization in Greece to employ external clinical audit before settling contracted private healthcare charges. Methods: One thousand two hundred hospitalization records were reviewed retrospectively and a fully anonymized clinical audit summary report created for each one of them by a team of clinical audit experts, proposing evidence-based cuts in pending charges where medical services were deemed clinically unnecessary. These audit reports were then collated and analysed to test trends in overcharges among hospitalized insureds per reason for hospitalization. Results: The clinical audit report concluded that 17.4% of a total reimbursement claim of €12,387,702.18 should not be reimbursed, as it corresponded to unnecessary or not fully justifiable according to evidence-based, best practice, medical service provision. The majority of proposed cuts were related to charges for medical devices, which are borne directly by social insurance with no patient or private insurance co-payment. Conclusion: Clinical audit of hospital practice may be a key tool to optimize care provision, address supplier-induced demand and effectively manage costs for national health insurance, especially in circumstances of budgetary constraints, such as in austerity-stricken settings or developing national healthcare systems.

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Diagnosis, Management and Return to Sport of a 16-year-old Patient with a Chiari I Malformation: A Case Report and Literature Review.

Journal of Athletic Training ◽

10.4085/1062-6050-0001.21 ◽

2021 ◽

Author(s):

MaKenna L. Turk ◽

Kelly Schmidt ◽

Melanie L. McGrath

Keyword(s):

Case Report ◽

Best Practice ◽

Return To Sport ◽

Chiari I Malformation ◽

Athletic Trainer ◽

Evidence Based ◽

Practice Recommendations ◽

Chiari I ◽

Access To Medical Care

This CASE report presents a 16-year-old female volleyball, basketball and track & field athlete who was diagnosed with a Chiari I Malformation following a concussion. Surgical decompression was recommended and performed 3 months following her initial diagnosis. This patient presented unique challenges due to her age, desire to return-to-sport, and the lack of access to medical care due to living in a rural area. There are few evidence-based best-practice recommendations for the management and return-to-sport of Chiari I Malformation patients, particularly for post-surgical Chiari I Malformation cases. This case study discusses the treatment and return-to-sport process for the patient, and also provides a comprehensive review of the published literature on patients attempting to return-to-sport following Chiari I Malformation diagnosis. Additionally, this case report suggests and explores the utilization of an athletic trainer to reconcile various barriers in management and return-to-sport evident in this case and the reviewed literature.

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Evidence-Based Practice Approach Over Three Visits in the Management of a Patient with Tibio-Femoral Osteoarthritis: A Case Study

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2009.1242 ◽

2009 ◽

Author(s):

Sjaan Gomersall ◽

Maureen McEvoy

Keyword(s):

Best Practice ◽

Evidence Based Practice ◽

Research Question ◽

Osteoarthritis Of The Knee ◽

Evidence Based ◽

Future Health ◽

Physiotherapy Student ◽

Future Health Care ◽

Practice Approach

Supervised training is essential for developing an evidence-based practice (EBP) approach for future health care clinicians. While the skills associated with asking a research question, accessing databases for best research evidence (BRE), and appraising this evidence can be taught in the classroom, the day-to-day application into patient management needs to be taught, and there is a lack of best practice models for this. This case study of a patient with osteoarthritis of the knee demonstrates over a series of three clinic visits how EBP can be used as a framework for guiding assessment and management from the perspective of a final year physiotherapy student.

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Use of Evidence in Acute Stroke Decision-Making: Implications for Evidence-Based Medicine

10.22541/au.161860163.36232122/v1 ◽

2021 ◽

Author(s):

Timothe Langlois-Therien ◽

Brian Dewar ◽

Ross Upshur ◽

Michel Shamy

Keyword(s):

Decision Making ◽

Evidence Based Medicine ◽

Best Practice ◽

Medical Decision Making ◽

Medical Decision ◽

Evidence Based ◽

Physician Decision Making ◽

Prescriptive Model ◽

Based Medicine

Evidence-Based Medicine proposes a prescriptive model of physician decision-making in which “best evidence” is used to guide best practice. And yet, proponents of EBM acknowledge that EBM fails to offer a systematic theory of physician decision-making. In this paper, we explore how physicians from the neurology and emergency medicine communities have responded to an evolving body of evidence surrounding the acute treatment of patients with ischemic stroke. Through analysis of this case study, we argue that EBM’s vision of evidence-based medical decision-making fails to appreciate a process that we have termed epistemic evaluation. Namely, physicians are required to interpret and apply any knowledge — even what EBM would term “best evidence” — in light of their own knowledge, background and experience. This is consequential for EBM as understanding what physicians do and why they do it would appear to be essential to achieving optimal practice in accordance with best evidence.

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Impact of policy support on uptake of evidence-based continuous quality improvement activities and the quality of care for Indigenous Australians: a comparative case study

BMJ Open ◽

10.1136/bmjopen-2017-016626 ◽

2017 ◽

Vol 7 (10) ◽

pp. e016626 ◽

Cited By ~ 10

Author(s):

Ross Bailie ◽

Veronica Matthews ◽

Sarah Larkins ◽

Sandra Thompson ◽

Paul Burgess ◽

...

Keyword(s):

Quality Of Care ◽

Best Practice ◽

Healthcare Services ◽

Policy Support ◽

Comparative Case Study ◽

Indigenous Australians ◽

Evidence Based ◽

Continuous Quality

ObjectivesTo examine the impact of state/territory policy support on (1) uptake of evidence-based continuous quality improvement (CQI) activities and (2) quality of care for Indigenous Australians.DesignMixed-method comparative case study methodology, drawing on quality-of-care audit data, documentary evidence of policies and strategies and the experience and insights of stakeholders involved in relevant CQI programmes. We use multilevel linear regression to analyse jurisdictional differences in quality of care.SettingIndigenous primary healthcare services across five states/territories of Australia.Participants175 Indigenous primary healthcare services.InterventionsA range of national and state/territory policy and infrastructure initiatives to support CQI, including support for applied research.Primary and secondary outcome measures(i) Trends in the consistent uptake of evidence-based CQI tools available through a research-based CQI initiative (the Audit and Best Practice in Chronic Disease programme) and (ii) quality of care (as reflected in adherence to best practice guidelines).ResultsProgressive uptake of evidence-based CQI activities and steady improvements or maintenance of high-quality care occurred where there was long-term policy and infrastructure support for CQI. Where support was provided but not sustained there was a rapid rise and subsequent fall in relevant CQI activities.ConclusionsHealth authorities should ensure consistent and sustained policy and infrastructure support for CQI to enable wide-scale and ongoing improvement in quality of care and, subsequently, health outcomes. It is not sufficient for improvement initiatives to rely on local service managers and clinicians, as their efforts are strongly mediated by higher system-level influences.

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Misophonia: An Evidence-Based Case Report

American Journal of Audiology ◽

10.1044/2020_aja-19-00111 ◽

2020 ◽

Vol 29 (4) ◽

pp. 685-690

Author(s):

C. S. Vanaja ◽

Miriam Soni Abigail

Keyword(s):

Quality Of Life ◽

Case Report ◽

Case History ◽

Pure Tone ◽

Physiological Responses ◽

Evidence Based ◽

Management Option ◽

Pure Tone Audiogram

Purpose Misophonia is a sound tolerance disorder condition in certain sounds that trigger intense emotional or physiological responses. While some persons may experience misophonia, a few patients suffer from misophonia. However, there is a dearth of literature on audiological assessment and management of persons with misophonia. The purpose of this report is to discuss the assessment of misophonia and highlight the management option that helped a patient with misophonia. Method A case study of a 26-year-old woman with the complaint of decreased tolerance to specific sounds affecting quality of life is reported. Audiological assessment differentiated misophonia from hyperacusis. Management included retraining counseling as well as desensitization and habituation therapy based on the principles described by P. J. Jastreboff and Jastreboff (2014). A misophonia questionnaire was administered at regular intervals to monitor the effectiveness of therapy. Results A detailed case history and audiological evaluations including pure-tone audiogram and Johnson Hyperacusis Index revealed the presence of misophonia. The patient benefitted from intervention, and the scores of the misophonia questionnaire indicated a decrease in the severity of the problem. Conclusions It is important to differentially diagnose misophonia and hyperacusis in persons with sound tolerance disorders. Retraining counseling as well as desensitization and habituation therapy can help patients who suffer from misophonia.

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Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

American Journal of Audiology ◽

10.1044/2019_aja-18-0156 ◽

2019 ◽

Vol 28 (4) ◽

pp. 877-894

Author(s):

Nur Azyani Amri ◽

Tian Kar Quar ◽

Foong Yen Chong

Keyword(s):

Clinical Practice ◽

Hearing Aids ◽

Best Practice ◽

Hearing Aid ◽

Evidence Based ◽

Future Directions ◽

Major Barrier ◽

Klang Valley ◽

Age Range ◽

Fitting Hearing Aids

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

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The use of the objective structured clinical examination (OSCE) in a practice-based health discipline: Academic and student experience in paramedicine

Health Education in Practice: Journal of Research for Professional Learning ◽

10.33966/hepj.3.2.14225 ◽

2020 ◽

Vol 3 (2) ◽

Author(s):

Andy Bell ◽

Jennifer Kelly ◽

Peter Lewis

Keyword(s):

Clinical Examination ◽

Best Practice ◽

Assessment Tool ◽

Clinical Performance ◽

Reliability And Validity ◽

Specific Area ◽

Training Model ◽

Objective Structured Clinical Examination ◽

Evidence Based ◽

Effective Measure

Abstract:Purpose:Over the past two decades, the discipline of Paramedicine has seen expediential growth as it moved from a work-based training model to that of an autonomous profession grounded in academia. With limited evidence-based literature examining assessment in paramedicine, this paper aims to describe student and academic views on the preference for OSCE as an assessment modality, the sufficiency of pre-OSCE instruction, and whether or not OSCE performance is a perceived indicator of clinical performance.Design/Methods:A voluntary, anonymous survey was conducted to examine the perception of the reliability and validity of the Objective Structured Clinical Examination (OSCE) as an assessment tool by students sitting the examination and the academics that facilitate the assessment. Findings:The results of this study revealed that the more confident the students are in the reliability and validity of the assessment, the more likely they are to perceive the assessment as an effective measure of their clinical performance. The perception of reliability and validity differs when acted upon by additional variables, with the level of anxiety associated with the assessment and the adequacy of feedback of performance cited as major influencers. Research Implications:The findings from this study indicate the need for further paramedicine discipline specific research into assessment methodologies to determine best practice models for high quality assessment.Practical Implications:The development of evidence based best practice guidelines for the assessment of student paramedics should be of the upmost importance to a young, developing profession such as paramedicine.Originality/Value: There is very little research in the discipline specific area of assessment for paramedicine and discipline specific education research is essential for professional growth.Limitations:The principal researcher was a faculty member of one of the institutions surveyed. However, all data was non identifiable at time of data collection. Key WordsParamedic; paramedicine; objective structured clinical examinations; OSCE; education; assessment.

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From Eco-Urbanism to Eco-Fusion: An Augmented Multi-Scalar Framework in Sustainable Urbanism

Sustainability ◽

10.3390/su13042373 ◽

2021 ◽

Vol 13 (4) ◽

pp. 2373

Author(s):

Ali Cheshmehzangi ◽

Andrew Flynn ◽

May Tan-Mullins ◽

Linjun Xie ◽

Wu Deng ◽

...

Keyword(s):

Best Practice ◽

Sustainable Urban Development ◽

Design Strategies ◽

Development Models ◽

Exploratory Case Study ◽

Sustainable Urbanism ◽

Integrated Methods ◽

Practical Factors ◽

Key Terms

This paper introduces the new concept of “eco-fusion” through an exploratory case study project. It suggests the importance of multi-scalar practice in the broader field of eco-urbanism. This study introduces eco-fusion as a multiplexed paradigm, which is then discussed in two different development models. This paper first highlights the position of “eco” in urbanism by providing a brief account of key terms and how they relate to one another. It then points out the associations between eco-fusion and sustainable urban development. Through an exploratory case study example in China, the practical factors of eco-development are assessed. The study aims to provide a set of intermediate development stages while maintaining each spatial level’s interface in their own defined and distinguished contexts. The key objective is to consider integrating the natural and built environments, which is considered the best practice of eco-development in urbanism. This study’s findings highlight integrated methods in eco-urbanism and suggest new directions for eco-planning/eco-design strategies.

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