Challenges to Evidence-Based Prescribing in Clinical Practice

2008 ◽  
Vol 42 (5) ◽  
pp. 704-707 ◽  
Author(s):  
Muhammad Mamdani ◽  
Andrew Ching ◽  
Brian Golden ◽  
Magda Melo ◽  
Ulrich Menzefricke
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Patient Preferences ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Competing Demands ◽  
Drug Policies ◽  
Clinical Conditions ◽  
Based Medicine

Although there appears to be widespread support of evidence-based medicine as a basis for rational prescribing, the challenges to it are signilicant and often justified. A multitude of factors other than evidence drive clinical decision-making, including patient preferences and social circumstances, presence of diseasedrug and drug-drug interactions, clinical experience, competing demands from more pressing clinical conditions, marketing and promotional activity, and systemlevel drug policies.

Clinical outcome assessment in mental health

2018 ◽  
pp. 191-200
Author(s):  
Skye P. Barbic ◽  
Stefan J. Cano
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Outcome ◽  
Outcome Assessment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Measurement Issues ◽  
Health Disorders ◽  
Based Medicine

Clinical outcome assessment (COA) in mental health is essential to inform patient-centred care and clinical decision-making. In this chapter, the reader is introduced to COA as it is evolving in the field of mental health. Multiple approaches to COA are presented, but emphasis is placed on approaches that generate clinically meaningful data. Understanding COA can position clinicians and stakeholders to better evaluate their own practice and to contribute to the ongoing evolution of COA research and evidence-based medicine. This chapter begins with the definitions of assessment and measurement. Conceptual frameworks and models of COA development and testing are then presented. These are followed by a discussion of measurement in practice that reviews measurement issues related to clinical decision-making, programme evaluation, and clinical trials. Finally, this chapter highlights the contribution of metrology to improving health outcomes of individuals who experience mental health disorders.

The ‘Number Needed to Treat’ and the ‘Adjusted NNT’ in Health Care Decision-Making

1998 ◽  
Vol 3 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Jack Dowie
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Population Based ◽  
Number Needed To Treat ◽  
Evidence Based ◽  
Based Medicine

Within ‘evidence-based medicine and health care’ the ‘number needed to treat’ (NNT) has been promoted as the most clinically useful measure of the effectiveness of interventions as established by research. Is the NNT, in either its simple or adjusted form, ‘easily understood’, ‘intuitively meaningful’, ‘clinically useful’ and likely to bring about the substantial improvements in patient care and public health envisaged by those who recommend its use? The key evidence against the NNT is the consistent format effect revealed in studies that present respondents with mathematically-equivalent statements regarding trial results. Problems of understanding aside, trying to overcome the limitations of the simple (major adverse event) NNT by adding an equivalent measure for harm (‘number needed to harm’ NNH) means the NNT loses its key claim to be a single yardstick. Integration of the NNT and NNH, and attempts to take into account the wider consequences of treatment options, can be attempted by either a ‘clinical judgement’ or an analytical route. The former means abandoning the explicit and rigorous transparency urged in evidence-based medicine. The attempt to produce an ‘adjusted’ NNT by an analytical approach has succeeded, but the procedure involves carrying out a prior decision analysis. The calculation of an adjusted NNT from that analysis is a redundant extra step, the only action necessary being comparison of the results for each option and determination of the optimal one. The adjusted NNT has no role in clinical decision-making, defined as requiring patient utilities, because the latter are measurable only on an interval scale and cannot be transformed into a ratio measure (which the adjusted NNT is implied to be). In any case, the NNT always represents the intrusion of population-based reasoning into clinical decision-making.

scholarly journals Reframing Perceptions in Restorative Dentistry: Evidence-Based Dentistry and Clinical Decision-Making

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Ayah A Al-Asmar ◽  
Ahmad S Al-Hiyasat ◽  
Motasum Abu-Awwad ◽  
Hakam N Mousa ◽  
Nesreen A Salim ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Root Canal ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Root Canal Treatment ◽  
Evidence Based ◽  
Dental Practice ◽  
Restorative Dentistry ◽  
Evidence Based Dentistry

Objectives. The worldwide interest of both dentists and patients in esthetic dentistry has affected decision-making in dental practice. The aim of this study was to investigate contemporary dental practice in restorative dentistry and the relationship between evidence-based dentistry in caries research and decision-making in clinical practice in restorative dentistry. Methods. The study was conducted through a structured questionnaire distributed randomly at the Jordanian Dental Association registered dentists in Jordan. The questionnaire aimed to clarify the degree of knowledge and practice of evidence-based dentistry in caries research the dentists hold regarding clinical decision-making in restorative dentistry. Results. The majority of the surveyed dentists (77%) treat teeth with irreversible pulpitis with root canal treatment rather than vital pulp therapy. 13.8% routinely insert a post and 23% routinely crown the tooth after root canal treatment regardless of the remaining tooth structure. Badly damaged teeth are treated with full crowns in 72% of the cases. Regarding Hollywood smile or smile makeover, the majority of dentists choose conservative approaches, and implants were the first choice to replace missing teeth for 93.8% of the surveyed dentists. Conclusion. A higher degree of implementation of evidence-based dentistry in clinical decision-making was found in Prosthetic Dentistry than in Endodontics. Yet, the gap between evidence-based data and clinical practice needs bridging. More emphasis on communicating these data to educators to integrate them into the dental curriculum is a must.

scholarly journals Desenvolvimento e Avaliação de uma Plataforma Colaborativa Digital para Educação e Tomada de Decisão Médica Baseada em Evidências

2019 ◽  
Vol 43 (1 suppl 1) ◽  
pp. 513-524
Author(s):  
Álisson Oliveira dos Santos ◽  
Alexandre Sztajnberg ◽  
Tales Mota Machado ◽  
Daniel Magalhães Nobre ◽  
Adriano Neves de Paula e Souza ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Real Life ◽  
Evaluation Process ◽  
Clinical Decision ◽  
Medical Decision ◽  
Alternative Form ◽  
Evidence Based ◽  
Life Problems

ABSTRACT The medical education for clinical decision-making has undergone changes in recent years. Previously supported by printed material, problem solving in clinical practice has recently been aided by digital tools known as summaries platforms. Doctors and medical students have been using such tools from questions found in practice scenarios. These platforms have the advantage of high-quality, evidence-based and always up-to-date content. Its popularization was mainly due to the rise of the internet use and, more recently, of mobile devices such as tablets and smartphones, facilitating their use in clinical practice. Despite this platform is widely available, the most of them actually present several access barriers as costs, foreign language and not be able to Brazilian epidemiology. A free national platform of evidence-based medical summaries was proposed, using the crowdsourcing concept to resolve those barriers. Furthermore, concepts of gamification and content evaluation were implemented. Also, there is the possibility of evaluation by the users, who assigns note for each content created. The platform was built with modern technological tools and made available for web and mobile application. After development, an evaluation process was conducted by researchers to attest to the valid of content, usability, and user satisfying. Consolidated questionnaires and evaluation tools by the literature were applied. The process of developing the digital platform fostered interdisciplinarity, from the involvement of medical and information technology professionals. The work also allowed the reflection on the innovative educational processes, in which the learning from real life problems and the construction of knowledge in a collaborative way are integrated. The assessment results suggest that platform can be real alternative form the evidence-based medical decision-making.

scholarly journals Progress in Clinical Neurosciences: Evidence Based Care in the Neurosciences

2002 ◽  
Vol 29 (2) ◽  
pp. 115-119 ◽  
Author(s):  
Samuel Wiebe ◽  
Bart Demaerschalk
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Ease Of Use ◽  
Evidence Based ◽  
Content Accessibility ◽  
Evidence Based Care

Abstract:We examine the relevance of Evidence Based Care (EBC) to the field of clinical neurosciences, with particular emphasis on feasible methods of implementing EBC in clinical practice. By using pre-appraised EBC summaries, busy clinicians can move toward EBC without engaging in the laborious process of searching and critically appraising the literature. After reviewing the neurological content, accessibility and ease of use of current sources of EBC summaries, we find them substantially lacking in coverage of the neurosciences, and therefore of limited use to clinicians in this field. We emphasize a particular type of EBC summary, the critically appraised topic, and comment on its usefulness and limitations as a tool to assist clinical decision-making in the neurosciences. Finally, we propose that a collection of easily accessible, good quality, peer reviewed critically appraised topics, covering a breadth of relevant topics, is a reasonable way of moving toward EBC in the clinical neurosciences.

scholarly journals 28 How is Postpartum Depression Currently Diagnosed and Managed? Insights from a Virtual Patient Simulation

CNS Spectrums ◽  
2019 ◽  
Vol 24 (1) ◽  
pp. 189-190
Author(s):  
Jovana Lubarda ◽  
Martin Warters ◽  
Piyali Chatterjee ◽  
Marlene P. Freeman ◽  
Roger S. McIntyre
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Postpartum Depression ◽  
Clinical Decision Making ◽  
Patient Simulation ◽  
Clinical Decision ◽  
Virtual Patient ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Practice Gaps

AbstractObjectivesThe goal of this study was to determine physician performance in diagnosis and management of postpartum depression (PPD) and to provide needed education in the consequence free environment of a virtual patient simulation (VPS).Methods∙ A continuing medical education activity was delivered via an online VPS learning platform that offers a lifelike clinical care experience with complete freedom of choice in clinical decision-making and expert personalized feedback to address learner’s practice gaps∙ Physicians including psychiatrists, primary care physicians (PCPs), and obstetricians/gynecologists (ob/gyns) were presented with two cases of PPD designed to model the experience of actual practice by including use of electronic health records∙ Following virtual interactions with patients, physicians were asked to make decisions regarding assessments, diagnoses, and pharmacologic therapies. The clinical decisions were analyzed using a sophisticated decision engine, and clinical guidance (CG) based on current evidence-based recommendations was provided in response to learners’ clinical decisions∙ Impact of the education was measured by comparing participant decisions pre- and post-CG using a 2-tailed, paired t-test; P <.05 was considered statistically significant∙ The activity launched on Medscape Education on April 26, 2018, and data were collected through to June 17,2018.Results∙ From pre- to post-CG in the simulation, physicians were more likely to make evidence-based clinical decisions related to:∙ Ordering appropriate baseline tests including tools/scales to screen for PPD: in case 1, psychiatrists (n=624) improved from 34% to 42% on average (P<.05); PCPs (n=197) improved from 38% to 48% on average (P<.05); and, ob/gyns (n=216) improved from 30% to 38% on average (P<.05)∙ Diagnosing moderate-to-severe PPD: in case 2, psychiatrists (n=531) improved from 46% to 62% (P<.05); PCPs (n=154) improved from 43% to 55% (P<.05); and, ob/gyns (n=137) improved from 55% to 73% (P<.05)∙ Ordering appropriate treatments for moderate-to-severe PPD such as selective serotonin-reuptake inhibitors: in case 2, psychiatrists (n=531) improved from 47% CG to 75% (P<.05); PCPs (n=154) improved from 55% to 74% (P<.05); and, ob/gyns (n=137) improved from 51% to 78% (P<.05)∙ Interestingly, a small percentage of physicians (average of 5%) chose investigational agents for PPD which were in clinical trials pre-CG, and this increased to an average of 9% post-CGConclusionsPhysicians who participated in VPS-based education significantly improved their clinical decision-making in PPD, particularly in selection of validated screening tools/scales, diagnosis, and pharmacologic treatments based on severity. Given that VPS immerses physicians in an authentic, practical learning experience matching the scope of clinical practice, this type of intervention can be used to determine clinical practice gaps and translate knowledge into practice.Funding Acknowledgements: The educational activity and outcomes measurement were funded through an independent educational grant from Sage Therapeutics, Inc.

scholarly journals A sociodental approach in prosthodontic treatment decision making

2004 ◽  
Vol 12 (2) ◽  
pp. 127-132 ◽  
Author(s):  
Cláudio Rodrigues Leles ◽  
Maria do Carmo Matias Freire
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Treatment Decision ◽  
Clinical Decision ◽  
Decision Making Process ◽  
Evidence Based ◽  
Critical Problem ◽  
Practice Model ◽  
Treatment Decision Making

A critical problem in the decision making process for dental prosthodontic treatment is the lack of reliable clinical parameters. This review discusses the limits of traditional normative treatment and presents guidelines for clinical decision making. There is a need to incorporate a sociodental approach to help determine patient's needs. Adoption of the evidence-based clinical practice model is also needed to assure safe and effective clinical practice in prosthetic dentistry.

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