scholarly journals Therapist perceptions of the Danish Physiotherapy Research Database for assessing patients with chronic disease

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259355
Author(s):  
Peter W. Stubbs ◽  
Henriette H. Stabel ◽  
Nils-Bo de Vos Andersen ◽  
Helle Rønn Smith ◽  
Erhard T. Næss-Schmidt
Keyword(s):  
Chronic Disease ◽  
Online Survey ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Patient Survey ◽  
Attrition Rate ◽  
Future Research ◽  
Research Database ◽  
Chronic Patients ◽  
Specific Assessment

Background The Danish Physiotherapy Research Database for chronic patients receiving Free of Charge Physiotherapy (PhysDB-FCP) was piloted over a 1-year period. The purpose of the PhysDB-FCP is to provide a user friendly digital online structured tool that standardizes initial and follow up clinical assessments generating data that can be used for clinical decision making and support future research in physiotherapy for patients with chronic disease. Although initial assessments were completed, the attrition rate was 73% and 90% at 3- and 6- months, respectively, which suggests problems with the current tool. Objective To evaluate the perspectives of the physiotherapists that used the PhysDB-FCP and propose changes to the tool based on this feedback. Materials and methods Fifty of the 103 physiotherapists introduced to the PhysDB-FCP completed an anonymous online survey. Physiotherapists were asked Likert/categorical and yes/no questions on experiences with the PhysDB-FCP within their practice, perceptions of patient experiences, suitability of the resources and support provided by the PhysDB-FCP working group and the ideal administration frequency of the assessments within the PhysDB-FCP. Open ended feedback on possible improvements to the PhysDB-FCP was also collected. Results Physiotherapists agreed that the PhysDB-FCP was useful for taking a physiotherapy assessment (74%) and the patient survey was useful for goal setting (72%). Although physiotherapists felt the PhysDB-FCP was well-defined (82%), only 36% would like to use a similar tool again. Generally, the PhysDB-FCP was too time-consuming, administered too frequently and included irrelevant items. For example, 72% of physiotherapists took >45 min to administer the assessment in the first consultation which was performed over multiple sessions. Conclusions The perspectives of physiotherapists using The PhysDB-FCP suggest specific changes that will ensure better use of the tool in future practice. Changes will likely involve administering the assessment less frequently (every 6-months to 1-year), shortening the assessment, and using diagnosis-specific assessment items.

scholarly journals Assessing the utility and attitudes toward molecular testing in neuro-oncology: a survey of the Society for Neuro-Oncology members

2021 ◽  
Author(s):  
Shannon Fortin Ensign ◽  
Maya Hrachova ◽  
Susan Chang ◽  
Maciej M Mrugala
Keyword(s):  
Online Survey ◽  
Clinical Decision Making ◽  
Unmet Needs ◽  
Practice Patterns ◽  
Response Rate ◽  
Clinical Decision ◽  
Molecular Testing ◽  
Newly Diagnosed ◽  
Tumor Boards ◽  
Oncology Practice

Abstract Background Molecular testing (MT) is utilized in neuro-oncology with increasing frequency. The aim of this study was to determine clinical practice patterns to acquire this information, interpret and utilize MT for patient care, and identify unmet needs in the practical clinical application of MT. Methods We conducted a voluntary online survey of providers within the Society for Neuro-Oncology (SNO) membership database between March and April 2019. Results We received 152 responses out of 2022 SNO members (7.5% of membership). 88.8% of respondents routinely order MT for newly diagnosed gliomas. Of those who do not, testing is preferentially performed in younger patients or those with midline tumors. 82.8% use MT in recurrent gliomas. Other common indications included: metastatic tumors, meningioma, and medulloblastoma. Many providers utilize more than one resource (36.0%), most frequently using in-house (41.8%) over commercially available panels. 78.1% used the results for clinical decision-making, with BRAF, EGFR, ALK, and H3K27 mutations most commonly directing treatment decisions. Approximately, half (48.5%) of respondents have molecular tumor boards at their institutions. Respondents would like to see SNO-endorsed guidelines on MT, organized lists of targeted agents available for specific mutations, a database of targetable mutations and clinical trials, and more educational programs on MT. Conclusion This survey was marked by several limitations including response rate and interpretation of MT. Among respondents, there is routine use of MT in Neuro-Oncology, however, there remains a need for increased guidance for providers to effectively incorporate the expanding genomic data resulting from MT into daily Neuro-Oncology practice.

scholarly journals Challenges in treatment of renal echinococcosis with gross hydatiduria and unsalvageable kidney: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Sameera Shuaibi ◽  
Abdelrahman AlAshqar ◽  
Munirah Alabdulhadi ◽  
Wasl Al-Adsani
Keyword(s):  
Clinical Decision Making ◽  
Scientific Evidence ◽  
Renal Involvement ◽  
Clinical Decision ◽  
Response To Treatment ◽  
Standards Of Care ◽  
Future Research ◽  
Positive Serology ◽  
Grape Skin

Abstract Introduction Renal echinococcosis is of rare occurrence, and although often asymptomatic, it can present with various mild to drastic presentations, of which hydatiduria is pathognomonic. Diagnosis can be preliminarily established by imaging, and treatment is primarily surgical. We present a patient with renal echinococcosis treated successfully with exclusive antiparasitic pharmacotherapy after refusing surgery despite extensive renal involvement. We hope through this report to help establish future solid guidelines regarding this uncommon therapeutic approach. Case presentation This is a case of a 49-year-old Syrian shepherd presenting with flank pain and passage of grape-skin-like structures in urine. A diagnosis of renal echinococcosis with hydatiduria and significant parenchymal destruction was established based on exposure history, positive serology, imaging findings, and renal scintigraphy. After proper counseling, the patient refused nephrectomy and was therefore started on dual pharmacotherapy (albendazole and praziquantel) and is having an uneventful follow-up and a satisfactory response to treatment. Conclusion This case embodies the daily challenges physicians navigate as they uphold the ethical principles of their practice and support their patients’ autonomy while delivering the best standards of care and consulting the scientific evidence. Although surgery is the cornerstone of renal echinococcosis treatment, treating physicians should be prepared to tackle situations where surgery cannot be done and offer the best next available option for patients who refuse surgery. As data on exclusive pharmacotherapy are limited, future research should thoroughly investigate the efficacy of this uncommon approach and outline reliable recommendations, facilitating future clinical decision-making in this avenue.

Evaluating Diagnostic Tests

1993 ◽  
Vol 7 (2) ◽  
pp. 66-69 ◽  
Author(s):  
C.W. Douglass
Keyword(s):  
Predictive Value ◽  
Diagnostic Tests ◽  
Clinical Decision Making ◽  
New Technologies ◽  
Clinical Decision ◽  
Future Research ◽  
Scientific Support ◽  
Body Of Knowledge ◽  
Efficacy Parameters ◽  
Sensitivity Specificity

The presentations at this conference will discuss new technologies and rapid scientific developments that have resulted in new diagnostic tests for periodontal disease, musculoskeletal imaging, temporomandibular joint dysfunctions, and incipient coronal and root dental caries. However, for many of these claims, there has been insufficient scientific support regarding the sensitivity and specificity of the tests, or their ability to predict the percent of cases in which the disease or condition progresses to the next state of development. Research is needed that will yield the basic diagnostic parameters of new diagnostic tests, i.e., their accuracy, precision, sensitivity, specificity, positive predictive value, and negative predictive value. The purpose and methods for calculating each of these measures are described in this paper. Five questions are then presented that will need to be addressed in future research regarding new diagnostic tests: (1) Does the scientific theory of the test fit with our current body of knowledge? (2) Have the efficacy parameters of the test been reliably determined? (3) How does the test affect clinical decision-making? (4) Does using the test improve the patient's health? and (5) Is the added expense of the test justified by increased effectiveness or by avoiding other health expenditures?

scholarly journals The experiences of family members witnessing the diminishing drinking of a dying relative: An adapted meta-narrative literature review

2019 ◽  
Vol 33 (9) ◽  
pp. 1146-1157 ◽  
Author(s):  
Annie Pettifer ◽  
Katherine Froggatt ◽  
Sean Hughes
Keyword(s):  
Oral Fluid ◽  
Cancer Cachexia ◽  
Clinical Decision Making ◽  
Family Members ◽  
Clinical Decision ◽  
Future Research ◽  
Inclusion Criteria ◽  
Relevant Research ◽  
Narrative Literature ◽  
Narrative Literature Review

Background:Addressing the concerns of family members is an important aspect of palliative and end-of-life care. One aspect that commonly causes family caregivers concern is the decline of patients’ oral fluid intake in the last few days of life.Aim:To map the narratives in which family members’ experiences of witnessing the diminishing drinking of a dying relative have been researched, review the findings within each narrative and consider directions for future research.Design:An adapted meta-narrative review approach.Data Sources:The Cumulative Index of Nursing and Applied Health Literature, Medline, PsycINFO, Psycharticles and Scopus databases were searched for relevant research published between January 1982 and December 2017. Quality was assessed using the Quality Assessment and Review Instrument.Results:A total of 22 papers met the inclusion criteria. No study focused specifically on the experiences of family members when witnessing the diminishing drinking of dying relatives. However, research about diminishing drinking was identified within studies broadly focusing on cancer cachexia, clinical decision-making about hydration and/or nutrition and support in a hospice context. The research indicates that family members’ experiences of diminishing drinking vary with their views about the significance of drinking, dying well and their expectations of themselves and healthcare professionals.Conclusion:While some understanding of the topic can be inferred from research in related areas, there is a paucity of information specifically about family members’ experiences when witnessing the diminishing drinking of a dying relative.

scholarly journals Public views regarding the responsibility of patients, clinicians, and institutions to participate in research in the United States

2019 ◽  
Vol 16 (6) ◽  
pp. 574-579 ◽  
Author(s):  
Kevin P Weinfurt ◽  
Li Lin ◽  
Jeremy Sugarman
Keyword(s):  
Health System ◽  
Online Survey ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The United States ◽  
Robust Learning ◽  
Learning Health System ◽  
English Speaking ◽  
Nationally Representative ◽  
Public Views

Background The need for more and better evidence to inform clinical decision making among all stakeholders has fueled calls for creating learning healthcare systems. The successful realization of a learning healthcare system seems to assume that various parties have a responsibility to participate in learning activities, including research. The objective of this study was to determine whether members of the general public perceive an ethical responsibility to participate in pragmatic clinical research that would be inherent to a learning health system. Methods A total of 2994 English-speaking adults completed a nationally representative online survey. Results About two-thirds of respondents were relatively neutral regarding a responsibility for themselves and others to participate in research; the remainder felt that they and others did not have a responsibility to participate in research. Conclusions Efforts to justify and develop a robust learning health system in an ethically acceptable fashion need to take these findings into account.

scholarly journals Integrated displays to improve chronic disease management in ambulatory care: A SMART on FHIR application informed by mixed-methods user testing

2020 ◽  
Vol 27 (8) ◽  
pp. 1225-1234
Author(s):  
Rebecca L Curran ◽  
Polina V Kukhareva ◽  
Teresa Taft ◽  
Charlene R Weir ◽  
Thomas J Reese ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Chronic Disease ◽  
Disease Management ◽  
Cognitive Load ◽  
Chronic Disease Management ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
User Feedback ◽  
Chronic Obstructive ◽  
Recommended Care

Abstract Objective The study sought to evaluate a novel electronic health record (EHR) add-on application for chronic disease management that uses an integrated display to decrease user cognitive load, improve efficiency, and support clinical decision making. Materials and Methods We designed a chronic disease management application using the technology framework known as SMART on FHIR (Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources). We used mixed methods to obtain user feedback on a prototype to support ambulatory providers managing chronic obstructive pulmonary disease. Each participant managed 2 patient scenarios using the regular EHR with and without access to our prototype in block-randomized order. The primary outcome was the percentage of expert-recommended ideal care tasks completed. Timing, keyboard and mouse use, and participant surveys were also collected. User experiences were captured using a retrospective think-aloud interview analyzed by concept coding. Results With our prototype, the 13 participants completed more recommended care (81% vs 48%; P < .001) and recommended tasks per minute (0.8 vs 0.6; P = .03) over longer sessions (7.0 minutes vs 5.4 minutes; P = .006). Keystrokes per task were lower with the prototype (6 vs 18; P < .001). Qualitative themes elicited included the desire for reliable presentation of information which matches participants’ mental models of disease and for intuitive navigation in order to decrease cognitive load. Discussion Participants completed more recommended care by taking more time when using our prototype. Interviews identified a tension between using the inefficient but familiar EHR vs learning to use our novel prototype. Concept coding of user feedback generated actionable insights. Conclusions Mixed methods can support the design and evaluation of SMART on FHIR EHR add-on applications by enhancing understanding of the user experience.

scholarly journals Awareness of predatory journals and open access among medical oncologists: results of an online survey

ESMO Open ◽  
2019 ◽  
Vol 4 (6) ◽  
pp. e000580 ◽  
Author(s):  
Georg Richtig ◽  
Erika Richtig ◽  
Alexandra Böhm ◽  
Christoph Oing ◽  
Farastuk Bozorgmehr ◽  
...  
Keyword(s):  
Open Access ◽  
Peer Review ◽  
Online Survey ◽  
Clinical Decision Making ◽  
Scientific Practice ◽  
Peer Review Process ◽  
Clinical Decision ◽  
University Hospital ◽  
Predatory Journals ◽  
Number Of Publications

IntroductionPredatory journals harm the integrity of science as principles of ‘good scientific practice’ are bypassed by omitting a proper peer-review process. Therefore, we aimed to explore the awareness of predatory journals among oncologists.MethodsAn online survey among oncologists working in Germany or Austria of various professional surroundings was conducted between October 2018 and April 2019.ResultsOne hundred and eighty-eight participants (55 women (29.2%), 128 men (68.1%)) completed the questionnaire. 41 (21.8%) participants indicated to work in a hospital, 24 (12.8%) in private practice and 112 (59.6%) in a university hospital. 98.9% of participants indicated to actively read scientific articles and consider them in clinical decision-making (96.3%). 90.4% of participants indicated to have scientific experience by publishing papers in journals with peer-review system. The open-access system was known by 170 (90.4%), predatory journals by 131 (69.7%) and Beall’s list by 52 participants (27.7%). Predatory journals were more likely to be known by participants with a higher number of publications (p<0.001), with more high-impact publications (p=0.005) and with recent publications (p<0.001). Awareness of predatory journals did not correlate with gender (p=0.515) or translation of scientific literature into clinical practice (p=0.543).ConclusionsThe problematic topic of ‘predatory journals’ is still unknown by a considerable amount of oncologist, although the survey was taken in a cohort of oncologists with scientific experience. Dedicated educational initiatives are needed to raise awareness of this problem and to aid in the identification of predatory journals for the scientific oncology community.

Nonsuicidal Self-injury: Examining the Relationship Between Diagnosis and Gender

2010 ◽  
Vol 32 (4) ◽  
pp. 324-341 ◽  
Author(s):  
Amanda Healey ◽  
Heather Trepal ◽  
Kelly Emelianchik-Key
Keyword(s):  
Counselor Training ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Future Research ◽  
Counselors In Training ◽  
Counseling Professionals ◽  
Biological Sex ◽  
Normative Expectations ◽  
And Gender ◽  
Societal Expectations

This study examined the perceptions of counselors in training concerning nonsuicidal self-injurious behaviors (NSSI), diagnosis, and the influence of gender-normative expectations on clinical decision making. Participants were asked to respond to a set of questions after reading a randomly assigned case study. The purpose was to determine the process through which counseling professionals diagnosed adolescents who self-injure and whether the sex of the client influenced the decision. Cases presented were identical except that the sex of the client was altered. It appears that societal expectations associated with biological sex may influence counselor diagnostic decisions at the training level. Implications for diagnosis, counselor training, and future research are presented.

scholarly journals Outcomes of an Online Post Professional Doctorate Degree in Occupational Therapy

2012 ◽  
Author(s):  
Joyce Salls ◽  
Ingrid Provident ◽  
Cathy Dolhi
Keyword(s):  
Occupational Therapy ◽  
Online Survey ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Doctorate Degree ◽  
One Year ◽  
Evidence Based Programs ◽  
Practice Skills

Purpose: The purpose of this study was to determine outcomes of a post professional Occupational Therapy Doctorate (OTD) program on graduates’ engagement in evidence-based practice, leadership, and scholarly activities one year post graduation. Method: Thirty graduates of a post professional OTD program completed an online survey addressing evidence-based practice skills, implementation of occupation and evidence-based programs, and participation in leadership and scholarly endeavors. Results: The majority of graduates reported confidence in their evidence-based practice skills and using evidence in clinical decision making. Over half of the respondents reported designing or revising occupation based programs, and all indicated that their OTD education improved their practice skills. Fifty-three percent reported assuming new leadership positions, with one third reporting engagement in scholarly activities since graduation.Conclusion: This research suggests post professional OTD programs have potential to develop practitioners grounded in occupation centered and evidence-based practice who can serve as professional leaders and mentors. Additionally, the results have implications for other allied health disciplines with post professional doctoral programs.

scholarly journals A realist review of brief interventions for alcohol misuse delivered in emergency departments

2021 ◽  
Author(s):  
Caitlin J Davey ◽  
Meredith SH Landy ◽  
Amanda Pecora ◽  
David Quintero ◽  
Kelly E McShane
Keyword(s):  
Alcohol Use ◽  
Emergency Departments ◽  
Clinical Decision Making ◽  
Alcohol Misuse ◽  
Realist Review ◽  
Clinical Decision ◽  
Brief Interventions ◽  
Future Research ◽  
Healthcare Settings ◽  
Favorable Conditions

Background: Brief interventions (BIs) involve screening for alcohol misuse and providing feedback to patients about their use, with the aim of reducing alcohol consumption and related consequences. BIs have been implemented in various healthcare settings, including emergency departments (ED), where they have been found to contribute mixed results in their ability to address alcohol misuse among adults. Mechanisms through which BIs work and contextual factors impacting BI effectiveness are not clear. The purpose of this review was to understand how, for whom, and under what circumstances BIs work for adults misusing alcohol and who have been admitted to an ED. A realist review was chosen to answer these questions as realist reviews create context-mechanism-outcome configurations, leading to the development of comprehensive and detailed theories; in this case explaining how and for whom BIs work. Methods: Databases including PsycINFO, Healthstar, CINAHL, Medline, and Nursing and Allied Health were searched for articles published until December 2013. The search strategy focused on studies examining BIs that targeted alcohol misuse among adults admitted into the ED. The search identified 145 relevant abstracts, of which 36 were included in the review. The literature was synthesized qualitatively (immersion/crystallization). Results: Four mechanisms were found within reviewed studies, including engagement in/retention of BI materials, resolving ambivalence, increased awareness/insight into consequences of drinking, and increased self-efficacy/empowerment to use skills for change. The following contexts were found to impact mechanisms: emotional state, injury attributed to alcohol use, severity of alcohol use, and baseline stage of change. Conclusions: This realist review provides advances in theories regarding which mechanisms to target during a BI and which contexts create the most favorable conditions for these mechanisms to occur, ultimately leading to optimal BI outcomes. These results can inform future clinical decision-making when delivering BIs in ED settings. Future research should conduct quantitative examination to confirm these findings. Systematic review registration: PROSPERO CRD42013006549

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