scholarly journals Increasing Neonatal Healthcare Productivity using Clinical Reasoning Coaching Tools

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Mossad AbdelHak Shaban Mohamed ◽  
Taher Halawa ◽  
Taufiq Hidayat ◽  
Asrar Abu Bakar ◽  
Azamin Anuar ◽  
...  
Keyword(s):  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Research Question ◽  
Control Policy ◽  
Clinical Decision ◽  
Medical Practitioners ◽  
Continuous Contact ◽  
Diagnostic Skills ◽  
Medical Subspecialty ◽  
Diagnostic Thinking

Introduction: Productivity in medical field has inherent value in terms of improving our lives, which can expand our economies. Productivity in medicine has many aspects including improving clinical diagnostic skills, safety, and quality and quantity care. This study will assess whether early exposure to structured clinical reasoning coaching tools would improve their clinical decision making and productivity. Research question: Does clinical reasoning coaching tools Increase neonatal healthcare productivity? Materials and method: Medical practitioners recently joined neonatal units will participate over 2 years in an innovative series of clinical reasoning coaching sessions blended with virtual patients. Practitioners will be exposed to many teaching methods during the neonatal training that includes lectures, bedside teaching sessions and small group discussions beside website continuous contact for learning and chairing skills. Teaching series scope should cover resuscitating sick neonates, handling ventilators either conventional or high frequency, practicing common neonatal procedures, dealing with common neonatal scenarios, infection control policy and, effective communication skills The evaluation sessions will be introduced at the beginning of their training, during the course and at the end of the clerkship to assess their improving productivity, using diagnostic thinking inventory(DTI). Selection of the medical practitioners will be based on either on stratified random sampling or cohort control depending on the funding and logistic. All items will be analysed advanced statistical analysis methods. Results: The coaching tool may yield dramatic impact, allowing the innovators to be more productive. Suggesting widely utilize it for nurses, undergraduate and postgraduate medical Subspecialty. Conclusion: The research hypothesis is assuming that DTI scores and productivity will be higher after the coaching sessions as rated by the candidate’s performance.

Supporting the Development of Clinical Reasoning of Preprofessional Novices in Dysphagia Management

2019 ◽  
Vol 40 (03) ◽  
pp. 151-161 ◽  
Author(s):  
Sebastian Doeltgen ◽  
Stacie Attrill ◽  
Joanne Murray
Keyword(s):  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Management Practice ◽  
Clinical Decision ◽  
Assessment Process ◽  
Evidence Based ◽  
Sources Of Information ◽  
Multiple Sources ◽  
Implicit Processing ◽  
Reasoning Skills

AbstractProficient clinical reasoning is a critical skill in high-quality, evidence-based management of swallowing impairment (dysphagia). Clinical reasoning in this area of practice is a cognitively complex process, as it requires synthesis of multiple sources of information that are generated during a thorough, evidence-based assessment process and which are moderated by the patient's individual situations, including their social and demographic circumstances, comorbidities, or other health concerns. A growing body of health and medical literature demonstrates that clinical reasoning skills develop with increasing exposure to clinical cases and that the approaches to clinical reasoning differ between novices and experts. It appears that it is not the amount of knowledge held, but the way it is used, that distinguishes a novice from an experienced clinician. In this article, we review the roles of explicit and implicit processing as well as illness scripts in clinical decision making across the continuum of medical expertise and discuss how they relate to the clinical management of swallowing impairment. We also reflect on how this literature may inform educational curricula that support SLP students in developing preclinical reasoning skills that facilitate their transition to early clinical practice. Specifically, we discuss the role of case-based curricula to assist students to develop a meta-cognitive awareness of the different approaches to clinical reasoning, their own capabilities and preferences, and how and when to apply these in dysphagia management practice.

Transducer-based comparisons of the prosthetic feet used by transtibial amputees for different walking activities: a pilot study

2012 ◽  
Vol 36 (2) ◽  
pp. 203-216 ◽  
Author(s):  
Edward Schreiber Neumann ◽  
Kartheek Yalamanchili ◽  
Justin Brink ◽  
Joon S Lee
Keyword(s):  
Clinical Decision Making ◽  
Research Question ◽  
Case Series ◽  
Clinical Decision ◽  
Residual Limb ◽  
Convenience Sample ◽  
Loading Patterns ◽  
Prosthetic Feet ◽  
Transtibial Amputees ◽  
Resultant Forces

Background: Knowledge of transtibial residual limb force and moment loading during gait can be clinically useful. The research question was whether a transducer attached between the socket and pylon can be used to detect differences in loading patterns created by prosthetic feet of different design and different walking activities in real-world environments outside the gait lab. Objectives: To develop methods for obtaining, processing, analyzing and interpreting transducer measurements and examining their clinical usefulness. Study Design: Case series design. Methods: A convenience sample of four K3-K4 transtibial amputees and a wireless tri-axial transducer mounted distal to the socket. Activities included self-selected comfortable speed walking, and ascending and descending ramps and steps. Measurements taken about three orthogonal axes were processed to produce plots of normalized resultant force versus normalized resultant moment. Within-subject differences in peak resultant forces and moments were tested. Results: Loading patterns between feet and subjects and among the activities were distinctly different. Optimal loading of peak resultant forces tentatively might occur around 25% and 69% to73% of stance during self-selected comfortable walking. Ascending and descending ramps is useful for examining heel and forefoot response. Conclusions: Force-moment plots obtained from transducer data may assist clinical decision making. Clinical relevance A pylon-mounted transducer distal to the socket reveals the moments and forces transmitted to the residual limb and can be used to evaluate the loading patterns on the residual limb associated with different foot designs and different everyday activities outside the gait lab.

scholarly journals The PICO strategy for the research question construction and evidence search

2007 ◽  
Vol 15 (3) ◽  
pp. 508-511 ◽  
Author(s):  
Cristina Mamédio da Costa Santos ◽  
Cibele Andrucioli de Mattos Pimenta ◽  
Moacyr Roberto Cuce Nobre
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Scientific Evidence ◽  
Research Question ◽  
Clinical Decision ◽  
Evidence Based ◽  
Review Of The Literature

Evidence based practice is the use of the best scientific evidence to support the clinical decision making. The identification of the best evidence requires the construction of an appropriate research question and review of the literature. This article describes the use of the PICO strategy for the construction of the research question and bibliographical search.

Leveraging Key Aspects of Collaborative Techniques to Assist Clinical Decisions

2017 ◽  
pp. 440-456
Author(s):  
Hoda Moghimi ◽  
Jonathan L. Schaffer ◽  
Nilmini Wickramasinghe
Keyword(s):  
Decision Making ◽  
Information Technologies ◽  
Clinical Decision Making ◽  
Research Question ◽  
Clinical Decision ◽  
Detection Model ◽  
Important Approach ◽  
Hip And Knee Arthroplasty ◽  
Expected Benefits ◽  
Key Aspects

Employing collaborative systems in healthcare contexts is an important approach towards designing and developing intelligent computer solutions. The objective of this study is to develop a real-time collaborative system using the Intelligent Risk Detection Model (IRD) to improve decision efficiency for the care of patients undergoing hip and knee arthroplasty (THA, TKA). Expected benefits include increasing awareness, supporting communication, improving decision making processes and also improving information sharing between surgeons, patients, families and consultants as key collaborative parties. The research question under investigation is: How can key information technologies be designed, developed and adopted to support clinical decision making in the context of THA and TKA? This research in progress has identified the value and benefit of developing a systematic and technology supported tool to facilitate the identification of various risks associated with THA and TKA.

Affective Aspects of Clinical Reasoning: Their Importance in Assessment of Behavioral Diagnoses in Medical Patients

1984 ◽  
Vol 55 (1) ◽  
pp. 143-149 ◽  
Author(s):  
Donna B. Greenberg ◽  
Sherman Eisenthal ◽  
John D. Stoeckle
Keyword(s):  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Diagnostic Testing ◽  
Clinical Decision ◽  
Severe Illness ◽  
Probabilistic Logic ◽  
Junior Resident ◽  
Medical Patients ◽  
Office Visits ◽  
Medical Problems

Physicians' expectations of patients' behavior are de facto aspects of clinical reasoning. Yet, for the most part, these aspects are not included in the modern paradigm of clinical decision making, which presumes that physicians should decide only on a normative probabilistic logic. If diagnostic cues are equivocal, physicians are more likely to be affected by the doctor-patient encounter from which they derive their expectations about patients' compliance. Affective aspects of clinical reasoning are particularly important in evaluation of behavioral diagnoses which are often equivocal. Physicians' reasoning about patients' compliance with diagnostic testing and medical treatment was studied by questionnaires completed at the end of the office visits. The physicians' expectations of testing compliance were associated with a high percent of significant medical problems, more severe illness, younger patients, and junior resident staff. The expectation of non-compliance with treatment was associated with a lower percent of significant medical problems, discomfort in talking to the patient, and a behavioral diagnosis. Physicians were more comfortable talking to sicker patients who had significant medical problems. We conclude that physicians expect patients to behave pragmatically, complying with testing and treatment if their problems are serious and treatable. When physicians are uncomfortable with patients because the patients have problems which are deemed less medically significant, more equivocal, or because of the patients' personalities, physicians are more likely to expect that the patient will not take treatment.

Clinical Reasoning: A State of the Science Report

2018 ◽  
Vol 15 (1) ◽  
Author(s):  
Amy Golden Holder
Keyword(s):  
Clinical Reasoning ◽  
Cognitive Process ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Future Research ◽  
Client Care ◽  
Current State ◽  
Process Understanding ◽  
Information Center ◽  
State Of The Science

AbstractClinical reasoning is the cognitive process that nurses use to gather and incorporate information into a larger bank of personal knowledge. This incorporated information guides therapeutic actions, and helps determine client care. Since the process guides therapeutic actions regarding client care, failure to use the process effectively leads to poor clinical decision-making, inappropriate actions, or inaction. Because of the criticality of this process, this paper presents an analysis of the literature that reveals the current state of the science of clinical reasoning, identifies gaps in knowledge, and elucidates areas for future research. A systematic review of the databases the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Educational Resources Information Center (ERIC), PsychInfo, the Education Full Text (H.W. Wilson), and PubMed revealed 873 articles on the topic of clinical reasoning. Quality appraisal narrowed the field to 27 pieces of literature. Appendix A gives the State of the Science Coding Sheet used to identify the selections used in this research. Appendix B contains a summary of this literature. Although analysis of this literature shows that three theories exist on how to utilize most effectively the clinical reasoning process presently; a clear consistent definition is lacking. Additional research should focus on closing gaps that exist in defining the process, understanding the process, establishing linkages to non-clinical reasoning processes, and developing measures to both develop and accurately measure clinical reasoning.

Comprehensive On-site Medical and Public Health Training for Local Medical Practitioners in a Refugee Setting

2013 ◽  
Vol 7 (1) ◽  
pp. 82-88 ◽  
Author(s):  
Ramin Asgary ◽  
Karen Jacobson
Keyword(s):  
Public Health ◽  
Clinical Decision Making ◽  
Health Workers ◽  
Medical Personnel ◽  
Clinical Decision ◽  
Medical Providers ◽  
Medical Practitioners ◽  
Use Of Resources ◽  
Public Health Training ◽  
Site Training

AbstractObjectivesIn refugee settings, local medical personnel manage a broad range of health problems but commonly lack proper skills and training, which contributes to inefficient use of resources. To fill that gap, we designed, implemented, and evaluated a curriculum for a comprehensive on-site training for medical providers.MethodsThe comprehensive teaching curriculum provided ongoing on-site training for medical providers (4 physicians, 7 medical officers, 15 nurses and nurse aids, and 30 community health workers) in a sub-Saharan refugee camp. The curriculum included didactic sessions, inpatient and outpatient practice-based teaching, and case-based discussions, which included clinical topics, refugee public health, and organizational skills. The usefulness and efficacy of the training were evaluated through pretraining and posttraining tests, anonymous self-assessment surveys, focus group discussions, and direct clinical observation.ResultsPhysicians had a 50% (95% CI 17%-82%; range, 25%-75%) improvement in knowledge and skills. They rated the quality and usefulness of lectures 4.75 and practice-based teaching 5.0 on a 5-point scale (1=poor to 5=excellent). Evaluation of medical officers’ knowledge revealed improvements in (1) overall test scores (52% [SD 8%] to 80% [SD 5%]; P < .0001); (2) pediatric infectious diseases (44% [SD 9%] to 79% [SD 7%]; P < .001); and (3) noninfectious diseases (57% [SD 16%] to 81% [SD 10%] P < .01). Main barriers to effective learning were lack of training prioritization, time constraints, and limited ancillary support.ConclusionsA long-term, ongoing training curriculum for medical providers initiated by aid agencies but integrated into horizontal peer-to-peer education is feasible and effective in refugee settings. Such programs need prioritizing, practice and system-based personnel training, and a comprehensive curriculum to improve clinical decision making.(Disaster Med Public Health Preparedness. 2013;7:82-88)

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