Choosing the Best Evidence to Guide Clinical Practice: Application of AACN Levels of Evidence

2014 ◽  
Vol 34 (2) ◽  
pp. 58-68 ◽  
Author(s):  
Mary H. Peterson ◽  
Susan Barnason ◽  
Bill Donnelly ◽  
Kathleen Hill ◽  
Helen Miley ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Nursing Care ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Improve Patient Care ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Levels Of Evidence ◽  
Evidence Based Nursing

Evidence-based nursing care is informed by research findings, clinical expertise, and patients’ values, and its use can improve patients’ outcomes. Use of research evidence in clinical practice is an expected standard of practice for nurses and health care organizations, but numerous barriers exist that create a gap between new knowledge and implementation of that knowledge to improve patient care. To help close that gap, the American Association of Critical-Care Nurses has developed many resources for clinicians, including practice alerts and a hierarchal rating system for levels of evidence. Using the levels of evidence, nurses can determine the strength of research studies, assess the findings, and evaluate the evidence for potential implementation into best practice. Evidence-based nursing care is a lifelong approach to clinical decision making and excellence in practice.

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 Quandaries of Autonomy and Empowerment in Evidence-Based Nursing Care

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Marita Nordhaug
Keyword(s):  
Decision Making ◽  
Nursing Care ◽  
Patient Empowerment ◽  
Professional Autonomy ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Autonomous Choice ◽  
Patient’S Autonomy ◽  
Research Findings ◽  
Evidence Based Nursing

Empowerment and evidence-based practice represent two influential principles in nursing care: that decision-making should be based upon the patient’s autonomous choice, and the most up-to-date research findings, respectively. In this article, patient empowerment is taken to imply a transfer of control and power from the nurse to the patient through communication and care and acknowledging the patient’s perspectives and values. Empowerment-based nursing may thus be central to enhancing a patient’s autonomy. Evidence-based nursing combines up-to-date research findings, the nurse’s clinical expertise and the patient’s preferences. This article concerns some of the potential conflicts these principles may give rise to in everyday deliberations in nursing care. It is argued that patient empowerment and autonomy potentially both have paternalistic connotations. It is also questioned whether an increased emphasis on patient empowerment and autonomy may lead to a risk of diminished professional autonomy.

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.

Clinical Practice Guidelines: What Are They? Where Are They? How Good Are They?

2009 ◽  
Vol 28 (5) ◽  
pp. 343-350 ◽  
Author(s):  
Joan Renaud Smith ◽  
Ann Donze
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Health Care Team ◽  
Decision Making Process ◽  
Evidence Based ◽  
Practice Setting ◽  
Team Members

PREVIOUS COLUMNS HAVE FOCUSED on utilizing evidence-based practice to incorporate the best evidence into clinical practice. This column builds upon that knowledge and describes a specific type of presynthesized evidence meant to guide and inform practice: clinical practice guidelines (CPGs). Clinical practice guidelines have been in existence for years, and their development is based on the desire to move research into practice and promote consistency among practitioners.1 Clinical practice guidelines are tools for health care team members to use to enhance their knowledge and skill in integrating evidence into the clinical decision making process. This column defines CPGs and the significance they have in the practice setting and provides tools and resources necessary to locate, develop, and critically appraise them.

Integrating the Patient and the Clinician With the Research

2016 ◽  
pp. 189-218
Author(s):  
John C. Norcross ◽  
Thomas P. Hogan ◽  
Gerald P. Koocher ◽  
Lauren A. Maggio
Keyword(s):  
Decision Making ◽  
Stages Of Change ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Simple Extrapolation ◽  
Complex Cases

This chapter demonstrates how research is integrated with the two other pillars of evidence-based practice (EBP): clinical expertise and patient characteristics. Research alone never suffices for making clinical decisions, nor does the simple extrapolation of research qualify as EBP. The chapter begins by correcting pernicious myths about EBP and then discusses enlarging clinical decision-making by adding the clinician and the patient into the mix. The chapter describes several ways in which the three pillars of EBP can be integrated and considers what to do when they cannot be integrated, particularly in complex cases. Clinicians will ultimately adopt, adapt, or abandon a research-supported intervention for a specific case. Finally, the chapter reviews the research on being responsive to patients’ transdiagnostic features, such as preferences, stages of change, and culture.

Commentary on Discussion Paper by Miles, A and Mezzich J.E. (2011). Person-centred medicine as an emergent model of clinical practice: The devil is in the details

2014 ◽  
Vol 2 (1) ◽  
pp. 67 ◽  
Author(s):  
Cathy Charles ◽  
Amiram Gafni
Keyword(s):  
Clinical Practice ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Integrated Model ◽  
Current Status ◽  
Evidence Based ◽  
Discussion Paper ◽  
Care Approach ◽  
Patient Values ◽  
Elementary Form

Miles and Mezzich have written a comprehensive review of the origins, development and current status of two influential international movements aimed at shaping the practice of medicine - evidence-based medicine (EBM) and patient-centred care. As the authors point out, these two movements have been largely independent of each other with little crossover of ideas as each pursues its own goals of trying to broaden its influence. Miles and Mezzich propose to take the strengths of both movements and to create a new integrated model of person-centred care (PCC) which is evidence-informed (rather than evidence-based) and incorporates a role for patient values in clinical decision-making. While laudable and logical to try to move forward with this approach which integrates two seemingly contradictory principles underlying each movement (clinical practice based on the findings of clinical research evidence and clinical practice that is responsive to patients’ values, preferences and beliefs), this task is not easy and, as the authors themselves note, the model that results from this process is still in elementary form. By proposing this new integrated model, the authors hope to stimulate further debate on the meaning of a person centred-care approach to medical practice.

Sustainability in changing clinical practice promotes evidence-based nursing care

2003 ◽  
Vol 41 (5) ◽  
pp. 509-518 ◽  
Author(s):  
Lars Wallin ◽  
Anne-Marie Boström ◽  
Karin Wikblad ◽  
Uwe Ewald
Keyword(s):  
Clinical Practice ◽  
Nursing Care ◽  
Evidence Based ◽  
Evidence Based Nursing
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