scholarly journals The Quality of Evidence-Based Morning Reports with an Interactive and Consultative Approach in the Viewpoint of Clinical Faculties and Residents: A Qualitative Study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Saeideh Daryazadeh ◽  
Payman Adibi
Keyword(s):  
Qualitative Study ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Educational Interventions ◽  
Influential Factors ◽  
Faculty Members ◽  
Evidence Based ◽  
Structured Interviews ◽  
Quality Of Evidence

Background: Morning reports are important training programs (especially for residents) as they enhance clinical decision-making skills, social interactions, and participatory learning. Given the need to eliminate the educational gap and provide optimal conditions, educational interventions regarding morning reports are often implemented in the form of evidence-based morning reports with an interactive and consultative approach. Objectives: The present study aimed to evaluate the quality of evidence-based morning reports using an interactive and consultative approach. Methods: This qualitative study was conducted with an inductive approach in 2019 in Iran. Changes were made to develop an evidence-based morning report and create a friendly educational environment between faculty members and residents, as well as interactive learning among the residents. The intervention was assessed through explaining the experiences of 16 participants via individual semi-structured interviews. Purposive sampling continued until data saturation. Data analysis was performed in the MAXQDA10 software. Results: In total, 153 codes, two main categories (education and dimensions of change), six categories (educational deficiencies, influential factors in the quality of education, requirements, barriers, benefits, and response to change), and 20 subcategories were extracted. Conclusions: According to the results, the residents were satisfied with the changes, while the faculty members needed more justification and motivation. The strengths and weaknesses identified in the intervention could lay the groundwork for broader changes in the same clinical fields.

Evaluating the Quality of Evidence

2017 ◽  
Author(s):  
Zach W Brown ◽  
Herb A. Phelan
Keyword(s):  
Patient Care ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Internal Validity ◽  
Medical Practitioner ◽  
Clinical Decision ◽  
Evidence Based ◽  
Quality Of Evidence ◽  
Relevant Topic

One of the most important skills a medical practitioner must develop is the ability to evaluate the evidence as evidence-based practice is the best way to provide patient care. Critical appraisal of an article requires a systematic approach to identify a clear and novel hypothesis, a relevant topic, valid study methods, and the overall importance of the research. This review identifies how to establish a baseline level of quality per the hierarchy of study designs. It then deconstructs each section of the standard IMRAD format article (Introduction, Methods, Results, Analysis, and Discussion), including a brief discussion of statistical methods. Finally, it shows how to apply some of the evaluation methods of the GRADE guidelines that were devised specifically to provide a process for determining quality of evidence through modifiers reflecting priorities in clinical decision making. In particular, the overall quality can be downgraded based on five criteria: imprecision, inconsistency, indirectness, publication bias, and lack of internal validity. In contrast, quality can be upgraded when the size of the effect seen is very large, when a dose-response relationship exists, or when plausible confounders or other biases paradoxically increase confidence in the direction or magnitude of the signal. Taken together, a final assessment of quality may be applied, and the practitioner may accept the research for inclusion into practice or reject it as low-quality evidence. Both are examples of appropriate evidence-based practice, and both result in better patient care. Key words: appraisal, evaluate, evidence, grade, statistics

Evaluating the Quality of Evidence

2018 ◽  
Author(s):  
Zach W Brown ◽  
Herb A. Phelan
Keyword(s):  
Patient Care ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Internal Validity ◽  
Medical Practitioner ◽  
Clinical Decision ◽  
Evidence Based ◽  
Quality Of Evidence ◽  
Relevant Topic

One of the most important skills a medical practitioner must develop is the ability to evaluate the evidence as evidence-based practice is the best way to provide patient care. Critical appraisal of an article requires a systematic approach to identify a clear and novel hypothesis, a relevant topic, valid study methods, and the overall importance of the research. This review identifies how to establish a baseline level of quality per the hierarchy of study designs. It then deconstructs each section of the standard IMRAD format article (Introduction, Methods, Results, Analysis, and Discussion), including a brief discussion of statistical methods. Finally, it shows how to apply some of the evaluation methods of the GRADE guidelines that were devised specifically to provide a process for determining quality of evidence through modifiers reflecting priorities in clinical decision making. In particular, the overall quality can be downgraded based on five criteria: imprecision, inconsistency, indirectness, publication bias, and lack of internal validity. In contrast, quality can be upgraded when the size of the effect seen is very large, when a dose-response relationship exists, or when plausible confounders or other biases paradoxically increase confidence in the direction or magnitude of the signal. Taken together, a final assessment of quality may be applied, and the practitioner may accept the research for inclusion into practice or reject it as low-quality evidence. Both are examples of appropriate evidence-based practice, and both result in better patient care. Key words: appraisal, evaluate, evidence, grade, statistics

scholarly journals Qualitative study of cardiologists’ perceptions of factors influencing clinical practice decisions

Heart ◽  
2019 ◽  
Vol 105 (10) ◽  
pp. 749-754 ◽  
Author(s):  
Veena Manja ◽  
Gordon Guyatt ◽  
John You ◽  
Sandra Monteiro ◽  
Susan Jack
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Qualitative Study ◽  
Health System ◽  
Financial Incentives ◽  
Clinical Decision Making ◽  
Health Spending ◽  
Clinical Decision ◽  
Evidence Based ◽  
The Usa

BackgroundHealthcare costs are increasing in the USA and Canada and a substantial portion of health spending is devoted to services that do not improve health outcomes. Efforts to reduce waste by adopting evidence-based clinical practice guideline recommendations have had limited success. We sought insight into improving health system efficiency through understanding cardiologists’ perceptions of factors that influence clinical decision-making.MethodsIn this descriptive qualitative study, we conducted in-depth interviews with 18 American and 3 Canadian cardiologists. We used conventional content analysis including inductive and deductive approaches for data analysis and mapped findings to the ecological systems framework.ResultsPhysicians reported that major determinants of practice included interpersonal interactions with peers, patients and administrators; financial incentives and system factors. Patients’ insurance status represented an important consideration for some cardiologists. Other major influences included time constraints, fear of litigation (less prominent in Canada), a sense that their obligation was never to miss any underlying pathology, and patient demands. The need to bring income into their health system influenced American cardiologists’ practice; personal income implications influenced Canadian cardiologists’ practice. Cardiologists reported that knowledge limitations and logistical challenges limit their ability to assist patients with cost considerations. All these considerations were more influential than guidelines; some cardiologists expressed a high level of scepticism regarding guidelines.ConclusionsClinical decision-making by cardiologists is shaped by individual, interpersonal, organisational, environmental, financial and sociopolitical influences and only to a limited extent by guideline recommendations. Successful strategies to achieve efficient, evidence-based care will require addressing socioecological influences on decision-making.

scholarly journals Methods for the Development of Healthcare Practice Recommendations Using Systematic Reviews and Meta-Analyses

2021 ◽  
Vol 12 ◽  
Author(s):  
Thomas Platz
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Systematic Reviews ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Practice Recommendations ◽  
Meta Analyses

Quality of healthcare can be improved when the best external evidence available is integrated in clinical decision-making in a systematic explicit manner. With the rapid expansion of clinical evidence, the opportunities for evidence-based high-quality healthcare increase. Paradoxically, the likelihood of any one person to get a complete and balanced picture of the evidence available decreases. This is especially true for rehabilitation interventions that are complex in nature and where clinical research is rather diverse. Given the complex nature of the evidence, there is a substantial risk of misinterpreting the complex information both at the level of individual sources (e.g., reports of clinical trials) and for aggregated data syntheses (e.g., systematic reviews and meta-analyses). These risks are inherent in these sources themselves and are in addition related to the methodological expertise necessary to make valid use of the evidence for clinical decision-making. Taken together, there is a great demand for systematic structured guidance from evidence to clinical decision. This methodology paper describes a structured process for the development and report of evidence-based clinical practice recommendations that uses systematic reviews and meta-analyses as evidence source. It provides a comprehensive framework with specific requirements for the development group, the formulation of the healthcare question addressed, the systematic search for the evidence, its critical appraisal, the extraction and the outcome-centered presentation of the evidence, the rating of its quality, strengths and weaknesses, any further considerations relevant for decision-making, and an explicit recommendation statement along with its justification, implementation, and resource aspects. The suggested methodology uses international standards in evidence synthesis, critical appraisal of systematic reviews, rating the quality of evidence, characteristics of recommendations, and guideline development as developed by Cochrane, GRADE (Grading of Recommendations Assessment, Development and Evaluation), AMSTAR (A MeaSurement Tool to Assess systematic Reviews), and AGREE (Appraisal of Guidelines for REsearch & Evaluation). An added distinctive feature of the methodology is to focus on the most up-to-date, most valid evidence and hence to support the development of valid practice recommendations in an efficient way. Practice recommendations generated by such a valid methodology would be generally applicable and promote evidence-based clinical practice globally.

Modeling Evidence-Based Practice for Graduate Clinicians: Perspectives from Off-Site Clinical Supervisors in Medical Settings

2014 ◽  
Vol 24 (1) ◽  
pp. 21-31 ◽  
Author(s):  
Sharon B. Hart ◽  
Kelly A. Kleinhans
Keyword(s):  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Scientific Evidence ◽  
Clinical Decision ◽  
Fundamental Aspect ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Structured Interviews ◽  
Medical Settings ◽  
Clinical Placements

A fundamental aspect of graduate education in speech-language pathology is facilitating clinical competence. Teaching clinical decision-making within an evidence-based practice framework is necessary during both on-site and off-site clinical experiences. In this article the authors present the results of semi-structured interviews with off-site supervisors in medical settings. Interview questions addressed aspects of evidence-based practice (EBP) that are discussed or modeled for students. Supervisors also weighed the importance of each EBP element in their practice. Clinical expertise was given slightly more weight as compared to external scientific evidence and client/patient/caregiver perspective elements. However, individual responses were highly variable across participants. Suggestions for ensuring continued EBP instruction during off-site clinical placements is discussed.

scholarly journals User-led research and evidence-based medicine

2002 ◽  
Vol 180 (1) ◽  
pp. 1-3 ◽  
Author(s):  
Alison Faulkner ◽  
Phil Thomas
Keyword(s):  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Medical Profession ◽  
Clinical Decision ◽  
Evidence Based ◽  
Ethical Concerns ◽  
Quality Of Medical Care ◽  
Based Medicine ◽  
Epistemological Basis

Evidence-based medicine (EBM) and clinical governance play a central role in raising the quality of medical care. People want clinical decisions to be based on the best evidence and EBM places scientific knowledge in the service of clinical decision-making. Yet a quite different agenda is engaging patients as partners in health research, to make the medical profession more accountable. Here, we examine the epistemological basis of EBM, and the ethical concerns raised by this. In particular, we examine the value of user-led research in psychiatry in improving the concept of ‘evidence’ in evidence-based psychiatry.

scholarly journals Values informing the development of an indicator of appropriate diabetes therapy: qualitative study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e044395
Author(s):  
Christina M LaVecchia ◽  
Victor M Montori ◽  
Nilay D Shah ◽  
Rozalina G McCoy
Keyword(s):  
Qualitative Study ◽  
Clinical Decision Making ◽  
Diabetes Management ◽  
Clinical Decision ◽  
Value Systems ◽  
Delphi Panel ◽  
Evidence Based ◽  
Diabetes Therapy ◽  
Public And Private ◽  
Clinical Complexity

ObjectivesDespite increasing focus on individualised diabetes management, current diabetes quality measures are based on meeting generic haemoglobin A1c thresholds and do not reflect considerations of clinical complexity, hypoglycaemic susceptibility or treatment burden. Our team observed a multidisciplinary stakeholder panel tasked with informing an appropriate diabetes therapy indicator (ADTI) and analysed their deliberations, seeking to understand what constitutes appropriate diabetes therapy and how it can be captured using an operational quality indicator. We focused specifically on factors the panel valued in an ideal indicator, how they defined appropriateness and how they thought an indicator of appropriateness could be operationalised.DesignQualitative study examining Delphi panel deliberations as it iteratively refined the ADTI.Participants and methodsThe 12-member panel was comprised of clinicians (endocrinology, primary care, geriatrics), pharmacists, nurses, researchers, and representatives of public and private health plans. It met for four teleconference calls and deliberated asynchronously using semi-structured questionnaires following each call to develop the ADTI. These semistructured questionnaires, as well as the meeting minutes, were then analysed using an inductive thematic approach.ResultsWe identified three themes in panellist discussions that represented the core value systems underpinning the indicator and its formation: (1) promoting individualised, evidence-based and equitable care; (2) balancing autonomy and prescriptiveness in clinical decision-making; and (3) ensuring an accurate, reliable and practical indicator. These three principles were operationalised into definitions of treatment intensity and clinical complexity, and yielded an indicator that participants judged both fair and effective.ConclusionsBetter understanding of what multidisciplinary stakeholders perceive as appropriate diabetes management can help develop quality indicators that are patient-centred, evidence-based, equitable and pragmatic across a range of clinical settings.

Evidence-Based Medicine

2005 ◽  
pp. 125-135 ◽  
Author(s):  
Nilmini Wickramasinghe ◽  
Sushil K. Sharma ◽  
Harsha P. Reddy
Keyword(s):  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
New Developments ◽  
Postgraduate Educational ◽  
New Knowledge ◽  
Based Medicine

The ongoing tension between certainty over uncertainty is the main force that is driving the evidence-based medicine movement. The central philosophy of this practice lies in the idea that one can never take for granted one’s own practice, but by using a structured, problem-based approach, practitioners can logically manoeuvre their way through the obstacle course of clinical decision-making. Attending postgraduate educational events and reading various science journals are no longer sufficient to keep healthcare practitioners aware of all the new developments in practice. To gain this knowledge they need to accept that there are questions they have to ask about their practice. Having posed a number of questions, answers should be found to the most important, practitioners should appraise the quality of the resulting evidence and, if appropriate, practitioners should implement change in response to that new knowledge.

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