Does the Implementation of Clinical Pathways Affect Hierarchical Structures Within a Surgical Department? A Qualitative Study

Objective: To explore effects of the implementation of clinical pathways (CPs) on hierarchical structures within a surgical department. Summary of background data: CPs are care plans stipulating diagnostic and therapeutic measures along a time axis for a given condition or procedure. They are widely used in surgery. There is limited evidence to what extent CP implementation has an effect on hierarchical structures within surgical departments. Methods: Semistructured individual interviews were conducted with key members of a CP project team in a large academic surgery department. Interviews were carried out by an external researcher to increase the likelihood of obtaining unbiased opinions. Using an interview guide, it was ensured that respondents provided opinions on various issues related to CP implementation, including hierarchical relationships within the department, but also between caregivers and patients. The transcribed text was independently content analyzed by 2 researchers who converged their findings. Results: Clinical pathway implementation changed perceived surgical hierarchy from a top-down to a participatory approach. However, it was acknowledged that some form of hierarchy is required to ensure successful clinical pathway implementation. Respondents felt that clinical pathways changed surgical culture from a largely eminence-based to more evidence-based medicine. Conclusions: The implementation of CPs potentially affects several dimensions of surgical hierarchy. It changes “traditional” surgical hierarchy and is associated with perception of increased autonomy and competency in junior staff. The clinical approach appears to shift from eminence- to evidence-based medicine. The knowledge about these changes is important for carrying out CP projects in surgery.

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Mental disorders of known aetiology and precision medicine in psychiatry: a promising but neglected alliance

Psychological Medicine ◽

10.1017/s0033291716001355 ◽

2016 ◽

Vol 47 (2) ◽

pp. 193-197 ◽

Cited By ~ 9

Author(s):

D. Fraguas ◽

C. M. Díaz-Caneja ◽

M. W. State ◽

M. C. O'Donovan ◽

R. E. Gur ◽

...

Keyword(s):

Personalized Medicine ◽

Mental Disorders ◽

Precision Medicine ◽

Psychiatric Disorders ◽

Evidence Based Medicine ◽

Prediction Models ◽

Deletion Syndrome ◽

Clinical Approach ◽

Evidence Based ◽

Based Medicine

Personalized or precision medicine is predicated on the assumption that the average response to treatment is not necessarily representative of the response of each individual. A commitment to personalized medicine demands an effort to bring evidence-based medicine and personalized medicine closer together. The use of relatively homogeneous groups, defined using a priori criteria, may constitute a promising initial step for developing more accurate risk-prediction models with which to advance the development of personalized evidence-based medicine approaches to heterogeneous syndromes such as schizophrenia. However, this can lead to a paradoxical situation in the field of psychiatry. Since there has been a tendency to loosely define psychiatric disorders as ones without a known aetiology, the discovery of an aetiology for psychiatric syndromes (e.g. 22q11.2 deletion syndrome in some cases of schizophrenia), while offering a path toward more precise treatments, may also lead to their reclassification away from psychiatry. We contend that psychiatric disorders with a known aetiology should not be removed from the field of psychiatry. This knowledge should be used instead to guide treatment, inasmuch as psychotherapies, pharmacotherapies and other treatments can all be valid approaches to mental disorders. The translation of the personalized clinical approach inherent to psychiatry into evidence-based precision medicine can lead to the development of novel treatment options for mental disorders and improve outcomes.

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Evidence-Based Medicine and Headache Patient Management by General Practitioners in Italy

Cephalalgia ◽

10.1111/j.1468-2982.2005.00972.x ◽

2005 ◽

Vol 25 (10) ◽

pp. 767-775 ◽

Cited By ~ 7

Author(s):

A Bianco ◽

MM Parente ◽

E De Caro ◽

R Iannacchero ◽

U Cannistrà ◽

...

Keyword(s):

Clinical Trials ◽

General Practitioners ◽

Evidence Based Medicine ◽

Clinical Effectiveness ◽

Clinical Approach ◽

Evidence Based ◽

Sources Of Information ◽

Headache Patient ◽

Practice Characteristics ◽

Based Medicine

The study explores the awareness of technical terms used in evidence-based medicine (EBM) and manner of treating patients with migraine among a random sample of 500 general practitioners (GPs). A mailed questionnaire included questions on GPs' demographics and practice characteristics; awareness of EBM; sources of information about migraine and EBM; and patient's treatment behaviour. Only 27.2% of GPs agreed that clinical trials are needed to evaluate the efficacy of treatments and this awareness was higher in those who learned about migraine from scientific journals or continuing education courses and who attended courses on EBM. For two-thirds of GPs, disability is equivalent to illness diagnosis, and this behaviour was more prevalent in those who agreed that clinical trials are needed to evaluate the efficacy of preventive or curative treatments of migraine and that the clinical approach to migraine required an evaluation of clinical effectiveness, in those who treated a lower number of headache patients, who were older, and in those who did not use guidelines. The majority (93.1%) of GPs indicated that it is important to integrate clinical practice and the best available evidence, and this behaviour was significantly more frequent in those who agreed that the clinical approach to migraine required a clinical effectiveness evaluation, that clinical trials are needed to evaluate the efficacy of preventive or curative treatments of migraine, and in those who attended courses on EBM. Training and continuing educational programmes on EBM and guidelines on treatments of headache for GPs are strongly needed.

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Clinical Pathway Based on Evidence-Based Medicine (EBM) for Chemotherapy for Lung Cancer

YAKUGAKU ZASSHI ◽

10.1248/yakushi.124.973 ◽

2004 ◽

Vol 124 (12) ◽

pp. 973-981 ◽

Cited By ~ 1

Author(s):

Mari KOGO ◽

Yumi SAITO ◽

Yuka KASHIWABARA ◽

Kayoko KOICHI ◽

Ikue ICHIKAWA ◽

...

Keyword(s):

Lung Cancer ◽

Clinical Pathway ◽

Evidence Based Medicine ◽

Evidence Based ◽

Based Medicine

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Construction of Clinical Pathway Information Management System under the Guidance of Evidence-Based Medicine

Journal of Healthcare Engineering ◽

10.1155/2021/4425449 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Xinyu Wang ◽

Jie Chen ◽

Fang Peng ◽

Jingtai Lu

Keyword(s):

Adverse Events ◽

Information Management ◽

Clinical Pathway ◽

Evidence Based Medicine ◽

Medical Staff ◽

Management System ◽

Information Management System ◽

Evidence Based ◽

Work Efficiency ◽

Based Medicine

This study focuses on clinical pathways guided by evidence-based medicine (EBM). With the clinical pathway as the center, the subjective and objective medical knowledge of medical staff are collected, and a clinical pathway management system guided by EBM is established through a unified process; user demand analysis; main considerations; implementation, evaluation, and monitoring of the clinical path; and dictionary maintenance, to help hospitals fully regulate medical behaviors. Next, the study displays the path access prompt box, area 1 management page, table management page, exit prompt box, mutation record page, doctor order interface, revocation of execution, and monitoring interface, and the system designed is compared with the Beijing Shankang Technology (ASK) clinical data management system in terms of user experience. The results showed that the reporting rate of medical adverse events in the system in this study was 0.21%, and the work efficiency was increased by 14%. In terms of users’ satisfaction, the hospital managers’ satisfaction was 84 ± 5.36%, and it was 95 ± 4.72% for medical staff and 88 ± 4.91% for system administrators, superior to the ASK system; the differences were statistically significant ( P < 0.05 ). In conclusion, the clinical pathway information management system is in line with the working environment of medical staff, and the synchronous monitoring and management of medical quality are achieved through digital means, which can reduce the occurrence of medical adverse events and improve the work efficiency of medical staff.

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Clinical Pathway Based on Evidence-Based Medicine (EBM) for Carboplatin/Paclitaxel (TJ) Chemotherapy for Ovarian Cancer

Iryo Yakugaku (Japanese Journal of Pharmaceutical Health Care and Sciences) ◽

10.5649/jjphcs.30.394 ◽

2004 ◽

Vol 30 (6) ◽

pp. 394-400 ◽

Cited By ~ 2

Author(s):

Mari Kogo ◽

Kumiko Matuoka ◽

Mami Kobayashi ◽

Sachiko Miyata ◽

Ikue Ichikawa ◽

...

Keyword(s):

Ovarian Cancer ◽

Clinical Pathway ◽

Evidence Based Medicine ◽

Evidence Based ◽

Based Medicine

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A clinical pathways project to promote evidence-based medicine in a large community oncology practice

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.6597 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 6597-6597

Author(s):

M. A. Neubauer

Keyword(s):

Colon Cancer ◽

Clinical Trials ◽

Evidence Based Medicine ◽

Clinical Pathways ◽

Small Cell ◽

Evidence Based ◽

Small Cell Lung ◽

Treatment Data ◽

Oncology Practice ◽

Based Medicine

6597 Background: Medical oncology therapy tends to vary widely due to a large number of drug choices and a wide array of reference sources for decision-making. It is assumed that this high variability reduces quality and efficient delivery of cancer care. We developed clinical pathways for common cancers in which we, after extensive review of seminal literature, distilled a succinct list of evidence- based regimens. We then instructed all physicians at KCCC (26 medical oncologists) to adhere to these pathways or write an exception to the pathway. Exceptions were reviewed by a practice peer-review committee before treatment was initiated. Methods: Included in this analysis is KCCC practice data on treatment choices for ALL patients who were started on treatment or had a change in treatment for breast cancer, non-small cell lung cancer, or colon cancer. All treatments required entry of patient information and staging information on a web-based pathway tool followed by selection of a pathway choice. If a physician preferred “off-pathway” treatment for his/her patient, then an exception sheet with an explanation for off-pathway therapy was submitted and reviewed before treatment. Data was collected from January 1, 2006 through October 31, 2006. The study endpoints were pathway adherence, pathway exception rate, and frequency of accrual to clinical trials. Results: Over a 10 month time period, there were 764, 624, and 326 patients treated for breast, non-small cell lung, and colon cancer, respectively. On-pathway treatment rates were 92.5%, 93.4% and 88.3%. Conversely, exceptions were utilized 7.5%, 6.6% and 11.7% of the time. Rate of accrual to clinical trials was 6.8%, 13.0% and 7.7% for breast, non-small cell lung and colon cancer. Conclusions: Strategies to support and enforce evidence-based medicine in a community based oncology practice can be successful in standardizing care, improving efficiencies, promoting clinical trial enrollment, and developing a practice profile. This pathway project is now being implemented throughout most of the US Oncology network. No significant financial relationships to disclose.

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Center for clinical studies in a surgical department—An approach for more evidence-based medicine

Contemporary Clinical Trials ◽

10.1016/j.cct.2005.10.004 ◽

2006 ◽

Vol 27 (3) ◽

pp. 211-214 ◽

Cited By ~ 11

Author(s):

Christoph M. Seiler ◽

Moritz N. Wente ◽

Markus K. Diener ◽

Boris E. Fröhlich ◽

Markus W. Büchler ◽

...

Keyword(s):

Evidence Based Medicine ◽

Clinical Studies ◽

Evidence Based ◽

Surgical Department ◽

Based Medicine

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Place of evidence-based medicine in the diagnosis of mental disorders

Neurology Bulletin ◽

10.17816/nb16463 ◽

2020 ◽

Vol LII (1) ◽

pp. 82-85

Author(s):

Evgeniya G. Poltavskaya

Keyword(s):

Mental Disorders ◽

Evidence Based Medicine ◽

Psychiatric Diagnosis ◽

Clinical Approach ◽

Evidence Based ◽

Based Medicine

The polemic article is a presentation of the authors opinion regarding the role of evidence-based medicine in the formulation of a psychiatric diagnosis, in particular schizophrenia. The principles of clinical approach and evidence-based medicine in psychiatry are compared.

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Ambiente e Salute News n.11 - settembre-ottobre 2021

PAGINE ELETTRONICHE DI QUADERNI ACP ◽

10.53141/peqacp.2021.6.am1 ◽

2021 ◽

Vol 28 (6) ◽

pp. 1

Author(s):

Costantino Panza

Keyword(s):

Retrospective Study ◽

Body Temperature ◽

Evidence Based Medicine ◽

Clinical Pathways ◽

Evidence Based ◽

Less Is More ◽

Based Medicine ◽

Well Child Visit ◽

Recent Retrospective Study ◽

Child Visit

Less is more: measuring body temperature during well child visits is not good for the child A recent retrospective study found the risk of prescribing unnecessary tests and therapies to the child in case of routine fever measurement during the well child visit. The article of the month discusses the need to offer clinical pathways based on evidence-based medicine.

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