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Journal of Evaluation in Clinical Practice

Sarah J Ronaldson, Lisa Dyson, Laura Clark, Catherine E Hewitt, David J Torgerson, Brendan G Cooper, Matt Kearney, William Laughey, Raghu Raghunath, Lisa Steele, Rebecca Rhodes, Joy Adamson
RATIONALE, AIMS, AND OBJECTIVES: Early identification of chronic obstructive pulmonary disease (COPD) results in patients receiving appropriate management for their condition at an earlier stage in their disease. The determining the optimal approach to identifying individuals with chronic obstructive pulmonary disease (DOC) study was a case-finding study to enhance early identification of COPD in primary care, which evaluated the diagnostic accuracy of a series of simple lung function tests and symptom-based case-finding questionnaires...
March 13, 2018: Journal of Evaluation in Clinical Practice
Sandra Monteiro, Geoff Norman, Jonathan Sherbino
There is general consensus that clinical reasoning involves 2 stages: a rapid stage where 1 or more diagnostic hypotheses are advanced and a slower stage where these hypotheses are tested or confirmed. The rapid hypothesis generation stage is considered inaccessible for analysis or observation. Consequently, recent research on clinical reasoning has focused specifically on improving the accuracy of the slower, hypothesis confirmation stage. Three perspectives have developed in this line of research, and each proposes different error reduction strategies for clinical reasoning...
March 13, 2018: Journal of Evaluation in Clinical Practice
Guillaume Bouzillé, Marie-Noëlle Osmont, Louise Triquet, Natalia Grabar, Cécile Rochefort-Morel, Emmanuel Chazard, Elisabeth Polard, Marc Cuggia
RATIONALE, AIMS, AND OBJECTIVES: The spontaneous reporting system currently used in pharmacovigilance is not sufficiently exhaustive to detect all adverse drug reactions (ADRs). With the widespread use of electronic health records, biomedical data collected during the clinical care process can be reused and analysed to better detect ADRs. The aim of this study was to assess whether querying a Clinical Data Warehouse (CDW) could increase the detection of drug-induced anaphylaxis. METHODS: All known cases of drug-induced anaphylaxis that occurred or required hospitalization at Rennes Academic Hospital in 2011 (n = 19) were retrieved from the French pharmacovigilance database, which contains all reported ADR events...
March 13, 2018: Journal of Evaluation in Clinical Practice
Sunil H Adwani, Cai Yuan, Leen Alsaleh, Julie Pepe, Khalid Abusaada
RATIONALE, AIMS, AND OBJECTIVES: Several studies have looked at patient-related variables influencing hospital length of stay (LOS) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). However, there has been increasing recognition that physician-related factors also play a significant role. This study aims to evaluate differences in practice patterns between teaching and nonteaching services and their effect on LOS in a large community hospital. METHODS: A retrospective study of 354 patients admitted to Florida Hospital, Orlando, with AECOPD between January 2009 and December 2011...
March 13, 2018: Journal of Evaluation in Clinical Practice
Sevdalina Kandilarova, Drozdstoy Stoyanov, Ivo D Popivanov, Stefan Kostianev
RATIONALE, AIMS, AND OBJECTIVES: In this study, we have attempted to replicate the findings of altered emotional processing in depressed patients compared with healthy controls by means of functional magnetic resonance imaging during passive viewing of positive, negative, and neutral pictures from the International Affective Pictures System. METHODS: Nineteen medicated depressed patients and 19 sex and age-matched healthy controls underwent functional magnetic resonance imaging during presentation of affective pictures in a block design...
March 13, 2018: Journal of Evaluation in Clinical Practice
Maria Mylopoulos, Kulamakan Kulasegaram, Nicole N Woods
In this era of increasing complexity, there is a growing gap between what we need our medical experts to do and the training we provide them. While medical education has a long history of being guided by theories of expertise to inform curriculum design and implementation, the theories that currently underpin our educational programs do not account for the expertise necessary for excellence in the changing health care context. The more comprehensive view of expertise gained by research on both clinical reasoning and adaptive expertise provides a useful framing for re-shaping physician education, placing emphasis on the training of clinicians who will be adaptive experts...
March 8, 2018: Journal of Evaluation in Clinical Practice
E Matifat, K Perreault, M Gagné, M Léveillé, F Desmeules
BACKGROUND: To improve the efficiency of the health care system, new interprofessional models of care are emerging. In 2015, two provincial professional colleges, regulating the practice of physiotherapists and that of pharmacists in the province of Québec, Canada, developed a new interprofessional model of care. This model is designed to guide non-prescription medication recommendations by physiotherapists treating patients in primary care with neuromusculoskeletal disorders (NMSKD) with the collaboration of pharmacists...
March 6, 2018: Journal of Evaluation in Clinical Practice
Mohamed Hassan Elnaem, Mohamad Haniki Nik Mohamed, Hasniza Zaman Huri, Shah M Azarisman
RATIONALE: Previous research reported underutilization of statin therapy among patients with type 2 diabetes mellitus. Improving health care providers' awareness and understanding of the benefits and risks of statin treatment could be of assistance in optimizing the statin prescribing process. AIMS AND OBJECTIVES: This study aimed to assess health care providers' knowledge related to statin therapy and the impact of educational outreach intervention based on the perceived knowledge...
March 6, 2018: Journal of Evaluation in Clinical Practice
Stefania Sarsah Cobbinah, Jan Lewis
Racial discrimination has been increasingly reported to have a causal link with morbidity and mortality of Black Americans, yet this issue is rarely addressed in a public health perspective. Racism affects health at different levels: institutional racism is a structural and legalized system that results in differential access to health services; cultural racism refers to the negative racial stereotypes, often reinforced by media, that results in poorer psychological and physiological wellbeing of the minorities...
March 6, 2018: Journal of Evaluation in Clinical Practice
Floortje B Moes, Eddy S Houwaart, Diana M J Delnoij, Klasien Horstman
RATIONALE, AIMS, AND OBJECTIVES: This paper examines a remarkable dispute between Dutch insurers, hospitals, doctors, and patients about a set of quality indicators. In 2013, private insurers planned to drastically reform Dutch emergency care using quality indicators they had formulated drawing from clinical guidelines, RCTs, and systematic reviews. Insurers' plans caused much debate in the field of emergency care. As quality indicators have come to play a more central role in health care governance, the questions what constitutes good evidence for them, how they ought to be used, and who controls them have become politically and morally charged...
March 6, 2018: Journal of Evaluation in Clinical Practice
Diogo Telles-Correia
A problem underlying the mind brain gap is the complex integration among the disciplines involved in it: neurosciences, clinical psychiatry and psychology, and philosophy of science. Research in neurosciences and clinical psychiatry requires a positioning in relation to some conceptual/philosophical aspects. These are related to the models of interrelationship of the brain and the mind, to explanatory approaches in psychiatry, and to conceptual issues such as dimensionality versus categories, symptoms versus disorders, and neurobiological correlates versus clinical determination of mental disorder...
March 2, 2018: Journal of Evaluation in Clinical Practice
Paul Hüsing, Bernd Löwe, Katharina Piontek, Meike Shedden-Mora
RATIONALE, AIMS, AND OBJECTIVES: Patients with somatoform disorders are frequent attenders in primary and secondary care. While co-morbid mental disorders, especially depression and anxiety, are frequently present, there is controversy on whether mental co-morbidity leads to higher health care utilization (HCU). The present paper investigates the influence of co-morbid depressive and anxiety disorders on primary, specialized somatic and mental HCU in primary care patients with somatoform disorders...
March 2, 2018: Journal of Evaluation in Clinical Practice
Chris O Ifediora, Gary D Rogers
RATIONALE, AIMS AND OBJECTIVES: This study explores the postconsultation follow-up behaviours of patients who used the Australian after-hours house-call (AHHC) medical services. These behaviours provide insights into the nature of the continuity of care (CoC) in the industry and are a measure quality in AHHC service delivery. Understanding the patterns of these CoCs and their predictors will enable stakeholders in the industry, both locally and globally, plan and implement higher quality services...
March 2, 2018: Journal of Evaluation in Clinical Practice
Fernando Antonio Glasner da Rocha Araujo, Ubirajara de Oliveira Barroso
RATIONALE, AIMS, AND OBJECTIVES: Prostate cancer (PC) presents with a high prevalence, but a low mortality. The evaluation of the risk-benefit ratio of current screening methods has led to conflicting results, which are reflected in some contradictory recommendations proposed by scientific and governmental entities. In this context of uncertainty, our objective is to verify the practices and beliefs of Brazilian physicians of different specialties regarding screening for PC. METHODS: A cross-sectional study was conducted through a self-administered questionnaire survey during the main events of the target specialties (general practitioner, geriatrics, and urology) during the year 2016...
February 27, 2018: Journal of Evaluation in Clinical Practice
Benjamin Djulbegovic, Iztok Hozo, William Dale
BACKGROUND: Contemporary delivery of health care is inappropriate in many ways, largely due to suboptimal Q5 decision-making. A typical approach to improve practitioners' decision-making is to develop evidence-based clinical practice guidelines (CPG) by guidelines panels, who are instructed to use their judgments to derive practice recommendations. However, mechanisms for the formulation of guideline judgments remains a "black-box" operation-a process with defined inputs and outputs but without sufficient knowledge of its internal workings...
February 27, 2018: Journal of Evaluation in Clinical Practice
Joan M Quigley, Juliette C Thompson, Nicholas J Halfpenny, David A Scott
RATIONALE, AIMS, AND OBJECTIVES: When randomized controlled trial data are limited or unavailable, or to supplement randomized controlled trial evidence, health technology assessment (HTA) agencies may rely on systematic reviews of nonrandomized studies (NRSs) for evidence of the effectiveness of health care interventions. NRS designs may introduce considerable bias into systematic reviews, and several methodologies by which to evaluate this risk of bias are available. This study aimed to identify tools commonly used to assess bias in NRS and determine those recommended by HTA bodies...
February 27, 2018: Journal of Evaluation in Clinical Practice
Quan Nha Hong, Araceli Gonzalez-Reyes, Pierre Pluye
RATIONALE, AIMS, AND OBJECTIVES: Systematic reviews combining qualitative, quantitative, and/or mixed methods studies are increasingly popular because of their potential for addressing complex interventions and phenomena, specifically for assessing and improving clinical practice. A major challenge encountered with this type of review is the appraisal of the quality of individual studies given the heterogeneity of the study designs. The Mixed Methods Appraisal Tool (MMAT) was developed to help overcome this challenge...
February 21, 2018: Journal of Evaluation in Clinical Practice
Mark R Tonelli
Precision medicine, which aims to individualize care based upon the unique combination of genetic, environmental, and lifestyle features in particular patients, will require an evolution in clinical decision making. Practitioners of precision medicine will need to utilize an expanded body of medical knowledge derived from a wide variety of sources. Clinical judgement in the case-based reasoning necessary for individualizing care will involve understanding and utilizing methodological approaches not commonly invoked in medicine, including mechanistic and qualitative research results...
February 21, 2018: Journal of Evaluation in Clinical Practice
Elena Rudolfovna Isaeva, Gulfya Gadilevna Lebedeva, Yulia Alexandrovna Simon
RATIONALE, AIMS, AND OBJECTIVES: The article is dedicated to the search of more accurate psychodiagnostic methods and methods of evaluation that can help to define the degree of manifestation of cognitive deficiency among patients suffering from various schizophrenic disorders. The notions of cognitive deficiency and cognitive profile are analysed; we understand them as the correlation between intact and damaged components of cognitive processes and their diagrammatic representation. The authors prove that it is essential to provide a detailed scale of cognitive deficiencies detectable in case of schizophrenic disorders and to design universal algorithms that could translate the results of traditional content analysis of cognitive disorders into quantitative indicators...
February 21, 2018: Journal of Evaluation in Clinical Practice
Ariel Linden
RATIONALE, AIMS AND OBJECTIVES: Interrupted time series analysis (ITSA) is an evaluation methodology in which a single treatment unit's outcome is studied serially over time and the intervention is expected to "interrupt" the level and/or trend of that outcome. The internal validity is strengthened considerably when the treated unit is contrasted with a comparable control group. In this paper, we introduce a robustness check based on permutation tests to further improve causal inference...
February 20, 2018: Journal of Evaluation in Clinical Practice
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