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Uvod: Za načrtovanje strategije uvajanja na dokazih podprte prakse v slovenski zdravstveni negi je pomembna ocena znanj, prepričanj in različnih vidikov uporabe na dokazih podprte prakse pri izvajalcih zdravstvene nege. Ocena mora biti zanesljiva, veljavna in reprezentativna, da lahko koristi načrtovanju nacionalnih strategij na tem področju. Namen raziskave je prikaz psihometrične analize uporabljenega in mednarodno uveljavljenega instrumenta.Metode: Sodelovalo je 1014 visokošolsko izobraženih medicinskih sester in zdravstvenikov z vseh treh nivojev zdravstvenega varstva. V raziskavi sta bili uporabljeni dve lestvici, in sicer »Evidence-Based Practice Beliefs Scale« in »Evidence-Based PracticeImplementation Scale«. Lestvici sta bili psihometrično analizirani s testi zanesljivosti in veljavnosti.Rezultati: Povprečna vrednost prepričanj na dokazih podprte prakse je 3,47 (s = 0,54). Zanesljivost lestvice je znašala 0,909, varianca je bila pojasnjena v 63,71 % s tremi faktorji (prepričanja v znanje, prepričanja v uporabnost, težavnost uporabe in časovna potratnost). Povprečna vrednost implementacije je 2,23 (s = 0, 89). Zanesljivost lestvice je znašala 0,969, varianca je bila pojasnjena v 68,52 % z dvema faktorjema (uporaba znanj, uporaba korakov).Diskusija in zaključek: Testirana instrumenta se pokažeta kot zanesljiva in veljavna. Raziskava zelo poudari primanjkljaj znanj za razvoj na dokazih podprte prakse in znanj, ki so del vsakodnevnih razvojnih aktivnosti v delokrogu visokošolsko izobražene medicinske sestre. Zahtevajo se aktivnosti za izboljšanje stanja na ravni visokošolskih in zdravstvenih zavodov, kot na ravni nacionalnih združenj v zdravstveni negi. Introduction: Planning the strategy of evidence-based care implementation in Slovenian nursing calls for an assessment of knowledge, beliefs, and various aspects of evidence-based care implementation among nursing care providers. The assessment should be reliable, valid and representative in order to be used for the planning of national strategies in this field. The aim of the article is to present the psychometric analysis results of the internationally-renowned instrument used.Methods: A total of 1,014 nurses with a higher education degree from all three levels of health care participated in the research. Two established scales were used in the research: Evidence-Based Practice Beliefs Scale and Evidence-Based Practice Implementation Scale. A psychometric analysis of the data was conducted using reliable, valid tests.Results: The mean value for evidence-based practice beliefs was 3.47 (s = 0.54). Reliability of the scale was 0.909, the variance was explained in 63.71% with three factors (beliefs in knowledge beliefs in usefulness difficulty of implementation and time efficiency). The mean value for implementation was 2.23 (s = 0.89). Reliability of the scale was 0.969, the variance was explained in 68.52% with two factors (application of knowledge application of implementation steps).Discussion and conclusion: The tested instruments have proven to be reliable and valid.Research results clearly demonstrate insufficient knowledge for the development of evidence-based practice and knowledge that is required for daily development activities implemented by nurses with a higher education degree. Steps should be taken to improve the situation in higher education institutions, healthcare institutions, and at the level of national nursing associations.

This article encourages the obstetrician-gynecologists to use social media platforms to share their wealth of clinical expertise and experience with the public in an engaging and empowering way. Social media is a powerful tool that increases communication, education, and support that can be leveraged to increase comprehension of women's health topics and advocate for our patients, both inside and outside the examination room. Included are tips for physicians on how to harness their social media superpower to connect with patients on social media, build a brand, and network in a meaningful and authentic way.

This document provides consensus-based recommendations for general physicians and primary care physicians who diagnose and manage patients with mitochondrial diseases (MD). It builds on previous international guidelines, with particular emphasis on clinical management in the Australian setting. This statement was prepared by a working group of medical practitioners, nurses and allied health professionals with clinical expertise and experience in managing Australian patients with MD. As new treatments and management plans emerge, these consensus-based recommendations will continue to evolve, but current standards of care are summarised in this document.

BACKGROUND US nursing homes (NHs) have struggled to overcome a historic pandemic that laid bare limitations in the number and clinical expertise of NH staff. PROBLEM For nurse staffing, current regulations require only one registered nurse (RN) on duty 8 consecutive hours per day, 7 days per week, and one RN on call when a licensed practical/vocational nurse is on duty. There is no requirement for a degreed or licensed social worker, and advanced practice registered nurses (APRNs) in NHs cannot bill for services. APPROACH It is time to establish regulation that mandates a 24-hour, 7-day-a-week, on-site RN presence at a minimum requirement of 1 hour per resident-day that is adjusted upward for greater resident acuity and complexity. Skilled social workers are needed to improve the quality of care, and barriers for APRN billing for services in NHs need to be removed. CONCLUSIONS Coupling enhanced RN and social work requirements with access to APRNs can support staff and residents in NHs.

This article offers insights into the Covid 19 Pandemic by comparing the experiences of Norway and the UK. The Norwegian case study has distinctive characteristics. It offers evidence of an agile government at work and evidence of a successful clinical experience to lead the Norwegian management of the Covid pandemic. This was a successful approach with low mortality rates and a protected population. By contrast, the UK experience was quite different.Clinical expertise was available to politicians who managed the pandemic, but this relationship was tense and contested over the pandemic. The political steering of the UK pandemic was erratic and unpredictable. The Government was initially keen on herd immunity but discarded his approach in early 2020 when it became clear that the fatalities would be grim. The UK's Prime Minister is a member of the libertarian wing of his political party which is opposed on principle to intervening in the lives of citizens. This meant the UK Prime Minister was in a conflicted position. This was evidence by his reluctance to have lockdowns and the slowness with which lockdowns were initiated which experts said cost many lives. The fatalities in the UK were among the worst in the world.

For some years, we have been witnessing a steady stream of high-profile studies about machine learning (ML) algorithms achieving high diagnostic accuracy in the analysis of medical images. That said, facilitating successful collaboration between ML algorithms and clinicians proves to be a recalcitrant problem that may exacerbate ethical problems in clinical medicine. In this paper, we consider different epistemic and normative factors that may lead to algorithmic overreliance within clinical decision-making. These factors are false expectations, the miscalibration of uncertainties, non-explainability, and the socio-technical context within which the algorithms are utilized. Moreover, we identify different desiderata for bridging the gap between ML algorithms and clinicians. Further, we argue that there is an intriguing dialectic in the collaboration between clinicians and ML algorithms. While it is the algorithm that is supposed to assist the clinician in diagnostic tasks, successful collaboration will also depend on adjustments on the side of the clinician.

Palliative care has evolved to be an integral part of comprehensive cancer care with the goal of early intervention to improve quality of life and patient outcomes. The NCCN Guidelines for Palliative Care provide recommendations to help the primary oncology team promote the best quality of life possible throughout the illness trajectory for each patient with cancer. The NCCN Palliative Care Panel meets annually to evaluate and update recommendations based on panel members’ clinical expertise and emerging scientific data. These NCCN Guidelines Insights summarize the panel’s recent discussions and highlights updates on the importance of fostering adaptive coping strategies for patients and families, and on the role of pharmacologic and nonpharmacologic interventions to optimize symptom management.

The current write-up is for Dr P.K.Sen TAI Gold Medal Oration Award for 2020 conferred to Dr Rupak Singla and delivered on 19 th December 2020. The title chosen for the oration was "Introduction and scale up of new anti-TB drugs in India: role of NITRD.ˮ However, in the oration the role this institute has played for overall scale up of Drug-resistant TB services in India under National Tuberculosis Elimination Programme (NTEP) at different times from the beginning of national TB programme has also been presented. National Institute of TB and Respiratory Diseases has travelled with our country from beginning of DR-TB care. It demonstrated for the first time use of a Standardized Treatment Regimen with second line drugs for MDR-TB in field conditions. NITRD assisted NTEP for the concept of DST guided treatment. This institute guided NTEP for the management of MDR-TB failure patients with Pre-XDR and XDR-TB. Also, NITRD assisted India for the introduction of newer DR-TB drugs and scale up of newer drugs across the country. The strength of NITRD include clinical expertise, laboratory support and training division. NITRD commitment is strong and will continue to support NTEP for all endeavors in future also.

A wise man once told me, ‘if you don't like the rules, win the game and change them’. As clinicians, we can use this analogy to make the best of our clinical expertise and knowledge to change policies to improve patient care and outcomes. Within trauma and orthopaedics, we have numerous examples of the successful use of policy to deliver more consistent care to our patients, with the aim of improving outcomes. One of the most successful policies is the Best Practice Tariff for hip fractures, which has completely transformed our care delivery to a multidisciplinary and more timely approach and has shown clear improvements in outcomes. There was strong clinical engagement in the development and implementation of policy to commission our major trauma networks and centres and ongoing oversight from NHS specialized commissioning. As a clinical member of the National Clinical Reference Group (CRG) for Major Trauma and Burns, I have led the update of a number of policies and will provide an insight into the change process. The National CRGs play a vital role in providing clinical expertise to decision-making for NHS specialized commissioning.

Evidence-based medicine (EBM) is the “conscientious, explicit, and judicious use of current best evidence (Thamer Z. et al. 2018 .It is the evolving science of clinical care. It is the judicious use of the best current evidence in making decisions about the care of the individual patient. It also integrates clinical expertise, patient desires, values, and needs . (Michael LeFevre.2014 ) The current study intended to assess Knowledge, attitude and perception toward EBM among medical students in Shendi University in Sudan. It was descriptive cross-sectional one, from October to December 2020; It included one hundred and twenty one (121) medical students. Data was collected employing structural self –administered questionnaire and the data collected was analyzed by SPSS. The findings of the study described the current status of level of awareness and use of EBM .More than half of students have poor knowledge toward EBM. Approximately half or less have good attitude compared with their poor knowledge, while the perception of the importance of evidence based medicine was good (72%).

Despite technological innovations, clinical expertise remains the cornerstone of psychiatry. A clinical expert does not only have general textbook knowledge, but is sensitive to what is demanded for the individual patient in a particular situation. A method that can do justice to the subjective and situation-specific nature of clinical expertise is ethnography. Effective deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) involves an interpretive, evaluative process of optimizing stimulation parameters, which makes it an interesting case to study clinical expertise. The aim of this study is to explore the role of clinical expertise through an ethnography of the particular case of DBS optimization in OCD. In line with the topic of the special issue this article is a part of, we will also use our findings to reflect on ethnography as a method to study complex phenomena like clinical expertise. This ethnography of DBS optimization is based on 18 months of participant observation and nine in-depth interviews with a team of expert clinicians who have been treating over 80 OCD patients since 2005. By repeatedly observing particular situations for an extended period of time, we found that there are recurrent patterns in the ways clinicians interact with patients. These patterns of clinical practice shape the possibilities clinicians have for making sense of DBS-induced changes in patients’ lived experience and behavior. Collective established patterns of clinical practice are dynamic and change under the influence of individual learning experiences in particular situations, opening up new possibilities and challenges. We conclude that patterns of clinical practice and particular situations are mutually constitutive. Ethnography is ideally suited to bring this relation into view thanks to its broad temporal scope and focus on the life-world. Based on our findings, we argue that clinical expertise not only implies skillful engagement with a concrete situation but also with the patterns of clinical practice that shape what is possible in this specific situation. Given this constraining and enabling role of practices, it is important to investigate them in order to find ways to improve diagnostic and therapeutic possibilities.

This paper historicises the criticisms and backlash from within medicine against new computer technologies in the clinic. Physicians' reactions to proposals for the implementation of algorithmic te...

The road to the delivery of high-quality cleft surgery into communities in the LMIC is beset with numerous hurdles. These include the availability of trained health care personnel, the availability of infrastructure in health care, parent awareness of the need for timely interventions in these children, presence of affordable treatment centres with adequate means of transport to and from these facilities for patients coming from the interior rural locations, but most importantly, the financial considerations that are the underlying limitations in most of these above mentioned considerations. We would like to approach this problem by describing the evolution of our own centre over several decades. Our centre, The Charles Pinto Centre for Cleft lip and palate at the Jubilee Mission Hospital is located in Thrissur, in the beautiful state of Kerala. In the late 1950s, Dr HS Adenwalla who had trained under experts in the art of Cleft Lip and Palate Surgery in Mumbai joined the hospital and transformed it through sheer dedication and meticulous clinical expertise into a major hub for treatment and also training in this speciality. In this endeavour he was greatly helped by non governmental organizations of which Smile Train deserves special mention in view of its model of functioning, empowering local partners by adequate funding for treatment, training and establishment of infrastructure, while ensuring strict adherence to safety standards. We believe that it is essential that there should be trained and dedicated health care personnel who are willing to treat such patients without an eye on the monetary benefits accrued, and also enough funding either from the government or from the NGOs to provide equipment and infrastructure for safe, high quality and accessible treatment and the establishment of multidisciplinary management. Lastly, the patients should also be made aware of the need for timely treatment and long-term follow- up.

Barriers to identifying autism spectrum disorder (ASD) in young children in a timely manner have led to calls for novel screening and assessment strategies. Combining computational methods with clinical expertise presents an opportunity for identifying patterns within large clinical datasets that can inform new assessment paradigms. The present study describes an analytic approach used to identify key features predictive of ASD in young children, drawn from large amounts of data from comprehensive diagnostic evaluations. A team of expert clinicians used these predictive features to design a set of assessment activities allowing for observation of these core behaviors. The resulting brief assessment underlies several novel approaches to the identification of ASD that are the focus of ongoing research.

Machine learning is a domain within artificial intelligence that allows for computer algorithms to be learned from experience without them having being programmed. The objective of this study is to summarize the neurosurgical applications of machine learning when compared to clinical expertise. This study uses a systematic search to review articles from the PubMed and Embase databases in comparing various machine learning studies approaches to that of the clinical experts. For this study, 23 studies were identified which used machine learning algorithms for the diagnosis, pre-surgical planning, and outcome prediction. In conclusion, this study identifies that machine learning models can augment decision-making capacity for the surgeons and clinicians in neurosurgical applications. Despite this, there still exist hurdles that involve creation, validation, and the deployment of the machine learning techniques in clinical settings.

The Major Extremity Trauma and Rehabilitation Consortium and the American Academy of Orthopaedic Surgeons have developed the Appropriate Use Criteria (AUC) for the Diagnosis and Management of Acute Compartment Syndrome (ACS). Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care, aid decision-making, and obtain the best possible outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The AUC for the Diagnosis and Management of ACS were derived by identifying clinical indications typical of patients suspected of an ACS in clinical practice. These indications were most often parameters observable by the clinician, including symptoms or results of diagnostic tests. The 135 patient scenarios and five treatments were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a nine-point scale to designate a treatment as "appropriate" (median rating, seven to nine), "may be appropriate" (median rating, four to six), or "rarely appropriate" (median rating, one to three).

Phenomenon: Supervisors and trainees can learn skills related to evidence-based medicine from each other in the workplace by collaborating and interacting, in this way benefiting from each other’s strengths. This study explores supervisors’ perceptions of how they currently learn evidence-based medicine by engaging in learning conversations with their trainee. Approach: Semi-structured, video-stimulated elicitation interviews were held with twenty-two Dutch and Belgian supervisors in general practice. Supervisors were shown fragments of their video-recorded learning conversations, allowing them to reflect. Recorded interviews were analyzed using a grounded theory-based approach.Findings: Supervisors did not immediately perceive workplace learning conversations as an opportunity to learn evidence-based medicine from their trainee. They mostly saw these conversations as a learning opportunity for trainees and a chance to maintain the quality of care within their practice. Nevertheless, during the interviews, supervisors did acknowledge that learning conversations help them to gain up-to-date knowledge and search skills or more awareness of their own knowledge or gaps in their knowledge. Not identified as a learning outcome was how to apply evidence-based medicine within a clinical practice by combining evidence with clinical expertise and the patient’s preferences. Insights: Supervisors acknowledge that they learn elements of the three aspects of evidence-based medicine by having learning conversations with their trainee, but they currently see this as secondary to the trainee’s learning process. Emphasizing opportunities for bidirectional learning could improve learning of evidence-based medicine during workplace learning conversations.

The objectives of this retrospective, observer agreement study were to (a) test variability of radiographic left atrial dimension (RLAD) and vertebral left atrial size (VLAS) measurements among observers with different levels of expertise in thoracic radiology and cardiology, (b) assess whether one method is better than the other in detecting left atrial enlargement (LAE), and (c) assess the agreement among RLAD, VLAS, and American College of Veterinary Internal Medicine (ACVIM) classes. Seventy-four dogs (eight healthy and 66 with mitral valve disease) with thoracic radiographs and echocardiography performed on the same day were reviewed. Thirty showed echocardiographic LAE. Left atrial dimension was quantified using RLAD and VLAS by six different operators with three levels of clinical experience in veterinary cardiology/radiology. Vertebral heart score and fourth thoracic vertebra (T4) were also measured. Differences in T4, vertebral heart score (VHS), RLAD, and VLAS measurements were found among six operators and among the three levels of clinical expertise as well as between veterinary cardiology readers and veterinary radiology readers (P < .05). The area under the receiver operating characteristic (AUC) curve for VHS showed good performances for all observers and level and type of expertise; the AUC for RLAD and VLAS was suboptimal only for the radiology student. Our RLAD and VLAS cutoffs (1.9 and 2.43 v, respectively) were better related to qualitative radiographic than quantitative echocardiographic LAE evaluation. Radiographic LA dimension and VLAS showed an increase proportional to the worsening of the ACVIM class. In conclusion, these results allow us to affirm that RLAD and VLAS are reproducible measurements for detecting LAE. Better performances are associated with clinical expertise and background.

With more than 25 years of oncology nursing experience and more than 18 years as an oncology nurse practitioner, Christa Braun-Inglis, MS, APRN-Rx, FNP-BC, AOCNP, has a wealth of clinical expertise...

Evidence-based practice (EBP) models have been developed, in part, to enhance the likelihood that the outcome of health care treatment, including psychotherapy, leads to positive improvement. However, two additional outcomes can occur: no change and poor outcome (e.g., harm, worsening of symptoms). What does the clinician do when psychotherapy is not working? When faced with various treatment decisions, such as this, the EBP model posits that therapists should apply their clinical expertise in considering the “best available research” within the context of various patient characteristics. In part because of various limitations of this approach, I suggest that another important set of principles are important to consider in tandem when faced with this clinical dilemma—that is, ethical concerns. Borrowing from the American Psychological Association’s (2017a) Ethics Code, I discuss how the following issues exist when clinicians wrestle with this question: avoidance of harm, competence, conflicts of interest, and informed consent. I conclude this paper with a list of suggestions that can potentially foster the application of ethical principles when making treatment decisions.

Background Humility has recently been conceptualized as a positive, multifaceted attribute in fields outside of medicine, such as psychology and philosophy. In medicine, there has been limited study into the nature of humility and its role in clinical practice. We sought to develop a deeper understanding of humility in medical practice through the lived-experiences of peer-nominated excellent clinicians. Methods We conducted a qualitative study with secondary analysis of transcripts from individual open ended, semi-structured interviews of 13 peer nominated physicians [7 (54%) female] at an academic centre. Using constant comparative analysis, the transcripts were analyzed for instances where humility was discussed as it related to clinical practice. Results Participants perceived humility to be an important driver for excellence in clinical practice. This was further explained using two overarching themes: an inward, intellectual perspective and an outward, social perspective. The physician’s inward perspective was their view of their abilities and limits, their self-confidence, and their intellectual openness and adaptability to the limitations and evolving nature of knowledge in medicine. Their outward perspective was an understanding and appreciation for the larger system in which they worked, an openness to others, and valuing patients’ experience. Through these perspectives, humility positively influenced clinical care, learning and curiosity, motivation in the care of others, and relationships with team members and patients. Conclusions Humility in medicine is a rich, multifaceted construct that was perceived to be a driver for excellence in medical practice by peer-nominated excellent clinicians. Humility was seen as an active force in formulating and calibrating a clinician’s perspective of self and of others, and as such, positively influencing clinical practice. These findings will help inform a discourse in medical education and faculty development about the important role of humility in medical practice.

The article discusses Leading through change: Human-based leader development for health professionals, which includes historically, health professional education has focused on the development of clinical expertise over leadership skills that enable practitioners to lead dynamic teams who can adapt and pivot rapidly in a crisis.

Introduction. Vulvar intraepithelial neoplasia is a precancerous pathology of the vulva and is a very important medical and social problem. All the efforts of medical science are aimed at finding and developing the latest organ-preserving methods for the treatment of vulvar intraepithelial neoplasia. One of them is photodynamic therapy-method that allows preserving the anatomical structure of the organ. The aim of the study. The aim of the article is to carry out an analytical review of the literature on modern views on the problem of vulvar intraepithelial neoplasia, methods of its management and to present the results of the own clinical expertise of using a photodynamic method for its treatment. Materials and methods. Content analysis, method of system and comparative analysis, bibliosemantic method of studying the results of current scientific research on modern views on the problem of vulvar intraepithelial neoplasia, methods of its management have been used in the article. Fifty-six literature sources in English have been studied and analyzed. The sources have been taken in the following scientometric medical databases: PubMed-NCBI, Medline, ResearchGate, CochraneLibrary, EMBASE by keywords: intraepithelial neoplasia of the vulva, vulvar intraepithelial neoplasia (VIN), photodynamic therapy (PDT), treatment of vulvar intraepithelial neoplasia; VIN treatment. The results of own clinical expertise of using the photodynamic method for vulvar intraepithelial neoplasia treatment have been described in the article as well. Results. During the PS infusion and the period before the PDT session, the general condition of the patients was satisfactory, and the symptoms of cutaneous phototoxicity, allergic reactions, which were accompanied by severe dysfunctions of vital organs, were absent after it. Despite the premedication carried out before the PDT session, the patients had moderate pain syndrome (I-II degrees) after the session as well as moderately pronounced edema in the area of pathological tissues being under the influence of photoirradiation. Within 1-5 days after treatment, the beginning of the formation of a dark brown or black area of photochemical necrosis was noted. After 3, 6 and 24 months of observation of patients with precancerosis of the vulva, remission of clinical symptoms (pruritus in the vulva) in the treated pathological foci was stated. It should be noted that the insufficient effectiveness of PDT in five cases was due to the use of subtherapeutic doses of PS “Photolon®”. During the follow-up examination at 3, 6 and 24 months in 20 out of 30 patients who received a photosensibilizer session in a subtherapeutic dose followed by photoirradiation of high power (1.0 W), both clinically and morphologically complete regression was noted being justified from both treatment and financial point of view. In the post-procedural period, all patients who were treated with PDT are recommended to: observe the light regime for 3-4 days; adequate pain relief use; hygiene; sexual rest; local treatment. Conclusions. The real advantage of photodynamic therapy associated with vulvar intraepithelial neoplasia is its ability to treat the multifocal disease with minimal tissue destruction, preservation of the vulva anatomy and excellent cosmetic results. These properties confirm the photodynamic therapy to be an effective method in vulvar intraepithelial neoplasia treatment.

Background: Grand rounds and named lectureships are forums in academic medicine for sharing research, scholarly achievements, and clinical expertise. An invitation to speak at grand rounds is regar...

The ideal restoration of a root filled tooth is quite a controversial and a widely discussed topic. Due to its vast filled and clinical expertise required, the coronal rehabilitation of an endodontically treated teeth presents quite a challenge for clinicians. A thorough coronal seal essential for the longevity of the restoration. This review article discuss the factors involved in the clinical decision making and the various restorative options for the posterior post endodontic restorations.

OBJECTIVES: To describe the content of reviews submitted on Yelp that pertain to nursing home physicians. DESIGN: Retrospective qualitative study. SETTING AND PARTICIPANTS: US nursing homes reviewed on Yelp in 2009 - 2018 with reviews that discussed nursing home physicians (N=375 nursing homes in 31 states). MEASUREMENTS: Content analysis was performed to detect recurrent themes and divergent ideas about nursing home physicians perceived by reviewers. RESULTS: Average rating among nursing homes with physician reviews was 2.0 (standard deviation 1.5, range 1-5). The major themes from content analysis of reviews that discussed physicians were perceived attitudes of clinicians toward patients and caregivers, physician communication with patients or caregivers, and perceived clinical expertise of the physicians. CONCLUSION: Unsolicited online reviews of nursing homes that comment on patient and caregiver perceptions of physician care represent a small but growing number of online comments about nursing home. These reviews contain important information about aspects of physician care valued by nursing home patients and caregivers. However, the sample of comments about physicians represents a small proportion of online reviews and is not representative of all nursing homes. As online reviews grow in number and become more representative, these data could be used by physicians to improve perceptions of their care by the NH patients and their families, and by NHs to inform expectations of their medical director and attending physicians.

Requiring family authorization for apnea testing subtracts health professionals control over death determination, a procedure that has traditionally been considered a matter of clinical expertise a...

Exposure to retained metal fragments from war-related injuries can result in increased systemic metal concentrations, thereby posing potential health risks to target organs far from the site of injury. Given the large number of veterans who have retained fragments and the lack of clear guidance on how to medically manage these individuals, the Department of Veterans Affairs (VA) convened a meeting of chelation experts and clinicians who care for embedded fragment patients to discuss current practices and provide medical management guidance. Based on this group's clinical expertise and review of published literature, the evidence presented suggests that, at least in the case of lead fragments, short-term chelation therapy may be beneficial for embedded fragment patients experiencing acute symptoms associated with metal toxicity; however, in the absence of clinical symptoms or significantly elevated blood lead concentrations (greater than 80 µg/dL), chelation therapy may offer little to no benefit for individuals with retained fragments and pose greater risks due to remobilization of metals stored in bone and other soft tissues. The combination of periodic biomonitoring to assess metal body burden, longitudinal fragment imaging, and selective fragment removal when metal concentrations approach critical injury thresholds offers a more conservative management approach to caring for patients with embedded fragments.

The American Academy of Orthopaedic Surgeons has developed Appropriate Use Criteria for the Management of Surgical Site Infections (SSIs) (website: http://www.orthoguidelines.org/go/auc/default.cfm?auc_id=225018&actionxm=Terms). Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The Appropriate Use Criteria for the Management of SSIs were derived by identifying clinical indications typical of patients commonly presenting with a SSI in clinical practice. These indications were most often parameters observable by the clinician, including symptoms and diagnostic tests. The 264 patient scenarios and nine treatments were developed by the writing panel, which consisted of a group of clinicians who are specialists in this Appropriate Use Criteria topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a nine-point scale to designate a treatment as appropriate (median rating, seven to nine), may be appropriate (median rating, four to six), or rarely appropriate (median rating, one to three).

Machine learning (ML) applications have received extensive attention in endocrinology research during the last decade. This review summarizes the basic concepts of ML and certain research topics in endocrinology and metabolism where ML principles have been actively deployed. Relevant studies are discussed to provide an overview of the methodology, main findings, and limitations of ML, with the goal of stimulating insights into future research directions. Clear, testable study hypotheses stem from unmet clinical needs, and the management of data quality (beyond a focus on quantity alone), open collaboration between clinical experts and ML engineers, the development of interpretable high-performance ML models beyond the black-box nature of some algorithms, and a creative environment are the core prerequisites for the foreseeable changes expected to be brought about by ML and artificial intelligence in the field of endocrinology and metabolism, with actual improvements in clinical practice beyond hype. Of note, endocrinologists will continue to play a central role in these developments as domain experts who can properly generate, refine, analyze, and interpret data with a combination of clinical expertise and scientific rigor.

Aim The study aimed to assess the self-rated knowledge, attitude toward, and practice (KAP) of evidence-based medicine (EBM) among resident doctors in Nigeria. Methods This was a cross-sectional web-based survey among 238 resident doctors in four selected teaching hospitals in southern Nigeria. Survey questionnaire contained items assessing the KAP of EBM, familiarity with and understanding of key EBM terms, the use of EBM in decision making, barriers militating against EBM and ways to improve EBM adoption. Proportions and summary statistics were reported for the distribution of survey items. Results Mean number of years in clinical practice was 9.3 ± 4.5 years. Respondents were uniformly distributed in major clinical specialties. The majority (70.5%) were senior registrars. Respondents' understanding of EBM components included; current best clinical evidence (98.3%), clinical expertise (65.5%), and patients' choices (36.6%). Self-rated familiarity with EBM terms was high while perceived understanding of the terms was lower. The least understood concept was heterogeneity (20.6%). The attitude toward EBM was generally positive. Only about half (53.6%) had used medical bibliographic databases within the last 6 months prior to the survey. Barriers against EBM included lack of time (47.1%) and lack of requisite skills (32.4%). Suggestions to improve EBM adoption included training (58.1%), provision of free Wi-Fi, and free access to bibliographic databases (25.2%) and increased political will (23.1%). Conclusion A further understanding of the EBM concept, provision of enabling infrastructure, regular clinical audit and advocacy to hospital management and clinical consultants, may improve the level of adoption of EBM.

Objective: To assess the prevalence of intuitive decision-making (IDM) among health care practitioners (HCPs) and explore its person- and job-specific factors. Design and Outcome Measures: We used on-line survey data from a cross-sectional sample of Hungarian physicians and nurses (N = 460) to assess their reliance on IDM. In a second survey we asked physicians (N = 104) to rate medical specialties on dimensions of ‘emergency’ (necessity of making instantaneous decisions in unforeseeable situations) and ‘complexity’ (necessity of considering multiple perceptual and diagnostic aspects of patients’ health condition along with diverse treatment options). Results: Altogether 40% of participants reported ever relying on IDM. Using logistic regression analysis, we found the estimated probability of IDM was 0.24 greater for physicians than for nurses, 0.10 greater for females than for males, and 0.11 greater for advanced level HCPs than for novices. Reaching expert level further increased (by 0.31) the probability of IDM for physicians, but not for nurses. Concerning physicians, practicing in a medical specialty of ‘high likelihood of emergency’ or ‘high complexity’ increased the probability of IDM by 0.25 and 0.23; the same effects for nurses were 0.20 and 0.07. We found some (inconclusive) evidence for education positively influencing HCPs’ propensity for IDM. Additionally, we performed content analysis of participants’ free-text answers to explore the psychological background of IDM instances. HCPs educated in the subject of IDM were found more disposed to perform or request further medical investigation, less prone to deviate from medical protocols, apter to reflect on their mental processes, and more inclined to rely on a large scope of information for their decisions. Conclusions: The associations between job- and person-specific factors and HCPs’ propensity for IDM may have implications for their training and allocation in the health care system. Education has great potential for enhancing the quality of IDM in clinical practice.

Sialoliths, needless to say, are an extremely common entity for an otorhinolaryngologist. There’s a parade of causation behind the same. Parotid duct stone relatively stands as an uncommon occurrence. Not only proper and timed diagnosis arise as an important factor, but also clinical expertise and diagnostic simplicity play a vital role in providing patient relief. Keywords: Marsupialization, Stensens duct, Parotid duct, Parotid sialolith, Sialolithiasis, Salivary stone.

National audience; Les études scientifiques interventionnelles de remédiation de la dyslexie développementale sont généralement fondées sur des hypothèses causales d'une altération plus ou moins exclusive des traitements phonologique, visuo-attentionnel ou de l'intégration intermodalitaire. Or, des études récentes montrent que la cause de la dyslexie développementale est multifactorielle et que la majorité des lecteurs dyslexiques (LD) présentent plusieurs déficits cognitifs sous-jacents. L'originalité de cette étude longitudinale multicentrique, randomisée et croisée, est de proposer un protocole de remédiation multimodale (DDMR) composé de trois interventions (phonologique, visuo-attentionnelle et intermodalitaire) dans un contexte clinique de soin. Ainsi, les entraînements sont adaptés au profil cognitif et au profil de lecture de chaque LD selon une prescription individuelle de soins fondée sur l'expertise clinique de l'orthophoniste. Cette étude menée auprès de 120 LD (âgés de 8 à 13 ans) se déroule en trois phases : une première phase « contrôle pré-intervention » pendant deux mois, une deuxième phase « intervention avec entraînement intensif » pendant six mois et une troisième phase « contrôle post-intervention » pendant deux mois. La deuxième phase est constituée des trois interventions possibles avec un contrebalancement de l'ordre des deux premières interventions (phonologique et visuo-attentionnelle) entre les deux groupes de participants (n=60 pour chaque groupe). La présentation d'un cas unique illustre le protocole de soin et montre une normalisation de l'âge de lecture qui se maintient après l'arrêt de l'intervention. Les résultats préliminaires de cette étude de groupe sont encourageants dans la perspective de valider une alternative thérapeutique curative fondée sur les preuves dans le traitement des dyslexies développementales. Mots-clés : Dyslexie, intervention multimodale, essai clinique randomisé, expertise clinique, cas unique.

Oedema in the hands of people with tetraplegia may occur in the early stages of rehabilitation and if left untreated, can cause joint stiffness, pain and decreased range of motion, subsequently affecting hand function (Boomkamp-Koppen et al., 2005; Faghri, 1997; Guerts, 2000; Howard & Krishnagiri, 2001; Villeco, 2012). Optimal hand and arm function has been considered as one of the most important factors in improving quality of life of people with tetraplegia (Anderson, 2004; Simpson et al., 2012; Snoek et al., 2004; Wagner et al., 2007). It is therefore important that secondary consequences, such as oedema, are managed effectively. However, there is a significant lack of research evidence specific to the management of oedema in the hands of people with tetraplegia. In response, the aim of this thesis was to build the evidence for improved oedema management in the hands of people with tetraplegia. The evidence-based practice (EBP) framework by Hoffmann et al. (2017) guided the development of the research questions within this research program. The first research question sought to explore clinical expertise and asked: What is the current clinical practice for the management of oedema in the hands of people with tetraplegia in Australia? The second research question sought to develop objective research evidence for the management of oedema and asked: What are the effects of two treatment methods (the Boxing Glove [BG] compression bandaging and Coban��� compression bandaging) for the management of oedema in the hands of people with tetraplegia? Finally, the patient���s perspectives were explored with the third research question: What is the experience of the two treatment methods from the perspective of people with tetraplegia? The research program included two studies. Firstly, an online survey of clinicians addressed the first research question and collected data regarding their perception of cause and prevalence of oedema, assessment and treatment methods, and challenges with oedema management and impacts on rehabilitation. The survey findings identified inconsistent practice methods for the management of oedema in the hands of people with tetraplegia and use of common practices that were not supported by evidence. For example, the BG splint, which is unique to the spinal cord injury (SCI) population, was reportedly used by 53% of the participants of the survey, was considered effective by no participants, and is not supported by any evidence. Compression bandaging, which has shown to be effective amongst other clinical areas, was only considered to be effective by 41% of the participants of the survey and again, lacked any evidence specific to people with tetraplegia. These survey findings informed the second study, which addressed the second and third research questions. A convergent mixed methods design focused on exploring the effects and experiences of two treatment methods used in current clinical practice: the BG compression bandaging and Coban��� compression bandaging. An ABA single case design (SCD) study measured changes in circumferential measurements following application of either the BG compression bandaging or Coban��� compression bandaging. Interpretative description (ID) (Thorne, 2016) guided semi-structured interviews that explored the experience of the two treatment methods from the perspective of people with tetraplegia. Five people with tetraplegia with oedema in their hands, participated in the mixed methods study and the converged analysis of the quantitative and qualitative results led to four key findings. Firstly, there was minimal treatment effect measured and described by participants for the BG compression bandaging. Secondly, Coban��� compression bandaging showed a promising treatment effect in reducing oedema in the hands and was the preferred treatment method among people with tetraplegia. Thirdly, oedema returned once Coban��� compression bandaging was removed and some people with tetraplegia were disappointed as they felt that they could do more with their hands when applied. Finally, people with tetraplegia expressed various priorities for rehabilitation, and managing oedema was not always the focus especially for those with other priorities relating to medical issues. The findings from this research program have contributed to an important first step in building the evidence for oedema management of the hands of people with tetraplegia. The findings provide low-level evidence in regards to the application of two commonly used treatment methods to manage oedema in the hands of people with tetraplegia. This research program identified implications to clinical practice, as well as an evidence-to-practice gap, and provide clear directions for future research and knowledge translation.

Many people would like to die at home, but their loved ones can be nervous about looking after them fearing their own lack of clinical knowledge. Family and local health system engagement told us there was a gap in the provision of non-clinical family education. ‘Last Days Matter’ is the idea of the North Lancashire Compassionate Communities Group, who after research decided to develop their own programme that would support people without clinical expertise to look after their loved ones at home. The Group used their lay and clinical experiences to develop a three-hour programme consisting of five sessions. Each session is made up of a short film that follows the experience of John who is dying, and discussion time. Each session addresses a need that engagement had revealed; planning for the future; to care and accompany; saying goodbye, recognising the signs of dying and the new normal. We learnt that it was necessary to seek funding for professional actors and filming skills so that we could have a programme that would be professional and how important it was to seek the expertise of the patient and public for their feedback on all scripts and teaching materials. The result is a programme that is now ready to be used in local communities and has attracted the interest of North West NHS England and NHS Improvement. The programme will be made available further afield for adoption or adaption. It will support people to care for their loved ones at home by giving them the knowledge, reassurance and some of the necessary skills. Initial feedback from engagement and contributors suggests that ‘Last Days Matter’ is much needed, will be sought after and will be valued by those who need it most. It will also support palliative care staff across the health community.

Hemşirelikte uzmanlık, sorunları bağımsız olarak çözebilme ve sonuçları değerlendirmek için mesleki bilgi ve becerileri kullanma becerisi olarak tanımlanmaktadır. Teknolojik gelişmeler ile sağlık sisteminin değişmesi, bakımın karmaşıklığının ve sorumlulukların artması sonucunda hemşireler bilgiye dayalı olarak hareket etmek istemekte, bu durum uzmanlaşmayı getirmektedir. Akademik uzmanlık, yüksek lisans ve doktora gibi lisansüstü programların veya sertifika programlarının tamamlanmasıyla elde edilen bir unvan olarak ifade edilirken, Benner uzmanlığı klinik deneyime dayandırmaktadır. Benner’e göre uzman hemşire, yararlı olmayan tanı ve çözümler için gereksiz yere düşünmeden ve zaman kaybetmeden durumu kavrayan, doğru tanı ve çözümü üretebilmek için sezgisel bir anlayışa sahip olan kişidir. Uzman hemşire, hız, esneklik, deneyim, sezgisellik ve önemli unsurları belirleyebilme özelliklerine sahiptir. Hemşirelikte uzmanlık, akademik ve klinik uzmanlık olmak üzere iki boyutta karşımıza çıkmaktadır. Hemşireliğin daha bağımsız bir disiplin haline gelebilmesi için bu iki uzmanlık seviyesi birbirinden ayrı düşünülmemelidir. Bu derlemenin amacı, hemşirelikte uzmanlık kavramlarının ele alınması ve ülkemizdeki uzman hemşirelerin mevcut durumunun incelenmesidir., Expertise in nursing is defined as the ability to solve problems independently and to use professional knowledge and skills to evaluate results. As a result of the change in health system, the complexity of care and the increase in responsibilities because of technological developments, nurses want to act based on knowledge, which brings expertise. While academic expertise is expressed as a title obtained through the completion of graduate programs such as master's and doctorate, or certification programmes, Benner bases expertise on clinical experience. According to Benner, an expert nurse is a person who grasps the situation without unnecessary thinking and wasting of time for unhelpful diagnoses and solutions, and has an intuitive understanding to produce the correct diagnosis and solution. The expert nurse has the characteristics of speed, flexibility, experience, intuitiveness and ability to identify important elements. Nursing expertise comes in two dimensions: academic and clinical expertise. In order for nursing to become a more independent discipline, these two levels of expertise should not be considered separately. The purpose of this review is to address the concepts of expertise in nursing and to examine the current situation of expert nurses in our country.

Community acquired pneumonia (CAP) is an acute respiratory disease with a high mortality rate. CAP management follows clinical and radiological diagnosis, severity evaluation and standardised treatment protocols. Although established in practice, protocols are labour intensive, time-critical and can be error prone, as their effectiveness depends on clinical expertise. Thus, an approach for capturing clinical expertise in a more analytical way is desirable both in terms of cost, expediency, and patient outcome. This paper presents a systematic literature review of Machine Learning (ML) applied to CAP. A search of three scholarly international databases revealed 23 relevant peer reviewed studies, that were categorised and evaluated relative to clinical output. Results show interest in the application of ML to CAP, particularly in image processing for diagnosis, and an opportunity for further investigation in the application of ML; both for patient outcome prediction and treatment allocation. We conclude our review by identifying potential areas for future research in applying ML to improve CAP management. This research was co-funded by the NIHR Leicester Biomedical Research Centre and the University of Leicester.

PICO question In cats with diabetes mellitus, do protamine zinc insulin (PZI) and glargine show a similar effect in reducing clinical signs and hypoglycaemia episodes? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed The number and type of study designs that were critically appraised was one. This study was a non-randomised retrospective trial. A systematic review was also found, which analyses the influence of insulin in diabetic remission Strength of evidence Weak Outcomes reported Compared to PZI, using glargine in recently diagnosed diabetic cats fed exclusively an ultra-low carbohydrate-high protein canned diet, may result in lower fructosamine and mean 12 hour blood glucose concentrations as well as less episodes of hypoglycaemia Conclusion In view of the strength of evidence and the outcomes from the study the following conclusion is made: in cats with diabetes mellitus where currently licensed insulin fails to result in a good glycaemic control, glargine may be considered How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Evidence based nursing mainly focus on providing the best nursing care according to personnel clinical expertise and that should be in combination with the current available research topic and making quality decision. Practice based on evidence requires the incorporation of experienced staffs, involvement of research utilization into the clinical decision in order to guide the nursing care for patient welfare. 1 The ultimate aim and goal of the study was to impart the information awareness of the final year B.Sc nursing students regarding the evidence based practice. The pre experimental research design was used to carry out the study in selected nursing colleges at Bangalore among the 400 final year B.Sc nursing students and purposive sampling technique was used for the selection of students. The study results reported that there was vast disparity between pre test and post test knowledge score amongst the final year nursing students after the implementation of teaching programme and nursing students acquired the adequate information on evidence based practice after attending the teaching programme. Keywords: EBP, EBN, STP, Information awareness, Final year nursing students, Nursing colleges.

One of the most important ways that a mental health nurse develops their clinical expertise is by reflecting on their professional experiences. Previous articles in this series have examined some of the key elements of reflection and how these can be developed and incorporated into routine clinical practice for ongoing development. This formative approach to reflective practice helps build clinical expertise as a nurse moves from novice student to expert practitioner. While post-registration degrees and courses can help a nurse gain new ideas and knowledge, it is the learning gained from self-reflection on lived clinical and professional experiences, termed ‘experiential learning’ that will enable a nurse to move along the novice to expert continuum.

Patients are central to healthcare clinicians and organizations but often subsidiary to clinical expertise, knowledge, workplace processes, and culture. Shifting societal values, technology, and regulations have remoulded the patient-clinician relationship, augmenting the patient’s voice within the healthcare construct. Scaffolding this restructure is the global imperative to deliver person-centered care (PCC). The aim of the scoping review was to explore and map the intersection between patient feedback and strategies to improve the provision of PCC within acute hospitals in Australia. Database searches yielded 493 articles, with 16 studies meeting inclusion criteria. Integration of patient feedback varied from strategy design, through to multi-staged input throughout the initiative and beyond. Initiatives actioning patient feedback fell broadly into four categories: clinical practice, educational strategies, governance, and measurement. How clinicians can invite feedback and support patients to engage equally remains unclear, requiring further exploration of strategies to propel clinician-patient partnerships, scaffolded by hospital governance structures.

Evidence-based Medicine (EBM) reflects a combination of clinical expertise, patient’s values, and best available evidence in the decision-making process related to healthcare. In EBM, the medical professional prescribe medicine based on information from previous medical records (which is available in textual format). This information is often used in clinical practice and recently proved to be very useful in predicting diseases with computational approaches. This paper presents an extensive dataset of 11.8K patient descriptions of the most common 20 diseases, and contribute to their classification through unpretentious supervised machine learning techniques. After rigorous experiments under the Monte Carlo method, we found Random Forest Trees (RFT) outperformed all algorithms by achieving the overall highest accuracy of 83%, followed by Linear-Support Vector Machines (SVM) with 81% accuracy.

International audience; Purpose: Surgical Data Science (SDS) is an emerging research domain offering data-driven answers to challenges encountered by clinicians during training and practice. We previously developed a framework to assess quality of practice based on two aspects: exposure of the surgical scene (ESS) and the surgeon’s profile of practice (SPP). Here, we wished to investigate the clinical relevance of the parameters learned by this model by (1) interpreting these parameters and identifying associated representative video samples and (2) presenting this information to surgeons in the form of a video-enhanced questionnaire. To our knowledge, this is the first approach in the field of SDS for laparoscopy linking the choices made by a machine learning model predicting surgical quality to clinical expertise.Method: Spatial features and quality of practice scores extracted from labeled and segmented frames in 30 laparoscopic videos were used to predict the ESS and the SPP. The relationships between the inputs and outputs of the model were then analyzed and translated into meaningful sentences (statements, e.g., “To optimize the ESS, it is very important to correctly handle the spleen”). Representative video clips illustrating these statements were semi-automatically identified. Eleven statements and video clips were used in a survey presented to six experienced digestive surgeons to gather their opinions on the algorithmic analyses.Results: All but one of the surgeons agreed with the proposed questionnaire overall. On average, surgeons agreed with 7/11 statements.Conclusion: This proof-of-concept study provides preliminary validation of our model which has a high potential for use to analyze and understand surgical practices.

PICO question In routine canine caesareans, is alfaxalone a superior anaesthetic induction agent than propofol in increasing the rate of survival and vigour of neonates? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Three randomised positive clinical trials have compared the efficacy between alfaxalone and propofol in routine canine caesarean sections for increased neonatal survival and vigour Strength of evidence Weak Outcomes reported Although two studies found alfaxalone to be associated with higher Apgar scores for neonates than propofol, each study nonetheless revealed positive vigour and high survival rates from the use of either alfaxalone or propofol. The evidence is too weak to suggest that one induction agent is superior to another. The selection between the two induction agents may not be the main concern in regard to neonatal depression and 24 hour survival post-delivery, provided that the entire canine caesarean protocol is thoroughly and carefully studied Conclusion The evidence is too weak to suggest that alfaxolone or propofol is superior to another during canine cesareans. There is no signifcant difference seen in neonatal survival rate and vigour when using either alfaxolone or propofol How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Analyzing clinical data comes with many challenges. Medical expertise combined with statistical and programming knowledge must go hand-in-hand when applying data mining methods on clinical datasets. This work aims at bridging the gap between clinical expertise and computer science knowledge by providing an application for clinical data analysis with no requirement for statistical programming knowledge. Our tool allows clinical researchers to conduct data processing and visualization in an interactive environment, thus providing an assisting tool for clinical studies. The application was experimentally evaluated with an analysis of Type 1 Diabetes clinical data. The results obtained with the tool are in line with the domain literature, demonstrating the value of our application in data exploration and hypothesis testing.

Medicine in the twentieth century was practiced by highly esteemed physicians trained by even more esteemed professors, whose statements you would not dare to question. With the rise of scientific research and discoveries, new medicines, surgical techniques, and insights into the origin of diseases emerged. A peptic ulcer, for example, was initially seen as a manager's disease due to stress and excessive gastric acid, for which sometimes even extensive, risky surgical procedures were performed. This approach changed radically after the discovery of the bacterium causing the disease (Helicobacter pylori). Barry Marshall was awarded the Nobel Prize for this discovery in 2005. Treatment using medicine became the standard and surgeries disappeared.