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Summary: There is more and more online information available at our fingertips, but how do we efficiently identify and extract relevant information for good clinical decision making? The aim of this review article is to provide equine professionals with the building blocks to be able to develop skills for expertly navigating the scientific literature in a timely fashion. This includes what key questions you need to ask before starting (why am I searching and how much time do I have), where the best places are to search and how to find freely available legal copies of papers (articles, conference proceedings, book chapters and dissertations). Additionally, how to best conduct an information search and what you get from searches of varying comprehensiveness. Finally, this article will cover where to find databases of research syntheses where others have already carried out the hard work for you and some advanced techniques which are likely to save you substantial amounts of time. This article draws together expertise from a panel of veterinary clinicians, nurses and technicians, information specialists and librarians and clinical researchers. [ABSTRACT FROM AUTHOR]

Evidence‐based medicine (EBM), one of the most important movements in health care, has been a lightning rod for controversy. Conflicts about the meaning and value of EBM are owing in part to lack of clarity about basic questions regarding its development, the importance of expertise and intuition, and the role of evidence in clinical decision making. These issues have persisted in part because of unclarity at the outset, but also because of how EBM evolved, why it was introduced when it was, and how it was modified following its introduction. This paper traces the evolution of EBM from clinical epidemiology (CE) and the internal dispute that precipitated the developers to establish EBM as a distinct approach to clinical practice. The paper proposes that health care industrialization also had a significant role in EBM's emergence and that industrialization influenced the decision to merge EBM with the method of normative decision making known as decision analysis (DA). The paper discusses the impact of this merger, in particular how it led to EBM's identification with managed care and has added momentum to the effort at forging a connection between a normative decision model and clinical judgement. This effort would turn clinical decision making into a conduit for bringing administrative rules and regulations into the consulting room and would result in expertise becoming a surplus skill. The paper closes by discussing a challenge yet unmet by EBM's advocates and critics—to chronicle the dangers that EBM in the framework of DA during the current era of industrialization poses to health and health care, and discover ways of unhinging the relationship between model and judgement. [ABSTRACT FROM AUTHOR]

This article draws on 2 years' worth of ethnographic observation of team meetings to explore decision‐making in an NHS clinical genomics service. The focus of discussions was on ambiguous genomic results known as VUS or Variants of Uncertain Significance, which may be pathogenic but which also may turn out to be benign. In examining decision‐making around such results, we note how, in contrast to much policy and promotional material in this area, clinicians in these meetings (clinical geneticists and genetic counsellors) place great emphasis on parental phenotypes and whether the parents of a patient share the symptoms and signs of the suspected condition. This information is then combined with the result of genomic tests to decide whether the variant a patient has is responsible for their condition. This article explores the way in which clinicians attempt to flexibly enrol parents into genomic explanations through informal diagnosis of their possible phenotypes and the way in which actually meeting parents allows some clinicians to trump explanations based on documentary or photographic data. The paper sheds light on the way that earlier scholarly understandings of such decisions (around, say dysmorphology) remain relevant and explores claims that laboratory tests overrule clinical decision‐making. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of literature describing how surgeons (either novice or expert) mentally prepare to carry out a surgical procedure. This paper focuses on these processes, and is part of a larger piece of research based on the Royal Australasian College of Surgeons (RACS) Clinical Decision Making model. Methods: Interviews were conducted over a 3‐year period with registrars, trainees, fellows and consultants in the Department of Surgery at one large regional hospital in Victoria. Analysis began from the first interview with no pre‐conceived codes. Emerging themes were drawn from participants' interpretation of their experiences. Further information was obtained during discussions in theatre while patients were being prepared for surgery. Results: The findings show that the process of rehearsal changes as a surgeon gains more experience in a procedure. A 'novice' relies on external sources of information, for example textbooks and videos. After participating in a number of similar procedures their reliance gradually moves to their own sensory memories. Surgeons at all levels of experience discuss their preparations with peers, colleagues, senior clinicians, and where appropriate, with members of other disciplines. Conclusion: These findings offer insight into how surgeons, at different levels of experience, prepare for a procedure. These understandings have the potential to improve the teaching and learning of this essential component of surgical practice. [ABSTRACT FROM AUTHOR]

Despite the great promises that artificial intelligence (AI) holds for health care, the uptake of such technologies into medical practice is slow. In this paper, we focus on the epistemological issues arising from the development and implementation of a class of AI for clinical practice, namely clinical decision support systems (CDSS). We will first provide an overview of the epistemic tasks of medical professionals, and then analyse which of these tasks can be supported by CDSS, while also explaining why some of them should remain the territory of human experts. Clinical decision making involves a reasoning process in which clinicians combine different types of information into a coherent and adequate 'picture of the patient' that enables them to draw explainable and justifiable conclusions for which they bear epistemological responsibility. Therefore, we suggest that it is more appropriate to think of a CDSS as clinical reasoning support systems (CRSS). Developing CRSS that support clinicians' reasoning process therefore requires that: (a) CRSSs are developed on the basis of relevant and well‐processed data; and (b) the system facilitates an interaction with the clinician. Therefore, medical experts must collaborate closely with AI experts developing the CRSS. In addition, responsible use of an CRSS requires that the data generated by the CRSS is empirically justified through an empirical link with the individual patient. In practice, this means that the system indicates what factors contributed to arriving at an advice, allowing the user (clinician) to evaluate whether these factors are medically plausible and applicable to the patient. Finally, we defend that proper implementation of CRSS allows combining human and artificial intelligence into hybrid intelligence, were both perform clearly delineated and complementary empirical tasks. Whereas CRSSs can assist with statistical reasoning and finding patterns in complex data, it is the clinicians' task to interpret, integrate and contextualize. [ABSTRACT FROM AUTHOR]

Medical diagnosis has traditionally been the role of medical officers. However, mental health nurses working in crisis/emergency settings within Australia are expected to provide a provisional diagnosis postassessment of a consumer. There is limited literature and understanding how mental health nurses develop a provisional diagnosis. In this scoping review, we aimed to first identify and describe the clinical decision‐making processes used by mental health nurses across a variety of clinical settings. Second, we sought to explore the factors influencing mental health nurse's diagnostic practice in a variety of settings. Literature was searched using CINAHL (EBSCOhost), PubMed, and ProQuest. Peer‐reviewed literature published between 2007 and 2017 was used for this scoping review. Two major themes were identified: clinical decision making (CDM) in mental health nursing and diagnostic practice in nursing. A combination of clinician, environmental, and patient factors were found to have influenced CDM. Furthermore, mental health nurses rely heavily on tacit knowledge when making clinical decisions. Little is known about the use of diagnostic practice in mental health nursing in Australia; however, the limited literature revealed an overlap between the factors which influence CDM and diagnostic practice, respectively. Further research is needed into the use of diagnostic practice in mental health nursing to develop frameworks to assist with CDM pertaining to application of provisional diagnosis by mental health nurses working in assessment environments. [ABSTRACT FROM AUTHOR]

This study was conducted to investigate the effect of web‐based teaching on paediatric nursing internship students' self‐confidence and anxiety levels in the clinical decision‐making process. The study sample consisted of 61 students who received internship training in the Pediatric Nursing department. There were 30 students in the control group and 31 students in the experimental group. Data were collected using a sociodemographic form, and nursing anxiety and self‐confidence levels were measured using a clinical decision‐making scale. The data were analysed using a t test, a Mann‐Whitney U test, a correlation analysis, and a regression analysis, along with power and effect size. The self‐confidence scores of the experimental group were higher than the scores of the control group (p < 0.05), and the anxiety scores of the experimental group were lower than the scores of the control group (p < 0.05). The web‐based training program accounted for 17.8% of the change in self‐confidence and 12.8% of the change in anxiety level. Therefore, the web‐based training program was effective in increasing nursing students' self‐confidence levels and decreasing their anxiety levels in the clinical decision‐making process. Lay Description: Problem There is a general lack of an identified theoretical framework of "Effect of Web‐Based Education on Self‐Confidence and Anxiety Levels of Pediatric Nursing Interns in Clinical Decision‐Making Process."What is already known Web‐based education are effective educational methods to improve the learning outcome through nursing intern student knowledge and practice. But there is not enough information about the effect of web‐based education on self‐confidence and anxiety levels of paediatric nursing interns in clinical decision‐making process.What this paper adds This study provides evidence for web‐based education effect the self‐confidence and anxiety levels of paediatric nursing interns in clinical decision‐making process. [ABSTRACT FROM AUTHOR]

Abstract: In spite of substantial spending and resource utilization, today's health care remains characterized by poor outcomes, largely due to overuse (overtesting/overtreatment) or underuse (undertesting/undertreatment) of health services. To a significant extent, this is a consequence of low‐quality decision making that appears to violate various rationality criteria. Such suboptimal decision making is considered a leading cause of death and is responsible for more than 80% of health expenses. In this paper, we address the issue of overuse or underuse of health care interventions from the perspective of rational choice theory. We show that what is considered rational under one decision theory may not be considered rational under a different theory. We posit that the questions and concerns regarding both underuse and overuse have to be addressed within a specific theoretical framework. The applicable rationality criterion, and thus the “appropriateness” of health care delivery choices, depends on theory selection that is appropriate to specific clinical situations. We provide a number of illustrations showing how the choice of theoretical framework influences both our policy and individual decision making. We also highlight the practical implications of our analysis for the current efforts to measure the quality of care and link such measurements to the financing of health care services. [ABSTRACT FROM AUTHOR]

The 2021 virtual issue of the Health Information and Libraries Journal is published to link to the Future Technologies Conference 2021, which takes place in Vancouver, Canada, 28–29 October 2021. This event, which began in 2016, presents the best of current systems research and practice. One of the themes of the 2021 conference is Smart Healthcare. Although libraries may appear to be far removed from some of the breakthroughs reported in the Future Technologies Conference, what is clear is that unlike those who work with technology, librarians work closely with the end users of health information—clinicians, managers, students, patients and the general public. The articles included in this virtual issue provide important insights into what library user groups want and what does and does not meet their needs. [ABSTRACT FROM AUTHOR]

Objectives: This paper explores the practice of patient-centred care (PCC) within dentistry. The aim of this research was to explore the barriers and opportunities dentists face in practicing PCC. Methods: The results of N = 20 thematically analysed, in-depth semi-structured qualitative interviews with a range of dentists working across clinical and teaching positions within a large UK dental school are presented. Results: PCC was generally considered a positive, to be embraced concept which dentists believe they practice daily in the absence of any formal training. PCC presented dentists with opportunities to deliver treatment to highly compliant patients. The main barriers revolved around patients (e.g. disengaged or overly inquisitive) and practice factors (e.g. time and funding). Conclusions: PCC is a concept that is generally seen as important in the dental surgery, presenting dentists with opportunities for compliance-enhanced practice. Significant work is needed if dentists are going to be supported in overcoming self-identified barriers to their delivery of PCC as per UK General Dental Council guidelines. [ABSTRACT FROM AUTHOR]

INTRODUCTION: We describe the development and feasibility of using an online consensus approach for diagnosing cognitive impairment and dementia in rural South Africa. METHODS: Cognitive assessments, clinical evaluations, and informant interviews from Cognition and Dementia in the Health and Aging in Africa Longitudinal Study (HAALSI Dementia) were reviewed by an expert panel using a web‐based platform to assign a diagnosis of cognitively normal, mild cognitive impairment (MCI), or dementia. RESULTS: Six hundred thirty‐five participants were assigned a final diagnostic category, with 298 requiring adjudication conference calls. Overall agreement between each rater's independent diagnosis and final diagnosis (via the portal or consensus conference) was 78.3%. A moderate level of agreement between raters' individual ratings and the final diagnostic outcomes was observed (average κ coefficient = 0.50). DISCUSSION: Findings show initial feasibility in using an online consensus approach for the diagnosis of cognitive impairment and dementia in remote, rural, and low‐resource settings. [ABSTRACT FROM AUTHOR]

Rationale, Aims and Objectives: The development of clinical practice guidelines (CPG) suffers from the lack of an explicit and transparent framework for synthesising the key elements necessary to formulate practice recommendations. We matched deliberations of the American Society of Haematology (ASH) CPG panel for the management of pulmonary embolism (PE) with the corresponding decision‐theoretical constructs to assess agreement of the panel recommendations with explicit decision modelling. Methods: Five constructs were identified of which three were used to reformulate the panel's recommendations: (1) standard, expected utility threshold (EUT) decision model; (2) acceptable regret threshold model (ARg) to determine the frequency of tolerable false negative (FN) or false positive (FP) recommendations, and (3) fast‐and‐frugal tree (FFT) decision trees to formulate the entire strategy for management of PE. We compared four management strategies: withhold testing versus d‐dimer → computerized pulmonary angiography (CTPA) ('ASH‐Low') versus CTPA→ d‐dimer ('ASH‐High') versus treat without testing. Results: Different models generated different recommendations. For example, according to EUT, testing should be withheld for prior probability PE < 0.13%, a clinically untenable threshold which is up to 15 times (2/0.13) below the ASH guidelines threshold of ruling out PE (at post probability of PE ≤ 2%). Three models only agreed that the 'ASH low' strategy should be used for the range of pretest probabilities of PE between 0.13% and 13.27% and that the 'ASH high' management should be employed in a narrow range of the prior PE probabilities between 90.85% and 93.07%. For all other prior probabilities of PE, choosing one model did not ensure coherence with other models. Conclusions: CPG panels rely on various decision‐theoretical strategies to develop its recommendations. Decomposing CPG panels' deliberation can provide insights if the panels' deliberation retains a necessary coherence in developing guidelines. CPG recommendations often do not agree with the EUT decision analysis, widely used in medical decision‐making modelling. [ABSTRACT FROM AUTHOR]

Rationale, Aims and Objectives: Critics have charged that evidence‐based medicine (EBM) overemphasises algorithmic rules over unstructured clinical experience and intuition, but the role of structured decision support systems in improving health outcomes remains uncertain. We aim to assess if delivery of anticoagulant prophylaxis in hospitalised patients with COVID‐19 according to an algorithm based on evidence‐based clinical practice guideline (CPG) improved clinical outcomes compared with administration of anticoagulant treatment given at individual practitioners' discretion. Methods: An observational design consisting of the analysis of all acutely ill, consecutive patients (n = 1783) with confirmed COVID‐19 diagnosis admitted between 10 March 2020 to 11 January 2022 to an US academic center. American Society of Haematology CPG for anticoagulant prophylaxis in hospitalised patients with COVID‐19 was converted into a clinical pathway and translated into fast‐and‐frugal decision (FFT) tree ('algorithm'). We compared delivery of anticoagulant prophylaxis in hospitalised patients with COVID‐19 according to the FFT algorithm with administration of anticoagulant treatment given at individual practitioners' discretion. Results: In an adjusted analysis, using combination of Lasso (least absolute shrinkage and selection operator) and propensity score based weighting [augmented inverse‐probability weighting] statistical techniques controlling for cluster data, the algorithm did not reduce death, venous thromboembolism, or major bleeding, but helped avoid longer hospital stay [number of patients needed to be treated (NNT) = 40 (95% CI: 23–143), indicating that for every 40 patients (23–143) managed on FFT algorithm, one avoided staying in hospital longer than 10 days] and averted admission to intensive‐care unit (ICU) [NNT = 19 (95% CI: 13–40)]. All model's selected covariates were well balanced. The results remained robust to sensitivity analyses used to test the stability of the findings. Conclusions: When delivered using a structured FFT algorithm, CPG shortened the hospital stay and help avoided admission to ICU, but it did not affect other relevant outcomes. [ABSTRACT FROM AUTHOR]

National Health Service (NHS) knowledge and library services in England are integrating digital advances into their systems and services. Health Education England (HEE) leads on the development of NHS library services. A key workstream focuses on (1) improving the infrastructure to enable discovery and management of digital knowledge resources; (2) collaborating with local teams to establish regional library management systems that are integrated with the new national discovery service for healthcare staff and learners. This article explores initiatives on resource discovery as well as the need for system‐wide partnership working to ensure that biomedical knowledge in computable form is findable, accessible, interoperable and reusable. Low levels of health and digital literacy pose a significant barrier to using health information and accessing health services. A range of interventions are aimed at enhancing citizens' digital and health literacy skills. The education and life‐long learning needs of the knowledge and library services workforce are considered. Working with CILIP and higher education institutions, HEE delivers a range of educational offers through its Learning Academy. As Artificial Intelligence and automation are implemented in health systems, knowledge and library staff form a crucial bridge between technology and those who use it. [ABSTRACT FROM AUTHOR]

Technology advances and collaborations with information technology and computer science groups have enabled library services to expand into new domains. Listening to user needs, eliminating administrative burden and saving users time remain strong foundations on which to build new library services enabled by technology. Examples of what is now possible is described, including service to user groups, successes, failures and challenges. Although technology advances have enabled library service enhancements to all user groups, special emphasis on new library services in support of the research enterprise is discussed. As Lindberg and Humphreys predicted in 2015, the research enterprise's need for responsible curation of research data has created new opportunities for library services and examples of those services are discussed. As technology continues to advance, new library services are expected to emerge. These may include regulatory and compliance services. By developing these services with user feedback to save users time and expedite their work, and in collaboration with technology experts, libraries can expect to offer sustainable and valued services for years to come. [ABSTRACT FROM AUTHOR]

Background: Enteral nutrition (EN) is an integral component of standard management of critically ill patients in intensive care. However, achieving adequate nutrition in this environment continues to present many challenges. Design: A descriptive exploratory design using a retrospective review of medical records. Aims and objectives: The aims of this study were to describe nursing practice associated with EN feeding and identify barriers to optimal nutritional delivery in the intensive care unit (ICU). Methods: Patients admitted to a major Australian metropolitan health service ICU during a 6‐month period, and who received EN for at least 72 hours, were eligible for inclusion. Documented text from patient medical records was analysed using content analysis. Numerical data were analysed using SPSS software (version 25.0). Descriptive and inferential statistics were calculated. Results: A total of 150 patients were included in the study. The mean time from admission to EN commencement was 12.6 hours, with 59.3% commenced within 12 hours of admission. Only 9.3% of patients commenced EN at the target rate. Of the 150 patients, 24 (16%) received 80% of nutrition targets within 72 hours of admission. Patients who had EN commenced within 12 hours of admission and at the target rate were significantly more likely to achieve nutritional requirements (P = <.01). Patients who received an initial dietitian review within 24 hours of admission were more likely to achieve nutrition requirements (P = <.01). Conclusions: Commencing EN on time and meeting target volumes remains challenging in the ICU patient. Airway management, procedural requirements, and delayed dietitian review for prescribed hourly rate initiation provide barriers to optimal nutrition delivery to critically ill patients. Tackling these barriers may require interdisciplinary interventions. Relevance to clinical practice: Providing adequate nutrition to critically ill patients is challenging. This study provides evidence that day's one and two are problematic to EN delivery; particularly concerning airway management, procedural requirements, and delayed dietitian review for prescribed hourly rate initiation. Highlighting the need for further research into these aspects of nutrition management. [ABSTRACT FROM AUTHOR]

With a pair of oppositely valenced stimuli, rating the first one sometimes leads to a more extreme evaluation for the second (e.g., if the second is negatively valenced, rating the first stimulus would lead to a more negative rating for the second). We considered an evaluation bias in the case of clinical diagnosis relating to eating disorders. A population sample which included experienced clinical psychologists and psychiatrists showed partial evidence of an evaluation bias, when judging descriptions of individuals designed to be consistent with eating disorders or not. Quantum probability theory, the probability rules from quantum mechanics without any of the physics, is particularly well‐suited to modeling the evaluation bias (and constructive influences generally), because a measurement (or judgment) can change the state of the system. We applied a previous quantum model to the present result, an extension of the model embodying noisy processes, and belief adjustment model. We discuss how model fits inform an examination of rationality in the observed behavior. There has been evidence of so‐called constructive influences in decision making, whereby a decision appears to alter the underlying mental state. We explore such influences in the case of clinical judgments, based on realistic case information. Can such constructive influences be rational? We apply two models to the data, one based on quantum theory and one on heuristics, as a way to address this question and understand relevant behaviour better. [ABSTRACT FROM AUTHOR]

The wide‐scale adoption of electronic health records (EHRs) provides extensive information to support precision medicine and personalized health care. In addition to structured EHRs, we leverage free‐text clinical information extraction (IE) techniques to estimate optimal dynamic treatment regimes (DTRs), a sequence of decision rules that dictate how to individualize treatments to patients based on treatment and covariate history. The proposed IE of patient characteristics closely resembles "The clinical Text Analysis and Knowledge Extraction System" and employs named entity recognition, boundary detection, and negation annotation. It also utilizes regular expressions to extract numerical information. Combining the proposed IE with optimal DTR estimation, we extract derived patient characteristics and use tree‐based reinforcement learning (T‐RL) to estimate multistage optimal DTRs. IE significantly improved the estimation in counterfactual outcome models compared to using structured EHR data alone, which often include incomplete data, data entry errors, and other potentially unobserved risk factors. Moreover, including IE in optimal DTR estimation provides larger study cohorts and a broader pool of candidate tailoring variables. We demonstrate the performance of our proposed method via simulations and an application using clinical records to guide blood pressure control treatments among critically ill patients with severe acute hypertension. This joint estimation approach improves the accuracy of identifying the optimal treatment sequence by 14–24% compared to traditional inference without using IE, based on our simulations over various scenarios. In the blood pressure control application, we successfully extracted significant blood pressure predictors that are unobserved or partially missing from structured EHR. [ABSTRACT FROM AUTHOR]

Dietitians learn clinical decision making (CDM) predominantly as an autonomous cognitive process that considers the needs and preferences of the patient. Although interprofessional education is increasing in tertiary dietetic programmes, a paucity of research exists that explores the nature of how practising dietitians make decisions, independent or otherwise. This qualitative interpretative study explored the nature of experienced dietitian CDM in the acute care setting. Philosophical hermeneutic principles guided text construction and interpretation via in‐depth, semi‐structured interviews with practising dietitians with at least 3 years of experience. A reference focus group commented on the emerging findings, increasing the rigour of the research. Ten dietitians participated in the interviews and there were five dietitians in the reference focus group. CDM was found to be a highly social phenomenon with varying degrees of autonomy involving complex power relations with various other health professionals, in particular, medical practitioners. Dietitians respond to existing power relations in key ways, including building and maintaining relationships, advocating on behalf of the patient and negotiating decisions with other healthcare staff when in pursuit of improved health and nutrition related outcomes for patients. Strategic interprofessional communication skills are foundational to effective patient care and advancing the role of the dietitian. Power and autonomy in dietitian CDM are important concepts that could inform interprofessional education when seeking to promote both effective dietetic and interprofessional practice. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy (taking ≥ five medications) is common and associated with adverse drug events, medication nonadherence, and increased mortality and healthcare costs. Primary care providers are uniquely positioned to deprescribe unnecessary medications, yet little is known about factors that influence their deprescribing decisions. Objectives: We sought to identify factors that influence primary care providers' recommendations to deprescribe potentially unnecessary medications. Methods: This study represents a secondary data analysis from a national, cross‐sectional survey assessing providers' beliefs, attitudes, and experiences regarding medication deprescribing. A random sample of 2475 providers in Veterans Affairs (VA) primary care clinics were invited; 411 responded (16.6% response rate). Respondents included physicians (n = 304), nurse practitioners/physician assistants (n = 68), and clinical pharmacists (n = 39). Respondents estimated the proportion of their patients taking a potentially unnecessary medication. Of these patients, providers then identified the proportion for whom they recommended medication deprescribing (response options: <20%, 20%‐39%, 40%‐59%, 60%‐79%, ≥80%). We used multivariable logistic regression to determine factors associated with recommending deprescribing to ≥80% of candidate patients. Results: Although most respondents indicated having patients taking unnecessary medications, less than one‐third reported recommending deprescribing to most (≥80%) of their candidate patients. In adjusted analyses, factors significantly associated with increased likelihood of recommending deprescribing included having more patients who asked for medication information, providers' self‐rated comfort with deprescribing, and having support to monitor patients after deprescribing. When the indication for a medication was unclear, providers reported being less likely to recommend deprescribing. Conclusion: Most providers indicated caring for patients taking potentially unnecessary medications, yet they did not consistently say they recommended deprescribing to these patients. Our findings suggest that requiring prescriptions to include their reason for use and models of primary care designed to strengthen interdisciplinary teamwork and communication, such as the patient‐centered medical home, could address barriers providers face to deprescribing medications. [ABSTRACT FROM AUTHOR]

Network meta‐analyses (NMAs) simultaneously estimate the effects of multiple possible treatment options for a given clinical presentation. For allergists to benefit optimally from NMAs, they must understand the process and be able to interpret the results. Through a worked example published in Pediatric Allergy and Immunology, we summarize how to identify credible NMAs and interpret them with a focus on recent innovations in the GRADE approach (Grading of Recommendations Assessment, Development, and Evaluation). NMAs build on traditional systematic reviews and meta‐analyses that consider only direct paired comparisons by including indirect evidence, thus allowing the simultaneous assessment of the relative effect of all pairs of competing alternatives. Our framework informs clinicians of how to identify credible NMAs and address the certainty of the evidence. Trustworthy NMAs fill a critical gap in providing key inferences using direct and indirect evidence to inform clinical decision making when faced with more than two competing courses of treatment options. This document will help allergists to identify trustworthy NMAs to enhance patient care. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives: Several health information sources are available to assist physical therapists in the clinical decision‐making process, with a notable increase in the importance of using evidence‐based practice (EBP). The aim of this study is to investigate the health information sources most used by Brazilian physical therapists to guide their clinical decision making for knee osteoarthritis (OA) management, use of Physiotherapy Evidence Database (PEDro), knowledge about the existence of clinical practice guidelines (CPGs), and associated factors. Methods: A cross‐sectional study using an electronic survey was conducted. Physical therapists registered in a Regional Physical Therapy Council in Brazil were invited to participate. Sociodemographic data, professional training, health information sources, frequency of use of PEDro, and knowledge about CPGs were collected. Descriptive analysis of the data was performed, and the chi square test and multinomial and binary logistic regression were used to verify association between the variables. Results: The survey was completed by 370 professionals. The three health information sources most used by Brazilian physical therapists were clinical experience, courses, and books. Among these professionals, only 12.1% use PEDro frequently, and 60.5% know that CPGs for knee OA management exist. Level of education was associated with PEDro use and knowledge about the existence of CPGs (P <.05). Conclusions: The study results indicated a significant deficiency in engagement with research evidence by Brazilian physical therapists to guide their clinical decision making for knee OA. Further investigations on educational needs and the development of new strategies to narrow the gap between research evidence and clinical practice should be performed. [ABSTRACT FROM AUTHOR]

Deliberate clinical inertia is the art of doing nothing as a positive response. Individual clinicians can promote deliberate clinical inertia through teaching, re‐framing the act of 'doing nothing' as 'doing something' and engaging in shared decision making. Behaviour change on a larger scale requires a systematic approach. Nudging is a subtle change to the decision‐making context to prompt specific choices. A nudge unit is a team of relevant professionals who engage with various multidisciplinary teams within a health service who help test and implement nudge interventions in a clinical environment. A nudge unit could be used to design environments to prompt clinicians to re‐think before ordering unnecessary tests or treatments. Nudge units could improve knowledge translation, support continuous quality improvement and help build a learning health system. They could also boost collaboration and empower staff to evaluate their workplace decision‐making frameworks. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives: The current American Academy of Pediatrics policy calls for universal developmental screening (UDS) at the 18‐month well‐baby visit (18MWBV). In contrast, different clinical practice guidelines exist in other developed countries where only toddlers of concerned parents are referred for (selective) developmental screening (SDS). This study compares the expected benefit (EB) of these two strategies for monitoring children's behavioural development at the 18MWBV. Method: A clinical decision analysis was performed, with EB defined as gain (probability of screening when appropriate + probability of not screening when appropriate) minus cost (probability of screening when not appropriate + probability of not screening when not appropriate). Accordingly, a strategy's EB referred to its efficiency at distinguishing between toddlers who need to be referred for screening and those who do not. Results: The EB of the UDS strategy was estimated at −0.242. In contrast, the EB of the SDS strategy was much greater at 0.326. In fact, the EB of the UDS strategy could only equal or surpass that of the SDS strategy if screening toddlers with a problem was considered almost five times more important than not screening well toddlers. However, our monitoring effort should be more evenly distributed between these two imperatives. Also, the evidence in favour of the SDS strategy remained largely unchanged after considering a broad range of values for the (unique) probabilities in the decision tree. Conclusion: There are many steps involved in the monitoring of children's early behavioural development, but when it comes to decide whether or not to use behavioural screening, there is evidence for adopting the SDS strategy, and screening only if a behavioural concern is being raised by parents. [ABSTRACT FROM AUTHOR]

Background: Dietitian clinical decision making in the acute care setting likely incorporates a practitioner's clinical judgement to effectively support patient care. The term 'dietitian clinical judgement' is well used in clinical practice, yet is poorly defined and often used interchangeably with other concepts. The aim of this research was to describe the nature of dietitians' clinical judgement in the acute care setting. Methods: A qualitative design within the interpretative paradigm was used guided by principles of philosophical hermeneutics. Dietitians with at least 3 years experience were invited to participate in two 60‐min in‐depth semi‐structured interviews which were recorded, transcribed and interpreted using hermeneutic principles. A reference group was used to increase rigour and further interpretation of the findings. Results: Ten dietitians participated in the interviews and five of these same participants in the reference focus group. The findings revealed clinical judgement to be a sophisticated practitioner dependent meta‐reasoning process that helps the dietitian manage complexity, guide interpersonal interactions and individualise patient care. It is characterised by tacit and efficient use of various reasoning strategies reliant on the dietitian's clinical experience, used to synthesise and weigh up various types of information and knowledge with respect to delivering context‐relevant care. Conclusions: Dietitian clinical judgement is a necessary part of clinical decision making that extends beyond logical or critical thinking. It facilitates a person‐centredness to patient care and professional relationships that are key dimensions to dietitian clinical decision making. These findings provide training and professional development insights to managers, educators and supervisors. [ABSTRACT FROM AUTHOR]

Purpose: Describe use and predictive potential of an intracellular cytokine staining (ICS) cytomegalovirus cell‐mediated immunity (CMV CMI) assay and a risk factor screening tool on CMV reactivation in a real‐world clinical setting and compare this to serologically demonstrated immunity by CMV IGG. Methods: Adult transplant patients at our center with the ICS assay resulted between 10/1/2018 and 9/1/2019 were included. Assays were considered positive per manufacturer specifications. Results: Twenty‐five patients underwent ICS CMV CMI testing at our institution during the study period. The majority were kidney transplant recipients, 76% were D+/R−, and 76% were receiving CMV treatment. The positive predictive value (PPV) of the assay to predict lack of CMV was 87%; 93% when patients with antiviral resistance were excluded and 91% in only those receiving treatment. The presence of ≤2 clinical risk factors on the screening tool had a PPV of 92% in predicting lack of recurrence. In comparison, serologically demonstrated immunity by CMV IGG had a PPV of 62%. Conclusions: In our study representing real‐world clinical use, the ICS CMV CMI assay and the risk factor screening tool had predictive potential that was superior to serologically demonstrated immunity. The reliability of the assay seemed to decrease with higher degrees of clinical risk suggesting a multimodal screening approach is warranted. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Clinical practice guidelines (CPG) were introduced to summarize the best scientific evidence available. Thereby, CPG were meant to support evidence‐based medicine (EBM). However, besides evidence, EBM also asks for patients' preferences and physicians' experiences to be considered when coming to therapeutic decisions. Thus, deviations from CPG recommendations are sometimes necessary when practicing EBM. We wanted to examine whether CPG support deviations from their recommendations when appropriate. For operationalization, we asked whether absolute effect sizes (AES) for benefit and/or harm of suggested therapies were provided along with the respective CPG recommendation. Methods: This systematic survey comprised the most common CPG on chronic coronary heart disease (CCHD) and type 2 diabetes mellitus (T2DM) from English‐ and German‐speaking countries. Only CPG recommendations on pharmacotherapy were evaluated. If AES of a recommended therapy were reported, we rated how easily findable they were within the CPG. Moreover, we assessed whether the CPG provided patient information material and whether this material supplied AES allowing patients to determine the effects to be expected. Results: In the 13 CPG surveyed, 144 recommendations on pharmacotherapy were identified. For 108 recommendations (75%), no AES for benefit and/or harm were reported. Thirty‐one recommendations (22%) were accompanied by one or more AES for either benefit or harm. Along with five recommendations (3%), one or more AES for both benefit and harm were given. AES were considered easy to find for three of these 36 recommendations (8%). Patient information material was provided in three of the 13 CPG (23%) accounting for AES in one occasion only. Conclusion: Current CPG on T2DM and CCHD do not sufficiently offer AES for benefits and harms of recommended therapies. Thus, they lack satisfactory information to support deviations from CPG recommendations. Consequently, CPG in their present form do not adequately facilitate EBM. [ABSTRACT FROM AUTHOR]

Metastatic breast, prostate, lung, and other cancers often affect bone, causing pain, increasing fracture risk, and decreasing function. Management of metastatic bone disease (MBD) is clinically challenging when there is potential but uncertain risk of pathological fracture. Management of MBD has become a major focus within orthopedic oncology with respect to fracture and impending fracture care. If impending skeletal‐related events (SREs), particularly pathologic fracture, could be predicted, increasing evidence suggests that prophylactic surgical treatment improves patient outcomes. However, current fracture risk assessment and radiographic metrics do not have high accuracy and have not been combined with relevant patient survival tools. This review first explores the prevalence, incidence, and morbidity of MBD and associated SREs for different cancer types. Strengths and limitations of current fracture risk scoring systems for spinal stability and long bone fracture are highlighted. More recent computed tomography (CT)‐based structural rigidity analysis (CTRA) and finite element (FE) analysis methods offer advantages of increased specificity (true negative rate), but are limited in availability. Other fracture prediction approaches including parametric response mapping and positron emission tomography/computed tomography measures show early promise. Substantial new information to inform clinical decision‐making includes measures of survival, clinical benefits, and economic analysis of prophylactic treatment compared to after‐fracture stabilization. Areas of future research include use of big data and machine learning to predict SREs, greater access and refinement of CTRA/FE approaches, combination of clinical survival prediction tools with radiographically based fracture risk assessment, and net benefit analysis for fracture risk assessment and prophylactic treatment. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Context: Patient‐reported outcomes (PROs) are used in parallel with clinical evidence to inform decisions made by industry, clinicians, regulators, health technology assessment bodies and other health‐care decision‐makers. In addition, PRO data can also guide shared decision making and individual patient choice. Yet, the quality of many PROs in cancer clinical trials is suboptimal and requires improvement to add value to health care and policy decision making. Objective: To show how the integration of the patient and/or patient advocate at all stages of PRO development can help to realize the full potential of PROs. Methods: We examined the literature to show that the patient voice is often absent from the planning and implementation of PROs in cancer clinical trials. Good practice examples from the literature were combined with guideline recommendations, training or educational resources, and our own experience to create detailed practical steps for the inclusion of patients and/or patient advocates throughout PRO development. Results: Patient or patient advocates can play an active role in shaping PROs that are meaningful to the patient. They can contribute to content, choice of medium and implementation in a way that may support PRO completion and minimize missing data. Patients and their advocates can work to ensure PRO findings are disseminated appropriately in a way that is accessible to patients. Conclusion: This practical guidance aims to optimize PRO development and implementation in clinical trials, resulting in robust, relevant data that reflect the patient experience and that support decisions made by all stakeholders involved in research and health care. [ABSTRACT FROM AUTHOR]

Breaking barriers: implementing evidence-based practice It is equally important to understand what factors will influence a clinician's ability to change their practice to incorporate current evidence; without this element evidence-based practice will achieve very little[[2]]. Cognitive theorists argue that poor clinician knowledge about current evidence-base leads to poor compliance and clinicians need to experience a clinical problem themselves before they are motivated to utilize evidence to change practice. Factors which must be considered to implement evidence-based practice with resultant changes in clinician behaviour suggest that addressing all levels in clinical practice from patients, practitioners, healthcare team members and the organization itself is needed for lasting change. [Extracted from the article]

Objective: This study examined the impact of clinicians' demographics and response time on diagnostic accuracy. Method: We conducted mediation analyses on data from a WHO field study of the ICD-11 that required clinicians (N = 1,822, 44.3% female, 44.92 years old) to diagnose two case vignettes. Results: Contradictory to decision‐making theories, clinicians with more years of experience and slower response times had higher rates of diagnostic accuracy. In comparison to North American clinicians, clinicians in Asia who responded faster had lower accuracy rates, and clinicians in South America who responded slower had higher accuracy rates. Medical professionals with quicker response times had lower accuracy rates compared with psychologists and other clinical professionals. Conclusion: Findings indicate that clinicians should consider how their clinical setting, level of experience, and response time influence the diagnostic process. Future research on diagnostic accuracy should consider additional mediating factors, such as cultural differences in response time. [ABSTRACT FROM AUTHOR]

Background: Dental implants are available in different shapes. Aims: This systematic review aims to address whether tapered compared to non‐tapered implants demonstrate similar clinical and patient‐reported outcomes. The review follows the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) format. Materials & Methods: We searched electronic databases including MEDLINE through PubMed and the Cochrane Central Register of Controlled Trials for randomized clinical trials (RCT) that compare tapered versus non‐tapered implants with at least 10 treated participants and a minimum mean follow‐up time of 3 years. There were no restrictions to a particular treatment indication or outcome measures. Two authors independently conducted screening, risk of bias assessment, and data extraction of eligible trials in duplicate. We applied the Cochrane risk of bias assessment tool to consider risk of bias. Results: We identified 18 different RCTs, of which three reported outcomes at 3 years or greater. The three trials described the results of 245 participants with 388 implants at 3 years, from the initially 306 participants with 494 implants at baseline. The three trials compared, respectively, two, two, and three different commercially available implant brands and reported only clinically insignificant differences. We judged all three trials to be at moderate risk of bias. The low number and heterogeneity of RCTs did not allow for meta‐analyses. Discussion and conclusion: Appropriate professional judgment in clinical decision making must include a comprehensive diagnosis of the patient's jawbone quality and quantity and consideration of osteotomy protocol in accordance with the patient's treatment preferences, where the shape of the dental implant is only one contributory factor. [ABSTRACT FROM AUTHOR]

The aims of this pilot study were to evaluate the short-term impact of evidence-based dentistry (EBD) workshops on educators' use of clinical evidence in their clinical practice and educational activities and to identify barriers they encountered in implementing evidence in their teaching and clinical practice. Between April 2012 and January 2014, a series of EBD workshops was delivered to 31 dental faculty members and postdoctoral students at three Canadian dental schools. Survey I, assessing participants' perceptions of various aspects of the workshops, was administered immediately following the workshops. Survey II, evaluating the impact of the workshops on participants' EBD implementation, was conducted 10 to 31 months after their completion. Survey I was completed by all 31 participants (100% response rate); their mean scores ranged from 3.94 to 4.65 on a five-point scale. Survey II was completed by 20 participants (64.5% response rate; five postdoctoral students and 15 faculty members), using an online 20-item questionnaire. Of the respondents, 19 (95%) reported implementing EBD in their professional activities at that time, and 14 (70%) stated that the workshops had positively helped with EBD implementation. Eight respondents (40%) reported having experienced barriers to EBD implementation, while 15 (75%) reported that their patients/students welcomed use of EBD. The respondents reported believing that strategies such as increasing EBD education and dissemination and improving quality and accessibility of evidence would facilitate the transition to EBD practice. Reported barriers to EBD implementation included resistance and criticism from colleagues, difficulty in changing current practice model, and lack of time. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To investigate which opinions among dentists are associated with level of technology use, when characteristics of the dentist and dental practice, as well as motivating work aspects are taken into account. Methods: A total of 1000 general dental practitioners in the Netherlands received a questionnaire on digital technologies they use, opinions on using technologies and related motivating work aspects. Questions were derived from expert interviews, the Dentists’ Experienced Job Resources Scale and literature on technology implementation. Technology use was measured as the number of technologies used, and divided into three technology user groups: low (using 0‐4 technologies, mostly administrative and radiographic technologies), intermediate (using 5‐7, more varied technologies) and high technology users (using 8‐12, including more innovative diagnostic technologies). Opinions on technology use and motivating work aspects were analysed using principal components analysis (PCA) and exploratory factor analysis. Scores on all components and factors were calculated for each respondent by computing the mean of all valid responses on the underlying items. Differences in these scale scores on opinions among the technology user groups were assessed using one‐way analysis of variance and Kruskal–Wallis tests. A multiple linear regression analysis assessed the association of scale scores about opinions on technology use with the sum of technologies used, taking into account motivating work aspects and characteristics of the dentist and dental practice. Results: The response rate was 31%. Dentists who were high technology users perceived technologies as yielding more improvements in quality of care, adding more value to the dental practice and being easier to use, than low technology users. High technology users thought technologies added more value to their work and they reported higher skills and resources. They also focused more on technologies and thought these are more ready to use than low technology users. High technology users derived more motivation from “Immediate results” and “Craftsmanship” than low technology users. Personal and practice characteristics, motivating work aspects, and the opinion scales “Focus” and “Added value to dentist” explained 50% of the variance in the number of technologies a dentist uses. Conclusion: Opinions on digital technologies among dentists and motivating work aspects vary with level of technology use. Being more focused on technologies and perceiving a higher added value from using them are associated with using more digital dental technologies, when taking into account motivating work aspects and characteristics of the dentist and dental practice. [ABSTRACT FROM AUTHOR]

Purpose To identify available literature concerning the factors that contribute to nurses and midwives making sound clinical decisions. Method This is an integrative literature review. Findings Thirty-eight articles revealed four main domains that influence nurses' and midwives' clinical decision making-nurses and midwives' personal characteristics ( n = 30), e.g., clinical experience; organizational factors ( n = 26), e.g., colleagues; patient characteristics ( n = 26), e.g., physical and clinical status; and environmental factors ( n = 9), e.g., time. These four domains of factors combined influence sound clinical decision making in the context of nursing and midwifery. Conclusions Understanding the role of the factors influencing clinical decision making will help to improve patient and health outcomes. Practice Implications Further understanding about the extent of the impact some factors have on clinical decision making is needed. [ABSTRACT FROM AUTHOR]

Objective This study examined the role of expertise in clinicians' memory for case details. Clinicians' diagnostic formulations may afford mechanisms for retaining and retrieving information. Method Experts ( N = 41; 47.6% males, 23.8% females; 28.6% did not report gender; age: mean [ M] = 54.69) were members of the American Board of Professional Psychologists. Lay judges ( N = 156; 25.4% males, 74.1% females; age: M = 18.85) were undergraduates enrolled in general psychology. Three vignettes were presented to each group, creating a 2 (group: expert, lay judge) x 3 (vignettes: simple, complex-coherent, complex-incoherent) mixed factorial design. Recall accuracy for vignette details was the dependent variable. Results Data analyses used multivariate analyses of variance to detect group differences among multiple continuous variables. Experts recalled more information than lay judges, overall. However, experts also exhibited more false memories for the complex-incoherent case because of their schema-based knowledge. Conclusions This study supported clinical expertise as beneficial. Nonetheless, negative influences from experts' schema-based knowledge, as exhibited, could adversely affect clinical practices. [ABSTRACT FROM AUTHOR]

Objective To determine whether physician's attitudes toward patients with comorbid mental illness affect management of a chronic disease. Data Source A total of 256 primary care physicians interviewed in 2010. Study Design This randomized factorial experiment entailed physicians observing video vignettes of patient-actors with poorly controlled diabetes. Patients were balanced across age, gender, race, and comorbidity (schizophrenia with bizarre or normal affect, depression, eczema). Data Collection Physicians completed structured and semistructured interviews plus chart notes about clinical management and attitudes. Principal Findings Physicians reported more negative attitudes for patients with schizophrenia with bizarre affect ( SBA). There were few differences in clinical decisions measured quantitatively or in charting, but qualitative data revealed less trust of patients with SBA as reporters, with more reliance on sources other than engaging the patient in care. Physicians often alerted colleagues about SBA, thereby shaping expectations before interactions occurred. Conclusions Results are consistent with common stereotypes about people with serious mental illness. Vignettes did not include intentional indication of unreliable reporting or danger. Reducing health care disparities requires attention to subtle aspects of managing patients-particularly those with atypical affect-as seemingly slight differences could engender disparate patient experiences over time. [ABSTRACT FROM AUTHOR]

In decision making concerning the diagnosis and treatment of patients, doctors have a responsibility to do this to the best of their abilities. Yet we argue that the current paradigm for best medical practice - evidence-based medicine ( EBM) - does not always support this responsibility. EBM was developed to promote a more scientific approach to the practice of medicine. This includes the use of randomized controlled trials in the testing of new treatments and prophylactics and rule-based reasoning in clinical decision making. But critics of EBM claim that such a scientific approach does not always work in the clinic. In this article, we build on this critique and argue that rule-based reasoning and the use of general guidelines as promoted by EBM does not accommodate the complex reasoning of doctors in clinical decision making. Instead, we propose that a new medical epistemology is needed that accounts for complex reasoning styles in medical practice and at the same time maintains the quality usually associated with 'scientific'. The medical epistemology we propose conforms to the epistemological responsibility of doctors, which involves a specific professional attitude and epistemological skills. Instead of deferring part of the professional responsibility to strict clinical guidelines, as EBM allows for, our alternative epistemology holds doctors accountable for epistemic considerations in clinical decision making towards the diagnosis and treatment plan of individual patients. One of the key intellectual challenges of doctors is the ability to bring together heterogeneous pieces of information to construct a coherent 'picture' of a specific patient. In the proposed epistemology, we consider this 'picture' as an epistemological tool that may then be employed in the diagnosis and treatment of a specific patient. [ABSTRACT FROM AUTHOR]

Objective To describe the full range of behavior of the visible, noncavitated, early caries lesion in caries-active adults with substantial fluoride exposure, and to consider implications. Methods The data were from the Xylitol for Adult Caries Trial (X- ACT) collected annually for 33 months using condensed ICDAS caries threshold criteria. Individual tooth surfaces having a noncavitated caries lesion were included, and the patterns of transition to each subsequent annual clinical examination to sound, noncavitated or cavitated, filled or crowned were determined. The resulting sets of patterns for an individual tooth surface, looking forward from its first appearance as a noncavitated lesion, were combined into one of four behavior profiles classified as reversing, stable, oscillating, or continuously progressing, or were excluded if not part of the caries continuum. The distributions of profile types were assessed using the Rao-Scott chi-square test, which adjusts for clustering of tooth surfaces within teeth. Results Inter- and intra-examiner kappa scores demonstrated acceptable calibration at baseline and annually. 8084 tooth surfaces from 543 subjects were included. The distribution of profile types differed significantly between coronal and root surfaces. Overall, two-thirds of all coronal noncavitated lesions were first seen at baseline, half reversed, over a fifth were stable, 15% oscillated, and only 8.3% progressed to cavitation, filled, or crowned in 33 months or less (6.3% consistently Progressed plus 2.0% inconsistently, a subset of oscillating, which oscillated before progressing to cavitation). Approximal, smooth, and occlusal coronal surfaces each were significantly different in their individual distributions of profile types. Xylitol showed no significant and consistent effect on this distribution by tooth surface type. This was in keeping with the X- ACT's lack of effect of xylitol at the noncavitated plus cavitated lesion thresholds combined. Conclusions This study demonstrated the full dynamic range of early caries lesion behavior. The great majority were not progressive, and few (8.3%) became cavitated over 33 months in caries-active adults using fluorides. Important caries management implications favoring recorded longitudinal monitoring, prevention of active risks, and minimal restoration only after direct visual determination of cavitation are discussed. [ABSTRACT FROM AUTHOR]

Background and objective Recent international consensus statements have refined evidence-based guidelines for the diagnosis and management of idiopathic pulmonary fibrosis ( IPF). This study sought to investigate how closely these guidelines are adhered to and to compare current practices with those of a similar cohort 15 years ago. Methods A questionnaire on IPF diagnosis and management was distributed to respiratory physicians practising in Australia and New Zealand, in 2012-2013, and results were compared with a similar survey conducted in 1999. Results A total of 172 and 144 questionnaires were completed in 1999 and 2012-2013, respectively. The most important investigations in both survey populations were high-resolution computed tomography scans, spirometry, diffusing capacity for carbon monoxide, chest X-ray, static lung volumes and autoimmune serology. In 1999, physicians were more likely to perform arterial blood gases, bronchoalveolar lavage and transbronchial lung biopsy. In the 2012-2013 cohort, 6-min walk tests and pulse oximetry were more widely utilized. Treatment choices differed considerably between the two survey populations. In 1999, the majority would offer a steroid-based regimen, whereas most would not use any specific treatment or would refer for trial participation in 2012-2013. Conclusions Approach to IPF diagnosis and management is not uniform and has changed over 15 years. Surveyed respiratory physicians were generally practising in accordance with clinical guidelines, although significant variation in practice was identified in both cohorts. This study identifies the need to standardize care of IPF patients across Australia and New Zealand. [ABSTRACT FROM AUTHOR]

Research has demonstrated the validation of specific caries risk assessment (CRA) systems, but little is known about how dental practitioners assign a caries risk level to their patients. The aim of this study was to explore dental students' decision making in caries risk assignment when using the Caries Management By Risk Assessment (CAMBRA) system. Multiple correspondence analysis and chi-squared automated interaction detector analysis were performed on data collected retrospectively for a period of six years (2003-09) at the University of California, San Francisco predoctoral dental clinic. The study population consisted of 12,952 patients from six years of age through adult who received a baseline CRA during the period, were new to CAMBRA, and had not received any prior CAMBRA recommendations. The results showed variation in decision making and risk level assignment, illustrated by the range of percentages for the three scores (low, moderate, and high/extreme caries risk) when CRA was assigned for the first time. For those first-time CRAs, decision making was mainly based on four factors: cavities or caries lesions into dentin on radiograph, restorations during the last three years due to caries, visible heavy plaque, and interproximal lesions into enamel (by radiographs). This study's findings provide important data regarding one group of CAMBRA users and thus contribute to the development of knowledge about the implementation of caries risk assessment in contemporary dental practice. [ABSTRACT FROM AUTHOR]