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Background Physicians' clinical expertise forms an exclusive body of competences, which helps them to find the appropriate diagnostics and treatment for each individual patient. Empirical evidence, however, suggests that there is an inverse relationship between the number of years in practice and the quality of care provided by a physician. Knowledge and adherence to professional standards (such as clinical guidelines) are often used as indicators in previous research. Methods Semistructured interviews and the Q method were used for an explorative study on oncologists' views on the interplay between their own clinical expertise, intuition, and the external evidence incorporated in clinical guidelines. The interviews were audio recorded, transcribed ad verbatim, and analysed using qualitative content analysis. Results Data analysis shows the complex character of clinical expertise with respect to experience, professional development, and intuition. An irreplaceable role is attributed to personal and bodily experience during the providing of care for a patient. Professional experience becomes important, particularly in those situations that lie out of the focus of “guideline medicine.” Intuition is regarded as having a strong emotional component and helps for deciding which therapeutic option the patient can deal with. Conclusions Using measurable knowledge and adherence to standards as indicators does not account for the complexity of clinical expertise. Other factors, such as the importance of bodily experience and physicians' intuitive knowledge, must be considered, also with respect to the occurrence of treatment biases.

The aim of this report is to (i) review the current literature on the status of root filled teeth, (ii) analyse the most important factors in decision-making, (iii) discuss the current restorative concepts, and (iv) classify both the evidence and clinical practice in a way that seeks to be clear, understandable and helpful for clinicians. Restoration of root filled teeth represents a challenge for the clinician and remains a controversial subject. The guidelines describe a new classification that is drawn from evidence presented in the literature and also from clinical expertise-based reviews. It describes five categories of teeth.

Off-label prescribing is the use of a medicinal product outside the conditions set out in the summary of product characteristics and should only be undertaken if there is no licensed alternative available to achieve the best outcome. New evidence that emerges after a licence has been prescribed does not necessarily mean there will be an application for the licence to be extended. Randomised controlled trials based on a homogenised population may not represent the complexities of an individual patient. Therefore, prescribers need to consider a definition of evidence-based prescribing that extends beyond best research evidence to incorporate clinical expertise and individual needs and perspectives of patients. Nurse prescribers should ensure that their competence and expertise to prescribe off-label is addressed to deliver true evidence-based prescribing. An audit of off-label prescribing by nurse prescribers is a potential wealth of evidence yet to be discovered.

Background: Risk assessment for Lynch Syndrome may be a complex and challenging task. Demonstration of germline mutations has the benefits of confirming Lynch Syndrome diagnosis and may also provide screening and surgical orientation for affected members and relief for non-affected relatives. Objective: The present paper aimed to critically review the criteria to diagnose Lynch Syndrome, focusing the attention on the new perspective of adopting universal screening for patients diagnosed with colorectal cancer. Methods: We performed a literature review about the rationale and preliminary results of universal testing for Lynch Syndrome. Results: The use of selective eligibility criteria to determine who should undergo Lynch Syndrome testing may fail in a substantial proportion of cases. Moreover, universal strategy is feasible, cost-effective and more sensitive than previous methods. However, there still exist problems regarding clinical practice implementation and compliance either by medical doctors and patients. Conclusions: Standard guidelines for colorectal cancer screening are not ideal to provide early detection of Lynch Syndrome patients. And although universal screening has been associated with an increased identification of Lynch Syndrome patients, a successful implementation of this approach is still limited by the lack of clinical expertise among physicians, and also requires standardization of the existing protocols for routine genetic screening. Resumo: Introdução: A avaliação de risco para síndrome de Lynch (SL) pode ser tarefa complexa e desafiadora. A demonstração de mutações na linha germinal resulta em benefícios, como a confirmação do diagnóstico de SL e também pode proporcionar orientações para a triagem e procedimentos cirúrgicos para os membros afetados, além de trazer alívio para os parentes não afetados. Objetivo: Este artigo teve por objetivo oferecer uma revisão crítica dos critérios para o diagnóstico de SL, com enfoque na atenção sobre a nova perspectiva de adoção da triagem universal para pacientes diagnosticados com câncer colorretal (CCR). Métodos: Procedemos a uma revisão da literatura com ênfase nas justificativas e resultados preliminares de testes universais para SL. Resultados: O uso de critérios seletivos de qualificação, com vistas a determinar quem deveria passar por um teste para SL, pode ser malsucedido em substancial percentual de casos. Foi também constatado que a estratégia universal é exequível, com bom custo-benefício e com maior sensibilidade, em comparação com os métodos previamente utilizados. Contudo, ainda existem problemas concernentes à sua implementação na prática clínica e também na cooperação de médicos e de pacientes. Conclusões: As orientações padronizadas para a triagem de CCR não são ideais, em termos de se obter a imediata detecção de pacientes com SL. Por outro lado, embora a triagem universal tenha sido associada a um aumento na identificação de pacientes com SL, a bem-sucedida implementação dessa abordagem fica ainda limitada pela pouca experiência clínica entre os médicos e, além disso, também há a necessidade de padronização dos protocolos existentes para a triagem genética de rotina. Keywords: Lynch Syndrome, Genetics, Screening, Colorectal cancer, Testing, Palavras-chave: Síndrome de Lynch, Genética, Triagem, Câncer colorretal, Testes

This article provides an overview of how integrating quality palliative and end-of-life care into geriatric assessment can be a tremendous benefit to older adult patients and their families. Although the quality of palliative and end-of-life care for older adults has improved greatly, there are still many opportunities to improve the quality of life and function for older adult patients in the last few years of their life. More clinical expertise in comprehensive palliative and end-of-life care must be developed and maintained. There also must be greater focus and more direct reimbursement developed for physicians and health system providers.

Mental illness is a prevalent and extraordinarily complex phenomenon. Psychologists have developed distinct approaches toward understanding and treating mental illness, rooted in divergent epistemology. This introduction to the Special Issue on Clinical Psychological Science and Practice provides a brief overview of the scientist-practitioner gap, and explores one step (of many) toward bridging this divide. Seven compelling case illustrations featured in this Special Issue apply empirical findings to case formulation, treatment selection, and assessment across complex and varied clinical presentations. This issue thereby demonstrates the feasibility of integrating research and clinical expertise in mental healthcare.

Background: The nursing faculty shortage has generated the interest of some nurse–midwives to teach in baccalaureate nursing programs. These seasoned practitioners bring a wealth of knowledge and clinical expertise to classrooms and clinical settings. The purpose of this study was to explore and describe the experiences of nurse–midwives who teach in baccalaureate nursing programs. Method: This study used a qualitative phenomenological research design based in the naturalistic paradigm. Colaizzi's procedure for analyzing phenomenological data was used to examine verbatim transcriptions from 16 interviews. Data saturation was achieved. Results: Six themes emerged from the data: Emphasis on Normal; Knowing My Stuff: Confidence and Competence; Students Wanting to Become Nurse–Midwives in the Future; Students Desiring Nurse–Midwifery Care; Teaching and Imparting the Nurse–Midwifery Philosophy; and Professional Challenges: The Faculty Role. Conclusion: Nurse–midwives teaching in baccalaureate nursing programs are in strategic positions to influence nursing students. While helping the faculty shortage, they impart professional values and skills. They may inspire students to embrace the nurse–midwifery model of care. [J Nurs Educ. 2017;56(2):77–84.]

Adjunct faculty are being used more frequently to meet the instructional and practice experience needs of growing nursing program cohorts. While most adjunct faculty tend to have clinical expertise, many lack formal training in online instruction. This article describes how faculty used technology to develop and implement a faculty support site to provide ongoing orientation and encourage informal mentoring relationships for online adjunct faculty.

Introduction The Neurostimulation Appropriateness Consensus Committee (NACC) was formed by the International Neuromodulation Society (INS) in 2012 to evaluate the evidence to reduce the risk of complications and improve the efficacy of neurostimulation. The first series of papers, published in 2014, focused on the general principles of appropriate practice in the surgical implantation of neurostimulation devices. The NACC was reconvened in 2014 to address specific patient care issues, including bleeding and coagulation. Methods The INS strives to improve patient care in an evidence-based fashion. The NACC members were appointed or recruited by the INS leadership for diverse expertise, including international clinical expertise in many areas of neurostimulation, evidence evaluation, and publication. The group developed best practices based on peer-reviewed evidence and, in the absence of specific evidence, on expert opinion. Recommendations were based on international evidence in accordance with guideline creation. Conclusions The NACC has recommended specific measures to reduce the risk of bleeding and neurological injury secondary to impairment of coagulation in the setting of implantable neurostimulation devices in the spine, brain, and periphery.

Early diagnosis of immune-mediated arthropathies is important for early and effective treatment, but often relies on clinical expertise. Can the use of a new genetic risk score help rule out and prioritize certain diagnoses? And does this score add any clinical utility to current clinical diagnostic pathways?

Financial difficulties, lack of social coverage and medical shortages contribute to the fact that many patients and their families in Uganda are left to fend for themselves. However, health care teams and associations are acting together to disseminate palliative culture while respecting cultural diversity. Nurses are very autonomous in their clinical expertise, providing care and visiting patients at home.

BACKGROUND: Media coverage of medical research influences the views and behaviours of clinicians, scientists and members of the public. We examined how frequently commenters in news stories about medical research have relevant expertise and have academic and financial conflicts, how often such conflicts are reported and whether there are associations between the conflicts and the disposition of the comments toward the findings of the source research. METHODS: We analyzed 104 independent comments in news stories on original clinical research published in high-impact medical journals from Jan. 1 to Mar. 31, 2013, and 21 related journal editorials. Main outcomes were prevalence of relevant academic and clinical expertise, prevalence and reporting of academic and financial conflicts of interest, and disposition of comments toward study findings. RESULTS: Only 1 in 6 news stories included independent comments. Overall, 25% of commenters and 0% of editorialists had neither relevant academic nor clinical expertise (p = 0.007). Among the 104 comments, an academic conflict of interest was present for 56 (54%), of which 25 (45%) were reported in the news stories. A financial conflict of interest was present for 33 (32%) of the comments, of which 11 (33%) were reported. When commenters’ conflicts of interest were congruent with the findings of the source research, 97% and 93% of comments associated with academic and financial conflicts of interest, respectively, were favourably disposed toward the research. These values were 16% and 17%, respectively, when the conflicts of interest were not congruent with the research findings. INTERPRETATION: Independent commenters in new stories about medical research may lack relevant academic or clinical expertise. Academic or financial conflicts of interest were frequently present among independent commenters but infrequently reported, and were often associated with the disposition of comments about the source research.

The American Dental Association defines the evidence-based dentistry (EBD) as “an approach to oral health care that requires the integration of systematic assessments of clinically relevant scientific evidence, relating to the patient’s oral and medical condition and history, with the dentist’s clinical expertise and the patient’s treatment needs and preferences” [1]. Nowadays, evidence-based care is regarded as the gold stan- dard in health care delivery. Published reports of research pro- jects constitute the basis of EBD. They are analyzed systemati- cally in meta-analysis. This paper investigates the concept of evidence-based dentistry, its benefits and its limitations. Resume L’Association des Dentistes des Etats Unis definit la dentiste- rie fondee sur des donnees probantes comme « une approche aux soins de sante bucco-dentaire qui necessite l’integration des evaluations systematiques des preuves scientifiques cli- niquement pertinentes, relatives a la situation et a l’histoire orale et medicale du patient, a l’expertise clinique du dentiste et aux besoins et preferences therapeutique du patient »[1]. De nos jours, les soins fondes sur des preuves sont conside- res comme l’etalon-or dans la prestation des soins de sante. Les rapports publies des projets de recherche constituent la base de cette dentisterie. Rapports et resultats d’etudes sont analyses systematiquement par des meta-analyses. Cet article etudie le concept de la dentisterie fondee sur les preuves, ses avantages et ses limites.

Accurately addressing the diverse and complex issues of rare diseases (RD) in terms of prevention, recognition, diagnosis, treatment, care and research along key RD specificities, such as great heterogeneity, a limited number of patients, scarcity of relevant knowledge and expertise as well as enormous costs for patient care is a challenging task for healthcare providers and authorities that makes a supranational approach particularly feasible. The European Union has acknowledged RD matters by several initiatives, including efforts to implement national centres of expertise and European reference networks as well as a cross-border referral mechanism to foster access to expert services and to boost dissemination of clinical expertise and research activities. Exemplified by the EB House Austria, a centre of expertise for epidermolysis bullosa cross-linked with international reference partner institutions, this strategy proves its potential to be translated into optimized patient care and to meet the major medical, scientific, social and health-economic impact of RD.

Background and scope The management of GOJ cancers remains controversial and may vary between countries. Evidence-based attitudes and guidelines are not easy to elaborate since most of the trials and studies reported mixed cases of oesophageal (both adenocarcinoma and squamous cell tumours), GOJ and gastric cancers. The aim of this expert discussion and position paper is to elaborate practical recommendations that integrate evidence-reported literature and experience-based attitude covering all clinical aspects of GOJ cancer across different specialities and countries in Europe. Methodology Opinion leaders, selected on scientific merit were asked to answer to a prepared set of questions covering the approach of GOJ tumours from definition to therapeutic strategies. All answers were then discussed during a plenary session and reported here in providing a well-balanced reflection of both clinical expertise and updated evidence-based medicine. Results Definition, classification, diagnosis and staging of GOJ tumours were updated and debated. Therapeutic aspects including endoscopic therapy, surgical management, both multimodal curative and palliative management were also reviewed for proposing practical and consensual positions and recommendations whenever possible. Conclusion GOJ tumours deserve specific attention,not only for uniformising clinical management across countries but also for performing specific clinical and translational research,mainly in the curative perioperative setting.

Therapeutic apheresis can be used to treat many diseases. The American Society for Apheresis (ASFA) publishes Guidelines on the use of therapeutic apheresis every 3 years with the goal of providing the best available evidence for apheresis practice as well as clinical expertise. The 2016 (7th ed.) ASFA Guidelines contain 87 diseases (up from 78 in the 6th ed.) and 179 indications. This review outlines three new therapeutic apheresis indications for hematological disorders.The three new nonmalignant and nontransplant-related hematological disorders discussed are therapeutic plasma exchange procedures for hemophagocytic syndrome, hemolysis, elevated liver enzymes, and low platelets syndrome, and red blood cell exchange to prevent alloimmunization after exposure to rhesus (D)-positive red blood cells. All three indications are ASFA category III indications (i.e., optimal role of apheresis therapy is not established) with Grade 2C recommendation (weak recommendation, low-quality evidence).Although the three new therapeutic apheresis indications related to hematological disorders are ASFA category III with Grade 2C recommendations, along with other ASFA category III with Grade 2C recommendations, they may form the list of diseases for which basic, translational, and clinical research is needed to provide better evidence for clinical practice.

The American Academy of Orthopaedic Surgeons has developed the Appropriate Use Criteria (AUC) for the Management of Osteoarthritis of the Hip. 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 Management of Osteoarthritis of the Hip AUC clinical patient scenarios were derived from indications typical of patients presenting with osteoarthritis of the hip in clinical practice. The 270 patient scenarios and 9 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 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

Pulmonary nocardiosis is a rare disease, which mainly affects immunocompromised hosts such as uncontrolled diabetics; HIV patients; and patients on immunosuppressive therapies such as anticancer drugs, systemic steroids, and transplant recipients. The diagnosis is often missed and delayed, resulting in inappropriate treatment and thus higher mortality. We are reporting a case of pulmonary nocardiosis with acute presentation in an immune-competent host, who presented with community-acquired pneumonia to the Intensive Care Unit. Clinical expertise with multiple high-end and interventional investigations timely confirmed the case as pulmonary nocardiosis. Conservative management with medications led to her complete recovery.

Nurse educators must provide high quality student education and demonstrate foundational competencies to fulfill the academic role. Reports on nursing and health care underscore the importance of nurse educators' clinical expertise and educational preparation in teaching; yet, a framework to framework faculty selection and preparation to teach courses does not exist. The purpose of this article is to describe an innovative Faculty-Course Selection Framework (FCSF) for nursing education and discuss two practical examples of application in one school of nursing. The FCSF describes student, organizational, and faculty elements for consideration in determining faculty-course assignment. The fundamental units of the framework include workload needs, credentials, skills, content interest, individual attributes, and commitment. The FCSF equips nursing program administrators and directors to cultivate a highly functioning faculty team that can achieve pedagogical, subject, social, and organizational competence to practice the nurse educator role skillfully and artistically and optimize the student learning environment.

The objective of this article is to review evidence-based strategies available for the nonrestorative management of caries lesions, both cavitated and noncavitated. The goal is to help clinicians make appropriate decisions regarding nonrestorative management of caries lesions. In addition, in the decision-making process, clinicians must consider thresholds for restorative and nonrestorative care and strategies for nonrestorative management that are supported by best available evidence. It is important that this information be considered taking into account a provider's clinical expertise and a patient's treatment needs and preferences, in order to maintain health and preserve tooth structure.

Because of the ever increasing economic, social, legal, and regulatory complexities of the current healthcare environment, traditional clinical training may be insufficient to establish a thriving surgical practice and to achieve individual career goals. Competing constituencies and agendas require thoughtful strategies to achieve professional goals. An orthopaedic surgeon's formal professional education, research experience, and clinical expertise may not fully equip individuals for success in the contemporary healthcare market. With the pressures of modern surgical practices, formal and informal senior mentorship may be critically important, especially for young orthopaedic surgeons. The role of mentorship in job satisfaction, retention, clinical productivity, and research output has been recently investigated across multiple medical and surgical disciplines. These data support the theory that senior mentorship is critical for retention, job satisfaction, clinical volume, professional networking, career progression, and research productivity.

The aim of the study was to develop criterion assessment system of the actual level of expertise of dental professionals practicing Implant dentistry. The study comprised fifteen dental experts aged from 35 to 47 years with the average 15 years clinical experience. For evaluation of the clinical portfolio of the dentists we developed 10 reference points and to ensure unification of the assessment approach we organised consensus methodical conference for our expert group. Scores were applied by parity of reasoning with point-rating system applied in continuing education programs of Medical University. Assessment of 43 clinical portfolios with short term and long term results of implant supported restorations was performed. Treatment was provided with the use of Nobel Biocare implants and prosthodontic rehabilitation was achieved with the use of CAD/CAM 'Procera' technology. The study showed that dentists who practice implant dentistry from 1 to 7 years have good manual skills and clinical expertise sufficient for achieving positive treatment outcome. At the same time in general their actual diagnostic skills are not sufficient, they misapply additional diagnostic methods, do not perform risk analysis of potential clinical complications that leads to shifting responsibilities on the patients in case of complications emergence. Methods of Computer Assisted Design are widely popular during all stages of rehabilitation (diagnostic, surgical stent, final prosthesis framework). Actual level of expertise of dental professionals doesn't depend on sex distribution. Males and females who practice implant dentistry have similar levels of clinical expertise.Цель работы - разработка критериальной системы оценки реальных компетенций молодых специалистов-стоматологов, занимающихся дентальной имплантологией, вскоре после окончания ими клинической ординатуры. В пилотном исследовании приняли участие группа экспертов-стоматологов из 15 человек в возрасте от 35 до 47 лет со средним стажем в дентальной имплантологии 15 лет. Были выработаны 10 критериев для оценки клинического портфолио врачей-стоматологов и проведена согласительная методическая конференция экспертов для унификации подходов к оценке. По аналогии с балльно-рейтинговой системой, применяемой при непрерывном образовании в медицинском вузе, осуществлено баллирование. Проведена оценка 43 клинических портфолио молодых врачей-стоматологов с ближайшими и отдаленными результатами имплантационного протезирования с использованием имплантатов Нобель Байокер и протезов, полученных с использованием технологии компьютерного моделирования и фрезерования (CAD/CAM) Procera. Было показано, что врачи-стоматологи, занимающиеся дентальной имплантологией, обладают хорошими мануальными навыками и клиническими компетенциями при стаже работы от 1 года до 7 лет, что позволяет им достигать положительных исходов лечения. Одновременно с этим в большинстве своем они не владеют в достаточной мере реальными навыками диагностики, неправильно используют параклинические методы обследования, не прогнозируют риски клинических осложнений, тем самым перекладывая ответственность за них на пациента. В то же время широко используются методы компьютерного моделирования на всех этапах реализации плана лечения (диагностика, хирургический шаблон, каркас окончательного протеза). Реальные компетенции врачей-стоматологов не зависят от их пола. Женщины и мужчины, занимающиеся дентальной имплантологией, обладают сходными клиническими компетенциями.

Background: Quality of life (QOL) is important to people with aphasia and their family members and is influenced by a range of factors within the scope of practice for speech and language therapy. Interestingly though, clinicians largely assess patients’/ clients’ QOL informally through discussion, and rarely measure QOL as an outcome from aphasia rehabilitation. Research is needed to understand why there is relatively little consideration of QOL in clinical practice and little use of formal assessments.\ud \ud Aims: This study explores aphasia clinicians’ views and reported practices regarding QOL as a concept and its assessment.\ud \ud Methods & Procedures: Nineteen practising speech and language therapists working in rehabilitation with adult clients with neurogenic communication disorders volunteered and completed the study. They completed an online survey of 48 questions with a range of response options, including free text. Descriptive and inferential statistics were used for count and categorical data, and content analysis for text responses.\ud \ud Outcomes & Results: These clinicians felt initially unprepared for practice, and had limited awareness, knowledge and confidence in using QOL assessments, but nonetheless thought QOL was important in clinical management. They considered QOL as being individualized, pertaining to life satisfaction and enjoyment, and additionally considered it as communication, participation in activities, education, and emotional support. The majority used informal methods, although some formal assessment use was reported. Many perceived barriers related to lack of resources (physical, staff, and time). Clinicians also reported scope of practice issues with the broader multidisciplinary rehabilitation team and specifically clinical psychology.\ud \ud Conclusions: Training and access to existing available QOL assessments are clear implications from this study. Further research is needed to assess the extent to which these findings are representative of the broader aphasia clinician community in England.

Introduction The ambulance care setting is complex and unpredictable and the personnel must prepare for upcoming assignments. Prehospital emergency care nurses (PENs), are frequently exposed to critical incidents (CIs). There are, to our knowledge, no prior studies describing experiences of requirements for management of caring for a patient during a CI in the ambulance care context. Therefore, the aim of the study was to explore PENs’ experiences of care in CIs. Method A qualitative research design with content analysis has been used, based on semi-structured interviews with eleven PENs in Sweden. Results PENs’ experiences can be described as: “In a critical incident, personal ability based on experiential knowledge is central to patient care”. Three generic categories underpinned the main category: “Clinical expertise”, “Professional approach” and “Broad knowledge base”. Conclusions The care given during a CI in the ambulance care setting depends on PENs’ personal ability based on experiential knowledge. Employers need to build an organization providing prerequisites and support during an CI. Suggested activities are to create forums for PENs to share experiences with each other, possibility to get feedback on completed assignments and continued training to develop new knowledge and be prepared for the unpredictable environment that characterizes CI.

Physical examinations are recommended as part of a comprehensive evaluation for individuals with neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder. These examinations should include assessment for morphological variants. Previous studies have shown an increase in morphological variants in individuals with NDDs, particularly ASD, and that these variants may be present in greater amounts in individuals with genetic alterations. Unfortunately, assessment for morphological variants can be subjective and time-consuming, and require a high degree of clinical expertise. Therefore, objective, automated methods of morphological assessment are desirable. This study compared the use of Face2Gene, an automated tool to explore facial morphological variants, to clinical consensus assessment, using a cohort of N = 290 twins enriched for NDDs (n = 135 with NDD diagnoses). Agreement between automated and clinical assessments were satisfactory to complete (78.3-100%). In our twin sample, individuals with NDDs did not have greater numbers of facial morphological variants when compared to those with typical development, nor when controlling for shared genetic and environmental factors within twin pairs. Common facial morphological variants in those with and without NDDs were similar and included thick upper lip vermilion, abnormality of the nasal tip, long face, and upslanted palpebral fissure. We conclude that although facial morphological variants can be assessed reliably in NDDs with automated tools like Face2Gene, clinical utility is limited when just exploring the facial region. Therefore, currently, automated assessments may best complement, rather than replace, in-person clinical assessments.

Background Excessive salt intake is widely known to be a cause of hypertension, cardiovascular events, and so on. However, simple tools for screening excessive salt intake are lacking. Objective We aimed to develop a simple screening tool to identify community-dwelling adults with excessive salt intake. Methods The present study involved participants who received health check-ups in Fukushima, Japan, in 2016 and 2017. We defined data from the 2016 check-up as the derivation set, and data from those who received check-ups in 2017 but not 2016 as the validation set. The outcome measure was excessive salt intake, defined as the estimated daily salt intake of 1 SD or more. Candidate predictors associated with the outcome were extracted using the Delphi method by an expert panel and narrowed down with clinical expertise and stepwise backward selection. The screening tool was developed using a coefficient-based multivariable scoring method and externally validated. Results A total of 1101 participants were included in the derivation set and 249 in the validation set. At the conclusion of the deviation process, 8 predictors were selected and scored. The areas under the receiver operating characteristic curve for derivation and external validation were 0.70 (95% CI: 0.67, 0.74) and 0.71 (95% CI: 0.62, 0.80), respectively. The calibration slope and intercept for external validation were 1.16 and -0.03, respectively. Conclusion We developed a screening tool to identify adults with excessive salt intake. By extracting groups with excessive salt intake, target populations needing intervention for salt reduction can be highlighted efficiently.

The founding tenet of evidence-based medicine is to combine best evidence with clinical expertise. As David Sackett opined ‘Without clinical expertise, practice risks becoming tyrannised by evidence’. Rigid protocols and mandates, based on an inconclusive and low-level evidence base, cannot suit the physiological, biochemical and biological heterogeneity displayed by the individual septic patient. Indeed, clear proof of outcome benefit through adoption of an inflexible management approach is lacking and will certainly be detrimental to some. Therapy thus needs to be tailored to meet the individual patient’s needs. The same principle should be applied to clinical trials; the continued disappointments of multiple investigational strategies trialled over three decades, despite (often) a sound biological rationale, suggest a repeated methodological failure that does not account for the marked heterogeneity within the septic patient’s biological phenotype and thus marked variation in their host response. The increasing availability of rapid point-of-care diagnostics and theranostics should facilitate better patient selection and titrated optimization of the therapeutic intervention.

Background The medical education system based on principles advocated by Flexner and Osler has produced generations of scientifically grounded and clinically skilled physicians whose collective experiences and contributions have served medicine and patients well. Yet sweeping changes launched around the turn of the millennium have constituted a revolution in medical education. In this article, a critique is presented of the new undergraduate medical education (UME) curricula in relationship to graduate medical education (GME) and clinical practice. Discussion Medical education has changed and will continue to change in response to scientific advances and societal needs. However, enthusiasm for reform needs to be tempered by a more measured approach to avoid unintended consequences. Movement from novice to master in medicine cannot be rushed. An argument is made for a shoring up of biomedical science in revised curricula with the beneficiaries being nascent practitioners, developing physician-scientists --and the public. Conclusion Unless there is further modification, the new integrated curricula are at risk of produce graduates deficient in the characteristics that have set physicians apart from other healthcare professionals, namely high-level clinical expertise based on a deep grounding in biomedical science and understanding of the pathologic basis of disease. The challenges for education of the best possible physicians are great but the benefits to medicine and society are enormous.

Razvoj sestrinstva kroz povijest u svim zemljama u svijetu uvjetovan je mnogim čimbenicima, ali u najvećoj mjeri razvojem znanosti i tehnologije, društvenim zbivanjima, odnosima u društvu općenito te sustavom vrijednosti koje društvo formalno ili neformalno promiče kao i mogućnostima i kvalitetom međunarodne suradnje i komunikacije. Sestrinstvo i danas, pod utjecajem navedenih čimbenika, doživljava stalni razvoj i promjene. Profesionalna sestrinska skrb, s naglaskom na individualiziranu/personaliziranu skrb, obuhvaća spoznajna i kulturološki naučena ponašanja koja omogućuju pojedincu, obitelji i zajednici da poboljšaju ili očuvaju zdravlje. Zdravstvena njega utemeljena na dokazima označava promišljen i metodički pristup u postupku donošenja sestrinskih odluka i definira se kao savjesna, jasna i kritička primjena najboljeg znanstvenog dokaza u donošenju odluka o skrbi za pojedinog bolesnika. Metodologija sestrinstva utemeljenog na dokazima objedinjuje traženje znanstvenih činjenica/dokaza dobivenih znanstvenim istraživanjima, sažimanje dokaza, kritičku prosudbu, odabir najboljeg ili najprimjenjivijeg dokaza te njegovu primjenu u svakodnevnoj kliničkoj praksi. Potrebne vještine za prakticiranje sestrinstva utemeljenog na dokazima uključuju: poznavanje informacijskih tijekova, oblikovanje strategije traženja dokaza, lociranje izvora dokaza, selekciju nađenih informacija, analizu i interpretaciju dokaza, procjenu njihove primjenjivosti i njihovo postavljanje u okvire drugih informacija i procjena potrebnih za rješavanje problema (kliničko iskustvo, želje i stavovi bolesnika i sl.). Cilj ovog diplomskog rada je ukazati na postojeće prepreke za provođenje zdravstvene njege utemeljene na dokazima u kliničkoj praksi, u sustavu zdravstva Republike Hrvatske. Ukazivanjem na postojeće prepreke, odnosno osvještavanjem njihovog postojanja, pružila bi se mogućnost za njihovo uklanjanje, što bi otvorilo put daleko kvalitetnijem prakticiranju zdravstvene njege. Krajnji rezultat bi bio veće zadovoljstvo bolesnika, zadovoljstvo medicinskih sestara, bolji ishodi liječenja i u konačnici bi sve bilo financijski isplativije za zdravstveni sustav države., The development of nursing through history and in all countries in the world is conditioned by many factors, but to a large extent by the development of science and technology, social events and relationships in society in general and the system of values that society promotes formally or informally as well as the possibilities and the quality of international cooperation and communication. Nursing today, under the influence of the mentioned factors, experiences constant development and change. Professional nursing care, with an emphasis on individualized care, encompasses cognitive and culturally learned behaviors that enable an individual, family, and community to improve or maintain their health status. Evidence-based healthcare means a deliberate and methodical approach to nurses decision making, and is defined as the conscientious, clear and critical application of the best scientific evidence in deciding on the care of each individual patient. The evidence-based nursing methodology combines information retrieval, critical judgment, information compression, and application of information in everyday clinical practice, as well as assessment of clinical decision outcomes. Evidence-based skill practice skills required include: knowledge of information flows, design of information retrieval strategy, location of information sources, selection of information found, analysis and interpretation of information, assessment of their applicability and their placement in the framework of other information necessary for solving problems (clinical experience, wishes and attitudes of patient). The aim of this graduate thesis is to point out the existing barriers to the implementation of health care based on evidence in clinical practice, in the health system of the Republic of Croatia. Pointing to the existing obstacles, or raising awareness of their existence, would provide an opportunity for their removal, which would open the way to a far better quality of practicing health care. The end result would be greater patient satisfaction, nursing satisfaction, better treatment outcomes and ultimately would be all financially more cost-effective for the health system of the state.

David Sackett, the father of evidence-based medicine once said, “Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough”. This quote represents the delicate balance of evidence and opinion in the practice of evidence-based medicine (EBM) and evidence-based surgery (EBS). Doctors and surgeons alike are constantly dealing with an ever-changing environment, as well as individual patients who require individualized care. Therefore, while evidence from high-quality clinical trials should be considered, some evidence may not be applicable for an individual patient or situation. It is times like these, where a surgeon may need to seek out an expert opinion, either in person or within the literature. Currently, expert opinion is at the bottom of the hierarchy of evidence, yet it remains to be an integral part of the practice of EBS. Due to the importance of expert opinion in the practice of EBS, surgeons and surgeon-researchers need to understand what makes a reliable and trustworthy source. This chapter will outline, for the reader, the value and limitations of expert opinion, where expert opinion fits into surgery, and if it applies to the readers’ practice. Lastly, the reader will be given a set of questions that can be used to appraise the article, and the author of that article to ensure that the opinions stated can be trusted.

This chapter introduces evidence-based practice and empirically supported treatments for individuals with intellectual disabilities. The chapter begins by providing a brief history of the evolution of evidence-based practice, which is rooted in the field of medicine. The key components of evidence-based practice (i.e., research evidence, clinical expertise, and patient variables) are discussed, followed by a section outlining the methods used to identify empirically supported treatments. The chapter concludes with a brief discussion regarding barriers to implementing evidence-based practice, as well as future directions.

Proven experience can be shared. Given this, we cannot assume that the character of proven experience is always manifest as a physical token in each individual sharing it. But the token might still exist somewhere. Perhaps that is a condition of the proven experience’s existence. Something similar could have been accepted as true of scientific knowledge, especially if those who argued that scientific claims were only shorthand for more complicated claims about observations had been right. But it seems that they were not. Hence there might be an ontological difference explaining why there will always be a netto divergence between science and proven experience.