Better Understanding Of Clinical Practice Research Articles

Reconciling imperatives: Clinical guidelines, antibiotic prescribing and the enactment of good care in lower-level health facilities in Tororo, Uganda

ABSTRACT Faced with the threat of antimicrobial resistance, health workers are urged to reduce unnecessary prescription of antimicrobials. Clinical guidelines are expected to form the basis of prescribing decisions in practice. Emerging through evaluations of best practice – bundling clinical, technological and economic dimensions – guidelines also create benchmarks through which practice can be assessed with metrics. To understand the relationships between guidelines and practice in the prescribing and dispensing of antibiotics, ethnographic fieldwork was undertaken in lower-level health care facilities in rural Eastern Uganda for 10 months between January and October 2020, involving direct observations during and outside of clinics and interviews with staff. In a context of scarcity, where ‘care’ is characterised by delivery of medicines, and is constituted beyond algorithmic outputs, we observed that clinical practice was shaped by availability of resources, and professional and patient expectations, as much as by the clinical guidelines. For stewardship to care for patients as well as for medicines, a better understanding of clinical practice and expectations of care is required in relation to and beyond clinical guidelines.

Clinical management of drug-resistant bacteria in Australian hospitals: An online survey of doctors' opinions.

To gain a better understanding of clinical practice for the treatment of common drug-resistant infections. A web-based anonymous survey was developed to gain a better understanding of clinical practice of patients infected with drug-resistant bloodstream infections (BSI). The survey instrument was a questionnaire requesting doctors to provide their opinion on the most likely choice of an antibiotic, dose and route of administration for patients infected with a drug-resistant Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa or Enterococcus faecium. All of the survey participants (n=28) were hospital-based doctors. Choice of therapy for drug-resistant E. coli and K. pneumoniae was uniform across survey participants. However, optimal treatment of ceftazidime-resistant P. aeruginosa and VRE was less clear. The survey adds to the limited body of evidence in this clinical area and can be a useful tool for health economists in determining the additional cost of treating patients with drug-resistant infections.

Clinical Reflection: The experience of Nursing Students in the Obstetric Unit

Background: The reflective journal, a tool in students’ learning that helps student reflecting on and store their clinical learning in their memory. It also helps in better understanding of clinical practice as well as understanding of what they experienced and learned, provided the clinical instructors are not available for every student all the times. The outcome increases the confidence of the students and facilitates the ability of the instructor to customize clinical experiences for individual students based on their learning gaps. Method: Reflective journals of 40 nursing students from fall and spring 2013-2014 assigned to their Obstetric (OB) clinical placement were analyzed. Of them, 12 were interviewed face-to-face and were asking to relay their experiences in the postpartum units, labor and delivery, antepartum, and neonatal intensive care unit (NICU). Interviews were digitally recorded and transcribed verbatim. A qualitative phenomenological approach was used to explore the basic social process, which attempts to transcend student nurses’ experience regarding clinical reflection as a continual process and move it from a description of what is happening to an understanding of the process by which it happens. Findings: The findings of this study have the potential to contribute new knowledge concerning the process of experiential learning using reflection. Through reflection, nursing students in their obstetric clinical rotations demonstrated progress towards professional nursing status by developing confidence, and knowledge in nursing. Conclusion: Reflective journals as an educational strategy for facilitating learning in the extent of practice setting, and level of reflection achieved. Maternal-child nursing student was the participant in the process of his/her own clinical experience in various areas in the OB clinical unit. Reflective journaling also facilitates the nursing students’ learning and progress towards building confidence and knowledge, which are main components in providing quality of care.

Deciding About Fast and Slow Decisions

Two reports in this issue address the important topic of clinical decision making. Dual process theory has emerged as the dominant model for understanding the complex processes that underlie human decision making. This theory distinguishes between the reflexive, autonomous processes that characterize intuitive decision making and the deliberate reasoning of an analytical approach. In this commentary, the authors address the polarization of viewpoints that has developed around the relative merits of the two systems. Although intuitive processes are typically fast and analytical processes slow, speed alone does not distinguish them. In any event, the majority of decisions in clinical medicine are not dependent on very short response times. What does appear relevant to diagnostic ease and accuracy is the degree to which the symptoms of the disease being diagnosed are characteristic ones. There are also concerns around some methodological issues related to research design in this area of enquiry. Reductionist approaches that attempt to isolate dependent variables may create such artificial experimental conditions that both external and ecological validity are sacrificed. Clinical decision making is a complex process with many independent (and interdependent) variables that need to be separated out in a discrete fashion and then reflected on in real time to preserve the fidelity of clinical practice. With these caveats in mind, the authors believe that research in this area should promote a better understanding of clinical practice and teaching by focusing less on the deficiencies of intuitive and analytical systems and more on their adaptive strengths.

Robot decisions: on the importance of virtuous judgment in clinical decision making

The aim of this article is to argue for the necessity of emotional professional virtues in the understanding of good clinical practice. This understanding is required for a proper balance of capacities in medical education and further education of physicians. For this reason an ideal physician, incarnating the required virtues, skills and knowledge is compared with a non-emotional robot that is bound to moral rules. This fictive confrontation is meant to clarify why certain demands on the personality of the physician are justified, in addition to a rule- and principle-based moral orientation and biomedical knowledge and skills. Philosophical analysis of thought experiments inspired by science fiction literature by Isaac Asimov. Although prima facie a rule-oriented robot seems more reliable and trustworthy, the complexity of clinical judgment is not met by an encompassing and never contradictory set of rules from which one could logically derive decisions. There are different ways how the robot could still work, but at the cost of the predictability of its behaviour and its moral orientation. In comparison, a virtuous human doctor who is also bound to these rules, although less strictly, will more reliably keep at moral objectives, be understandable, be more flexible in case the rules come to their limits, and will be more predictable in these critical situations. Apart from these advantages of the virtuous human doctor referring to her own person, the most problematic deficit of the robot is its lacking deeper understanding of the inner mental events of patients which makes good contact, good communication and good influence impossible. Although an infallibly rule-oriented robot seems more reliable at first view, in situations that require complex decisions like clinical practice the agency of a moral human person is more trustworthy. Furthermore, the understanding of the patient's emotions must remain insufficient for a non-emotional, non-human being. Because these are crucial preconditions for good clinical practice, enough attention should be given to develop these virtues and emotional skills, in addition to the usual attention on knowledge, technical skills and the obedience to moral rules and principles.

I, Medical Robot. On the differences between a virtuous doctor and a good robot

Rationale, aims and objectives: The aim of this article is to argue for the necessity of emotional professional virtues in the understanding of good clinical practice. This understanding is required for a proper balance of capacities in medical education and further education of physicians. For this reason, an ideal physician, incarnating the required virtues, skills and knowledge, is compared with a non-emotional robot that is bound to moral rules. This fictive confrontation is meant to clarify why certain demands on the personality of the physician are justified, in addition to a rule- and principle-based moral orientation and biomedical knowledge and skills.Methods: Philosophical analysis of thought experiments inspired by science fiction literature by Isaac Asimov.Results: Though prima facie a rule-oriented robot seems more reliable and trustworthy, the complexity of clinical judgment is not met by an encompassing and never contradictory set of rules from which one could logically derive decisions. There are different ways in which the robot could still work, but at the cost of the predictability of its behaviour and its moral orientation. In comparison, a virtuous human doctor who is also bound to these rules, though less strictly, will more reliably keep to moral objectives, be understandable, be more flexible in case the rules come to their limits and will be more predictable in these critical situations. Apart from these advantages of the virtuous human doctor referring to his own person, the most problematic deficit of the robot is its lacking deeper understanding of the inner mental events of patients which makes good contact, good communication and good influence impossible.Conclusion: Though an infallibly rule-oriented robot seems more reliable at first view, in situations that require complex decisions such as clinical practice, the agency of a moral human person is more trustworthy. Since this is a crucial precondition for good clinical practice, sufficient attention should be given to develop these virtues in addition to the usual attention on knowledge, skills and adherence to moral rules and principles.

Certificate of Good Clinical Practice

This course is for all doctors interested in doing research at any level. Also, research nurses, pharmacists, and clinical research and clinical trials support staff may find the course useful. I did the course and exam during my third year as a medical specialist registrar; this was while I was trying to get a clinical trial off the ground. A basic understanding of Good Clinical Practice (an international set of standards regarding the organisation of research on humans) is a prerequisite for anyone carrying out or involved with clinical trials. I …