Clinical Decision-making Approaches Research Articles

Factors Affecting Clinical Decision-Making Among Dentists and Dental Students: A Crosssectional Study.

To determine the association between clinical decision-making approaches and personal and professional background factors. An electronic questionnaire was sent to 550 dentists and dental students all over Saudi Arabia from October 2019 to January 2020. The questionnaire assessed personal and professional background factors in addition to three different clinical scenarios, and each participant was asked to rate the importance of some factors that might affect clinical decision-making on a visual analog scale (VAS). Multivariate analysis of variance (MANOVA) was performed to assess the association between the exposure variables (background and professional factors) and the outcome variables, which were the three clinical decision-making approaches (patient-related, clinical-case, and operator-related factors). Regression coefficients (B), 95% CI, and the adjusted R2 of the models were calculated. A total of 420 participants responded to the questionnaire (76.36% response rate). Clinical-case factors had the highest mean scores, while the operator-related factors had the lowest mean scores. Men were significantly less likely than women to consider any factor decisive (P < .001). General dentists and specialists other than prosthodontists/restorative dentists assigned significantly lower importance to operator-related factors (P = .003) and clinical-case factors (P = .005). However, there was no statistically significant difference between undergraduate students and prosthodontists/restorative dentists in considering all decisive factors. Clinical-case factors were of greater importance compared to operator- and patient-related factors. General practitioners and specialists other than prosthodontists/restorative dentists gave lower attention to operator-related and clinical-case approaches, while experienced dentists showed greater importance to clinical-case and operator-related factors.

Clinical decision making approaches and associated factors among nurses working in a tertiary teaching hospital

IntroductionThe clinical decision-making approach is an ongoing process in the nursing clinical setting and has an impact on the survival of the patient under their care. ObjectiveTo assess clinical decision-making approaches among hospital nurses. Methods and materialsAn institutional-based cross-sectional study was conducted from March 20 to April 4, 2018. A single population proportion formula for sample size determination and stratified sampling technique was used to select the study participants. The data was gathered using a pretested, structured, self-administered questionnaire and trained data collectors. The data was analyzed using SPSS version 20. To explain the study variables, frequency tables, figures, and percentages were used. Bivariable and multivariable logistic regressions were used to see the association between independent and dependent variables. ResultsAmong the total participants, 44.3% had intuitive and 55.7% had analytical decision-making approaches. Being at a higher educational level (aOR = 3.49, 95 % CI (1.45, 13.16)), having 10 years experience, having a high workload (aOR = 0.54, 95 % CI (0.37,0.42)) and having training (aOR = 3.11, 95 % CI (1.83, 5.28)) were significantly associated with intuitive clinical decision making. ConclusionThe intuitive decision-making approach was lower as compared to most of the previous studies. Variables such as higher experience, the high workload in the working unit, and talking training in clinical decision-making were significantly associated with the intuitive decision-making approach. Therefore, policymakers ought to implement the standard nurse-to-patient ratio and design training on how to handle the patient in different situations to achieve a good decision-making approach.

Importance of In-Hospital Prospective Registry and Infectious Endocarditis Heart Team to Monitor and Improve Quality of Care in Patients with Infectious Endocarditis.

Aim: To investigate the value of prospective in-hospital registry data and the impact of an infectious endocarditis heart team approach (IEHT) on improvement in quality of care and monitor outcomes in hospitalized patients with IE. Methods: Between December 2014 and the end of 2019, 160 patients were hospitalized in one centre with the definite diagnosis of infectious endocarditis (IE) and entered in a prospective registry. From 2017, an IEHT was introduced. Propensity score matching was used to assess the impact of an IEHT approach on clinical outcomes. Results: Median age was 72.5 y (62.75–80.00), diabetes was present in 33.1%, chronic kidney disease in 27.5%, COPD in 17.5%, and a history of ischaemic heart disease in 30.6%. Prosthetic valve IE was observed in 43.8% and device-related IE in 16.9% of patients. Staphylococcus (37.5%) was the most frequent pathogen followed by streptococcus (24.4%) and enterococcus (23.1%). Overall, 30-day and 1-year mortality were 19.4% and 37.5%, respectively. The introduction of prospective data collection and IE heart team was associated with a trend towards reduction of adjusted 1-year mortality (26.5% IEHT vs. 41.2% controls, p = 0.0699). An IEHT clinical decision-making approach was independently associated with a shorter length of stay (p = 0.04). Conclusions: Use of a prospective registry of IE coupled with a heart team approach was associated with more efficient patient management and a trend towards lower mortality. Prospective data collection and dedicated IEHT have the potential to improve patient care and clinical outcomes.

Evidence-Based Practice in Oncology Nursing: Oncology Nursing Society Survey Results.

Evidence-based practice (EBP) is a clinical decision-making approach that improves quality and outcomes in health care but is not yet standard in clinical settings. The purpose of this study was to determine EBP beliefs, knowledge, implementation strategy self-efficacy, and competencies among a national sample of oncology nurses. Oncology nurses completed an online survey of EBP attributes and open-ended questions. Analyses were conducted on data collected from 893 participants from a range of healthcare organizations across a diverse geographic sample of the United States. Respondents rated themselves competent to question clinical practice to improve quality care. Oncology nurses reported competency to question clinical practice but deficits in EBP knowledge and skills.

Cryoablation may be superior to drug therapy for initial management of AFib

Results from two studies published in the New England Journal of Medicine support the use of catheter cryoballoon ablation over antiarrhythmic therapy as initial therapy for patients with symptomatic, paroxysmal atrial fibrillation (AFib). The research was based on two trials, known as EARLY-AF and STOP AF First, which both showed that initial use of cryoablation resulted in a significantly lower rate of AFib recurrence compared with drug therapy without increasing the risk for serious adverse events. “We can now offer pulmonary vein isolation–based ablation with greater confidence as first-line therapy for selected patients with paroxysmal atrial fibrillation, particularly those who are disinclined to take antiarrhythmic drugs,” said Joseph E. Marine, MD, from the division of cardiology at Johns Hopkins University School of Medicine, in an accompanying editorial. “The new data will inform shared decision-making discussions with all patients with paroxysmal atrial fibrillation.” The EARLY-AF (Early Aggressive Invasive Intervention for Atrial Fibrillation) trial included 303 adult patients with symptomatic, paroxysmal, untreated AFib who were randomized to catheter ablation with a cryothermy balloon (n = 154) or antiarrhythmic drug therapy (n = 149) as their initial rhythm control. Patients were followed for 12 months. The primary endpoint was the first documented recurrence of any atrial tachyarrhythmia (i.e., AFib, atrial flutter, or atrial tachycardia) lasting 30 seconds or longer between 91 and 365 days after catheter ablation or initiation of an antiarrhythmic drug. At 1 year, documented recurrence occurred in 42.9% of patients who underwent cryoablation compared with 67.8% in the antiarrhythmic group (hazard ratio 0.48 [95% CI 0.35–0.66]). The occurrence of serious adverse events was similar among the two groups: 3.2% of patients in the cryoablation group and 4.0% of patients in the antiarrhythmic group. The STOP AF First (Cryoballoon Catheter Ablation in Antiarrhythmic Drug Naive Paroxysmal Atrial Fibrillation) trial included 203 adult patients with paroxysmal AFib who had not previously received rhythm-control therapy. They were randomized to treatment with a class I or III antiarrhythmic (n = 99) or cryoballoon ablation (n = 104). The results were similar to those of the EARLY-AF trial. A higher percentage of patients in the cryoballoon ablation group had treatment success, defined as freedom from initial failure of the procedure or atrial arrhythmia recurrence after a 90-day period. The estimated percentage of treatment success at 12 months was 74.6% in the ablation group compared with 45.0% in the drug therapy group. Serious adverse events occurred in 14% of patients in both treatment groups. AFib is common, affecting approximately 0.4% to 1% of the general U.S. population, and recurrence rates are high, especially in individuals who are not receiving preventive treatments. Current guidelines by the American Heart Association/American College of Cardiology/Heart Rhythm Society and European Society of Cardiology have generally recommended the use of antiarrhythmic drugs as initial therapy for maintenance of sinus rhythm in patients with AFib. However, these medications tend to have limited efficacy and substantial adverse effects. Once an initial course of treatment fails, catheter ablation is superior to antiarrhythmic drug therapy for preventing further recurrences of atrial arrhythmias. Results of the EARLY-AF and STOP AF First trials could result in some modifications to these current recommendations, with catheter cryoballoon ablation used as initial management to prevent AFib recurrences in select patients. In his editorial, Marine noted that clinicians should consider the populations included in these trials when applying the data in clinical practice. As in the trials, most patients will need to have normal left ventricular function, normal left atrial size, and few coexisting conditions to be eligible for cryoablation. The results cannot be readily extrapolated to patients with persistent AFib, significant structural heart disease, or substantial coexisting conditions that may reduce the efficacy and safety of ablation. Clinicians will need to discuss with patients the benefits and risks of cryoablation compared with initial use of antiarrhythmic therapy. A shared clinical decision-making approach may be beneficial.

Learning by doing: To explore the influence of Simulation on Clinical Decision-Making Approaches on Final Year Medical Students at the University of Duisburg-Essen, Germany.

This article was migrated. The article was marked as recommended. Background: Final year medical students at the University Duisburg-Essen, Germany, are unsatisfied with their clinical judgement skills in common elective and emergency clinical situations. A competency based medical curriculum determines that clinical judgement is an essential tool in effective patient care, patient safety and limiting clinical error. Approaches to clinical judgement include either analytical, intuitive or a combination of both approaches. Novices show specific factors, which are typical in inexperienced clinicians. Simulation provides opportunities in a competency-based medical education curriculum. There is limited evidence showing that simulation can provide an effective environment for teaching and learning clinical decision-making skills. This project explores how final year medical students at the University of Duisburg-Essen approach the clinical decision-making process as well as how simulation influences this process. Methods: Ethics approval was obtained from the local ethics committee. After completing a 10-week simulation course,thirty-five students completed a clinical decision-making instrument to categorise their clinical decision-making approaches. The Novice Decision Making Model and the Cognitive Continuum Model were combined with learning theories in Simulation (Social Cognitive Theory) and used to explore and interpret data collected through questionnaires, interviews and observation. Results: The majority (60%) of students employed a predominantly analytic approach, some students showed intuitive tendencies in clinical situations. During interviews students displayed typical novice approaches to decision-making and expressed positive comments relating to simulation. Conclusions: Simulation presents an opportunity for teaching and learning clinical decision-making. Results show the need for further inquiry into learning clinical decision-making through simulation. This research provides initial evidence that simulation can be incorporated into curricular teaching of clinical decision-making.

Clinical decision-making approaches by health caregivers of patients with COVID-19

The Coronavirus disease of 2019 COVID-19) is the current health crisis in the world- a new, complex phenomenon that has affected and hospitalized many people around the world. Health care providers deal with COVID-19 patients daily and care for the patients while there is no definitive cure for it. Clinical decision-making is an important task of health professionals that plays an essential role in preserving the patient's life and providing quality care. Therefore, understanding clinical decision-making approaches by healthcare providers, such as nurses and physicians, especially in crises such as COVID-19, is essential.

Rural–Urban Differences in Human Papillomavirus Vaccination Among Young Adults in 8 U.S. States

Each year, nearly 44,000 new cancers attributable to human papillomavirus (HPV) infection are diagnosed in the U.S., approximately 79% of which could have been prevented by HPV vaccination.1 HPV vaccination is routinely recommended for all adolescents aged 11–12 years, with catch-up vaccination recommended through age 26 years.2 For unvaccinated adults aged 27–45 years, a shared clinical decision-making approach to HPV vaccination is recommended.2 HPV vaccination rates in the U.S. are suboptimal.

The decision is yours

The paramedic role requires countless sound, logical and sensible decisions to be made. Sometimes paramedics may be faced with decisions that they feel less confident about making. This paper will discuss the types of clinical decision-making approaches. The majority of everyday decisions are made intuitively. The brain uses its experience to match decisions that it has made, observed or contributed. This may not be a reliable method of decision making, especially if you have been unable to gather sufficient information. Pattern recognition is a skill-based activity. Unlike intuition, which can support near-instant decision making, it is done when time permits and there is no need to rush. Under the hypothetico-deductive model of clinical decision making, the clinician sorts the clues and findings into logical groups using previous knowledge of symptoms and anatomical locations and landmarks. Then a hypothesis is formulated based on experience and knowledge of pathological, physiological and psychological conditions. Generally, clinicians need to improve their awareness of clinical decision making: using intuition might well have a role to play coupled with heuristics and bias, but it has its limitations and risks. However, hypothetico-deductive reasoning has a prominent place and should be embedded into education and everyday use.

Paramedic clinical decision-making in mental health care: a new theoretical approach

This article aims to present a new theoretical approach for examining paramedic clinical decision-making in relation to mental health care. Recent theorizing has begun exploring key clinical decision-making approaches that are particularly relevant to paramedic practice. These approaches have also revealed some important factors that influence clinical decision-making behaviours among paramedics such as prior experience and clinical and tacit knowledge. The literature, however, provides very little insight into the clinical decision-making strategies paramedics draw on and use when dealing with mental health patients, in particular, those patients who are dealt with under involuntary provisions of mental health legislation. In addition, the literature provides limited coverage to account for how paramedics deal with and mitigate risk factors relating to patients experiencing a mental health emergency. Following these shortcomings, this article will propose the use of hermeneutic phenomenological methods as a suitable and innovative interpretive research approach for examining paramedic clinical decision-making in relation to prehospital mental health care. It is argued that this approach is well suited for exploring how paramedics make sense of their experience providing emergency mental health care, how they perceive their role within the clinician-patient relationship, and the particular circumstances in which paramedics exercise their legislative responsibilities under mental health legislation.

Paramedic clinical decision-making in mental health care: a new theoretical approach

This article aims to present a new theoretical approach for examining paramedic clinical decision-making in relation to mental health care. Recent theorizing has begun exploring key clinical decision-making approaches that are particularly relevant to paramedic practice. These approaches have also revealed some important factors that influence clinical decision-making behaviours among paramedics such as prior experience and clinical and tacit knowledge. The literature, however, provides very little insight into the clinical decision-making strategies paramedics draw on and use when dealing with mental health patients, in particular, those patients who are dealt with under involuntary provisions of mental health legislation. In addition, the literature provides limited coverage to account for how paramedics deal with and mitigate risk factors relating to patients experiencing a mental health emergency. Following these shortcomings, this article will propose the use of hermeneutic phenomenological methods as a suitable and innovative interpretive research approach for examining paramedic clinical decisionmaking in relation to prehospital mental health care. It is argued that this approach is well suited for exploring how paramedics make sense of their experience providing emergency mental health care, how they perceive their role within the clinician-patient relationship, and the particular circumstances in which paramedics exercise their legislative responsibilities under mental health legislation.

Complementary Therapies for Physical Therapy: A Clinical Decision-Making Approach

Complementary Therapies for Physical Therapy: A Clinical Decision-Making Approach

Re‐framing the clinician's role in collaborative clinical decision making: re‐thinking practice knowledge and the notion of clinician–patient relationships

AbstractMany clinicians are moving away from the traditional expert role towards a more collaborative approach to clinical decision making. Collaboration with patients has implications for the power distribution between clinician and patient, how health is defined, and what counts as evidence in the decision‐making process. A critical social science perspective provides the philosophical and theoretical underpinnings for collaborative clinical decision making. Key issues of critical social science are critical self‐reflection, questioning taken‐for‐granted practice, and transforming current practice. The way that clinicians define their role in clinical decision making reflects their beliefs and values about health, power and practice knowledge. Clinicians who adopt a collaborative clinical decision‐making approach reject the objective scientific view of evidence‐based practice, and embrace cultural and political influences on what counts as evidence. The purpose of collaboration is to increase understanding between the clinician and the patient. A distinction is made in this debate between manipulating and emancipating patients. Including patients in the decision‐making process promises to result in more realistic and appropriate treatments, reduced patient concerns and complaints and better, sustainable health outcomes, and increased patient and clinician satisfaction. In this article we re‐think practice knowledge and the notion of clinician–patient relationships.