Framework For Clinical Practice Research Articles

Ethics education in applied sport psychology

In applied sport psychology psychologists are often required to provide their services outside of the framework of traditional clinical practice, which has its advantages and limitations. Practitioners often face specific dilemmas and cannot find guidelines in the ethics code. Education in the field of ethics has been empirically proven as a powerful factor in the prevention of ethics violations. This issue becomes more important as there has been a growing number of psychologists in this field in recent years. That is why the focus of this paper is describing the specificity of ethics in applied sport psychology. Based on the review of the relevant literature, three most common issues have been identified: setting boundaries, confidentiality and competence. In the second, lesser, empirical part of the paper, the results of a pilot study on ethical beliefs related to the behavior of sports psychologists are presented. Data were collected on a sample of students of psychology (N = 92), some of which might become sport psychologists. Some of the behaviors that are necessary for effective practice but are atypical for traditional clinical practice (for example, the presence of psychologists in competitions) are seen as unethical by almost half of the respondents. Most of the respondents have similar beliefs regarding the disclosure of confidential information to trainers. Recommendations which refer to the need to develop specific training programs in applied sport psychology ethics are also presented.

ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research.

To update the Society of Critical Care Medicine's guidelines for ICU admission, discharge, and triage, providing a framework for clinical practice, the development of institutional policies, and further research. An appointed Task Force followed a standard, systematic, and evidence-based approach in reviewing the literature to develop these guidelines. The assessment of the evidence and recommendations was based on the principles of the Grading of Recommendations Assessment, Development and Evaluation system. The general subject was addressed in sections: admission criteria and benefits of different levels of care, triage, discharge timing and strategies, use of outreach programs to supplement ICU care, quality assurance/improvement and metrics, nonbeneficial treatment in the ICU, and rationing considerations. The literature searches yielded 2,404 articles published from January 1998 to October 2013 for review. Following the appraisal of the literature, discussion, and consensus, recommendations were written. Although these are administrative guidelines, the subjects addressed encompass complex ethical and medico-legal aspects of patient care that affect daily clinical practice. A limited amount of high-quality evidence made it difficult to answer all the questions asked related to ICU admission, discharge, and triage. Despite these limitations, the members of the Task Force believe that these recommendations provide a comprehensive framework to guide practitioners in making informed decisions during the admission, discharge, and triage process as well as in resolving issues of nonbeneficial treatment and rationing. We need to further develop preventive strategies to reduce the burden of critical illness, educate our noncritical care colleagues about these interventions, and improve our outreach, developing early identification and intervention systems.

Survey of U.S. Practitioners on the Validity of the Medicare Functional Classification Level System and Utility of Clinical Outcome Measures for Aiding K-Level Assignment

ObjectiveTo characterize the opinion of the prosthetic clinical care community on the Medicare Functional Classification Level (K-level) assignment process to classify the mobility and rehabilitation potential of persons with lower-limb loss, including limitations and practicalities involved with the integration of outcome measures (OMs) into the clinical practice framework for K-level assignment. DesignSurvey. SettingEnglish online questionnaire with built-in logic. ParticipantsVolunteer sample of prosthetics practitioners (N=236). Data were analyzed only for U.S. practitioners (n=213). InterventionsNot applicable. Main Outcome MeasuresSubjective responses to 19 multiple choice, Likert scale, and open-ended questions. ResultsForty-seven percent of respondents indicated that they were the sole determinant in the K-level assignment process, while 43% indicated that it was a collaborative process with other health care professionals. Sixty-nine percent of respondents reported using standardized OMs to assist in K-level assignment, and most did not agree that commonly reported barriers to implementation (eg, lack of time and training) were relevant. Sixty-seven percent of respondents did not believe the K-level system can accurately assign a level of rehabilitation potential, with 75% agreeing that incorporating OMs into clinical practice would enhance objectivity of the K-level assignment process. ConclusionsThe results suggest that most prosthetics practitioners are involved in the K-level assignment at some level, and most agreed that there are considerable limitations with this system. To address these issues, many practitioners are using OMs to assess various aspects of patient mobility and rehabilitation potential, and minimize the subjectivity of the assignment process.

Development of the UK Vessel Health and Preservation (VHP) framework: a multi-organisational collaborative

Vascular access is an important part of many patient care management plans but has some unwanted risks. Previous work published by Moureau et al. (2012) inspired a working group led by the UK Infection Prevention Society (IPS) to produce a vessel health and preservation (VHP) framework. This was with the intention of producing a resource for frontline staff to be able to assess and select the best vascular access device to meet the individual patient's needs and to preserve veins for future use. The working group produced a framework that used available evidence, expert opinion and some small scale testing of the components of the framework. The work so far has received positive feedback but further work is required to formally evaluate the VHP framework in clinical practice to measure both staff knowledge and patient outcomes.

診療を支える枠組み：最近の動き

診療を支える枠組み：最近の動き

Genetic markers as a predictive tool based on statistics in medical practice: ethical considerations through the analysis of the use of HLA-B(*)27 in rheumatology in France.

Introduction: The use of genetic predictive markers in medical practice does not necessarily bear the same kind of medical and ethical consequences than that of genes directly involved in monogenic diseases. However, the French bioethics law framed in the same way the production and use of any genetic information. It seems therefore necessary to explore the practical and ethical context of the actual use of predictive markers in order to highlight their specific stakes. In this study, we document the uses of HLA-B*27, which are an interesting example of the multiple features of genetic predictive marker in general medical practice.Materials and Methods: The aims of this monocentric and qualitative study were to identify concrete and ethical issues of using the HLA-B*27 marker and the interests and limits of the legal framework as perceived by prescribers. In this regard, a thematic and descriptive analysis of five rheumatologists' semi-structured and face-to-face interviews was performed.Results: According to most of the interviewees, HLA-B*27 is an “overframed” test because they considered that this test is not really genetic or at least does not have the same nature as “classical genetic tests”; HLA-B*27 is not concerned by the ethical challenges of genetic test; the major ethics stake of this marker is not linked to its genetic nature but rather to the complexity of the probabilistic information. This study allows also showing that HLA-B*27, validated for a certain usage, may be used in different ways in practice.Discussion: This marker and its clinical uses underline the challenges of translating both statistical concepts and unifying legal framework in clinical practice. This study allows identifying some new aspects and stakes of genetics in medicine and shows the need of additional studies about the use of predictive genetic markers, in order to provide a better basis for decisions and legal framework regarding these practices.

Applying Critical Consciousness and Evidence-Based Practice Decision-Making: A Framework for Clinical Social Work Practice

Social work education is increasingly driven by the established movement of evidence-based practice (EBP) that drives the delivery of mental health care with the promise of providing treatments that work and greater efficiency. This emphasis on EBP coexists with the profession’s expressed commitment to social justice. Social work literature rarely addresses the complexities of EBP decision-making in relation to social justice. Rather, separate conversations either explore the commitment to social justice through a reflective approach to practice decision-making or take a positivist approach to scientific inquiry. This article offers a framework to apply critical consciousness and EBP decision-making that integrates reflective and positivist approaches to facilitate processes and outcomes that amplify social justice aims in social work practice.

5As Team obesity intervention in primary care: development and evaluation of shared decision-making weight management tools.

SummaryDespite several clinical practice guidelines, there remains a considerable gap in prevention and management of obesity in primary care. To address the need for changing provider behaviour, a randomized controlled trial with convergent mixed method evaluation, the 5As Team (5AsT) study, was conducted. As part of the 5AsT intervention, the 5AsT tool kit was developed. This paper describes the development process and evaluation of these tools. Tools were co‐developed by the multidisciplinary research team and the 5AsT, which included registered nurses/nurse practitioners (n = 15), mental health workers (n = 7) and registered dieticians (n = 7), who were previously randomized to the 5AsT intervention group at a primary care network in Edmonton, Alberta, Canada. The 5AsT tool development occurred through a practice/implementation‐oriented, need‐based, iterative process during learning collaborative sessions of the 5AsT intervention. Feedback during tool development was received through field notes and final provider evaluation was carried out through anonymous questionnaires. Twelve tools were co‐developed with 5AsT. All tools were evaluated as either ‘most useful’ or ‘moderately useful’ in primary care practice by the 5AsT. Four key findings during 5AsT tool development were the need for: tools that were adaptive, tools to facilitate interdisciplinary practice, tools to help patients understand realistic expectations for weight loss and shared decision‐making tools for goal setting and relapse prevention. The 5AsT tools are primary care tools which extend the utility of the 5As of obesity management framework in clinical practice.

Nutrition Care Process Chains: The “Missing Link” between Research and Evidence-Based Practice

I N 2001,THE INSTITUTEOFMEDICINE of the National Academy of Sciences published Crossing the Quality Chasm: A New Health System for the 21st Century, which promoted evidence-based practice as a prerequisite to quality health care. Implementation of evidence-based practice guidelines has become an integral component of the national health care quality strategy mandated by the Patient Protection and Affordable Care Act of 2010, with the goal of providing affordable care that leads to healthier communities. Evidence-based practice guidelines are essential to the delivery of quality care that is safe, effective, efficient, personalized, timely, and equitable. Despite this emphasis, it is challenging to ensure that registered dietitian nutritionists (RDNs) and other health care practitioners are following guidelines and that guideline use does in fact lead to quality care. This article describes a novel framework that uses the Nutrition Care Process (NCP) to link evidence-based practice guidelines and nutrition practice. The value of this framework for research measurement and clinical practice is also described.

Maverick total disc replacement in a real-world patient population: a prospective, multicentre, observational study.

Controlled trials have shown that total disc replacement (TDR) can provide pain and disability relief to patients with degenerative disc disease; however, whether these outcomes can also be achieved for patients treated in normal surgical practice has not been well documented. This prospective, international study observed changes in disability and back pain in 134 patients who were implanted with Maverick TDR within the framework of routine clinical practice and followed for 2 years post-surgery. Primary and secondary outcomes were the differences from baseline to 6 months post-surgery in the means of the Oswestry Disability Index and the change in back pain intensity assessed on a 10-cm visual analogue scale, respectively. Mean patient age at surgery was 43 years, but ranged up to 65 years. One hundred twenty-three patients had an implant at one level, 10 patients at two levels, and one patient at three levels. Statistically significant improvements in mean disability (-25.4) and low back pain intensity (-4.0) scores were observed at 6 months postoperatively (P < 0.0001 for both) in the hands of experienced surgeons (>10 TDRs per centre). During the study, 56 patients (42 %) experienced a complication or adverse event. This is the first international observational study to report outcomes of TDR in real-world clinical settings. We showed statistically significant improvements in disability and pain scores at 6 months following Maverick TDR, which were maintained for 2 years alongside an acceptable rate of perioperative complications. The safety and tolerability shown in this observational study were comparable to those from controlled trials.

Measuring treatment effects on dual-task performance: a framework for research and clinical practice.

The relevance of dual-task walking to everyday ambulation is widely acknowledged, and numerous studies have demonstrated that dual-task interference can significantly impact recovery of functional walking in people with neurological disorders. The magnitude and direction of dual-task interference is influenced by the interaction between the two tasks, including how individuals spontaneously prioritize their attention. Therefore, to accurately interpret and characterize dual-task interference and identify changes over time, it is imperative to evaluate single and dual-task performance in both tasks, as well as the tasks relative to each other. Yet, reciprocal dual-task effects (DTE) are frequently ignored. The purpose of this perspective paper is to present a framework for measuring treatment effects on dual-task interference, specifically taking into account the interactions between the two tasks and how this can provide information on whether overall dual-task capacity has improved or a different attentional strategy has been adopted. In discussing the clinical implications of using this framework, we provide specific examples of using this method and provide some explicit recommendations for research and clinical practice.

Distraction of clinicians by smartphones in hospitals: a concept analysis.

To report an analysis of the concept of distraction of clinicians by smartphones and other mobile devices in hospitals. In the healthcare literature, the concept of distraction of clinicians by smartphones and other mobile devices in hospitals has no consistent definition. Concept analysis. Journal articles published from 2003-2014. Rodgers' Evolutionary Concept Analysis Method was used to analyse the concept of distraction of clinicians by smartphones and other mobile devices in hospitals. This analysis led to a definition of distraction of clinicians by smartphones as the interruption of a hospital clinician's primary task by the internally or externally initiated use of their smartphone or other mobile device. There are six attributes of distraction by smartphones and other mobile devices in hospitals. These attributes are: (1) an experience by a clinician; (2) an intrusion into a primary clinical task; (3) discontinuity of the clinical task; (4) externally or internally initiated; (5) situated in a healthcare setting; and (6) mediated by a smartphone or other mobile device. Use of the definition and the defining attributes of distraction of clinicians by smartphones will increase the validity and reliability of future studies. It will be extended to form a classification system of distractions within a framework of clinical practice, which will be used to unify and standardize future research studies.

The modulating effects of music listening on health-related exercise and physical activity in adults: a systematic review and narrative synthesis

A systematic review and narrative synthesis of theories was conducted to examine the modulating effects of music listening on health-related exercise and physical activity. Searches were conducted on multiple bibliographic databases from the earliest available date until April 2013 using the key terms of music, physical activity and theory and related synonyms. Two reviewers independently screened retrieved texts using the inclusion and exclusion criteria. The quality of included texts was appraised using a checklist, and key concepts were recorded and synthesised using inductive thematic analysis. The narrative synthesis comprised 23 theoretical texts representing three contexts: therapeutic outcomes, sports and exercise performance, and auditory-motor processing. The quality appraisal demonstrated some limitations in the reporting of evidence informing theories. Analysis across all texts identified a main theme, cortical and subcortical stimulation and response, and two sub-themes, physiological arousal and subjective experience. These themes contributed to a common hypothesis that music could promote behavioural change with increased exercise adherence and participation. A meta-theory is presented, offering a framework for clinical practice and research. Music therapists might use the meta-theory to inform music listening interventions in programmes that aim to increase levels of physical activity.

The science of clinical practice: disease diagnosis or patient prognosis? Evidence about "what is likely to happen" should shape clinical practice.

BackgroundDiagnosis is the traditional basis for decision-making in clinical practice. Evidence is often lacking about future benefits and harms of these decisions for patients diagnosed with and without disease. We propose that a model of clinical practice focused on patient prognosis and predicting the likelihood of future outcomes may be more useful.DiscussionDisease diagnosis can provide crucial information for clinical decisions that influence outcome in serious acute illness. However, the central role of diagnosis in clinical practice is challenged by evidence that it does not always benefit patients and that factors other than disease are important in determining patient outcome. The concept of disease as a dichotomous ‘yes’ or ‘no’ is challenged by the frequent use of diagnostic indicators with continuous distributions, such as blood sugar, which are better understood as contributing information about the probability of a patient’s future outcome. Moreover, many illnesses, such as chronic fatigue, cannot usefully be labelled from a disease-diagnosis perspective. In such cases, a prognostic model provides an alternative framework for clinical practice that extends beyond disease and diagnosis and incorporates a wide range of information to predict future patient outcomes and to guide decisions to improve them. Such information embraces non-disease factors and genetic and other biomarkers which influence outcome.SummaryPatient prognosis can provide the framework for modern clinical practice to integrate information from the expanding biological, social, and clinical database for more effective and efficient care.

Measuring treatment effects on dual-task performance: a framework for research and clinical practice

Measuring treatment effects on dual-task performance: a framework for research and clinical practice

A comprehensive framework and key guideline recommendations for the provision of evidence-based breast cancer survivorship care within the primary care setting.

Breast cancer survivors continue to experience physical and psychosocial health care needs post-treatment. Primary care involvement is increasing as cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up. Research suggests primary care providers (PCPs) are willing to provide survivorship care but many lack knowledge and confidence to provide evidence-based care. Although clinical practice guidelines (CPGs) exist for follow-up surveillance and certain aspects of survivorship care, no single comprehensive guideline addresses all significant breast cancer survivorship issues encountered in primary care. The purpose of this research was to create a comprehensive clinical practice framework to guide the provision of breast cancer survivorship care in primary care settings. This study consisted of an extensive search, appraisal and synthesis of CPGs for post-treatment breast cancer care using a modified Delphi method. Breast cancer survivorship issues and relevant CPGs were mapped to four essential components of survivorship care to create a comprehensive clinical practice framework to guide provision of breast cancer survivorship care. The completed framework consists of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations and a one-page list of guideline sources. The framework and key guideline recommendations were verified by a panel of experts for comprehensiveness, importance and relevance to primary care. This framework may serve as a tool to remind PCPs about issues impacting breast cancer survivors, as well as the evidence-based recommendations and resources to provide the associated care.

Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US Multi-Society Task Force on Colorectal Cancer.

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

Managing palliation in the neonatal unit

Professionals working in neonatology have a duty to act in the best interests of the infant. Normally, the goal of care is to sustain life and restore health. However, there...

Towards a Theory of PACS Deployment: An Integrative PACS Maturity Framework

Owing to large financial investments that go along with the picture archiving and communication system (PACS) deployments and inconsistent PACS performance evaluations, there is a pressing need for a better understanding of the implications of PACS deployment in hospitals. We claim that there is a gap in the research field, both theoretically and empirically, to explain the success of the PACS deployment and maturity in hospitals. Theoretical principles are relevant to the PACS performance; maturity and alignment are reviewed from a system and complexity perspective. A conceptual model to explain the PACS performance and a set of testable hypotheses are then developed. Then, structural equation modeling (SEM), i.e. causal modeling, is applied to validate the model and hypotheses based on a research sample of 64 hospitals that use PACS, i.e. 70% of all hospitals in the Netherlands. Outcomes of the SEM analyses substantiate that the measurements of all constructs are reliable and valid. The PACS alignment-modeled as a higher-order construct of five complementary organizational dimensions and maturity levels-has a significant positive impact on the PACS performance. This result is robust and stable for various sub-samples and segments. This paper presents a conceptual model that explains how alignment in deploying PACS in hospitals is positively related to the perceived performance of PACS. The conceptual model is extended with tools as checklists to systematically identify the improvement areas for hospitals in the PACS domain. The holistic approach towards PACS alignment and maturity provides a framework for clinical practice.

The health care transition research consortium health care transition model: a framework for research and practice.

The body of health care transition (HCT) research is in the early stages of development. One of the major limitations of this developing field of research is the lack of theoretically-directed studies. This research limitation has hindered understanding of the variables contributing to successful HCT. The inadequate understanding of HCT is due largely to the absence of an adequate conceptual model that addresses the complexity and the relationships amongst variables that influence HCT outcomes among adolescents and emerging adults with special health care needs (AEA-SHCN). Existing conceptual models do not sufficiently address the significant interrelationships amongst variables to explain, predict and/or control AEA-SHCN's biopsychosocial HCT outcomes. This article provides a description of a health care transition theoretical model developed by the international and interdisciplinary Health Care Transition Research Consortium (HCTRC) that can be applied for testing in research and serve as a framework for clinical practice and policymaking. The HCTRC model is composed of four domains that are considered integral to the HCT phenomenon: Individual, Family/Social Support, Environment, and the Health Care System. The HCTRC model specifies the variables, processes, and potential mediators and moderators that affect the HCT outcomes.