Science In Clinical Practice Research Articles

Early Career Training in Addiction Medicine: A Qualitative Study with Health Professions Trainees Following a Specialized Training Program in a Canadian Setting

Background: There has been a notable deficiency in the implementation of addiction science in clinical practice and many healthcare providers feel unprepared to treat patients with substance use disorders (SUD) following training. However, the perceptions of addiction medicine training by learners in health professions have not been fully investigated. This qualitative study explored perceptions of prior training in SUD care among early-career trainees enrolled in Addiction Medicine fellowships and electives in Vancouver, Canada. Methods: From April 2015 – August 2018, we interviewed 45 early-career physicians, social workers, nurses, and 17 medical students participating in training in addiction medicine. We coded transcripts inductively using qualitative data analysis software (NVivo 11.4.3). Results: Findings revealed six key themes related to early-career training in addiction medicine: (1) Insufficient time spent on addiction education, (2) A need for more structured addictions training, (3) Insufficient hands-on clinical training and skill development, (4) Lack of patient-centeredness and empathy in the training environment, (5) Insufficient implementation of evidence-based medicine, and (6) Prevailing stigmas toward addiction medicine. Conclusion: Early clinical training in addiction medicine appears insufficient and largely focused on symptoms, rather than etiology or evidence. Early career learners in health professions perceived benefit to expanding access to quality education and reported positive learning outcomes after completing structured training programs.

Когнитивно-поведенческая терапия депрессии: руководство

<p>Depression is one of the most common, disabling, and lethal (e.g., suicide) forms of psychopathology. Nearly 300 million people struggle with depression worldwide, and it is the leading cause of disability for people ages 15-44. Unfortunately, most people with depression do not receive the treatment they need. There is limited access to mental health services, and when services are available, the treatments used tend to have limited scientific support. This is because many mental health professionals are not trained in empirically supported treatments, are ambivalent about the role of science in clinical practice, and have limited access to scientific research (e.g., journal paywalls). The purpose of this special issue article is to provide a free and easy to use primer on Cognitive Behavioral Therapy (CBT) for depression. CBT is the most studied form of psychotherapy, has a strong theoretical basis, can be implemented by therapists of varying experience levels, and is as effective or more effective than existing treatments, including medication. CBT may not work for every client, but it is the best place to start. In this article, we discuss: a) why CBT should be the first-line treatment for depression, b) the theoretical basis of CBT for depression, and c) a basic overview of how to administer 12 sessions of CBT for depression. We also provide a reading list and supplemental open-access materials (e.g., a cognitive skills workbook) for further education.</p>

Charles E. Schmidt College of Medicine at Florida Atlantic University.

Charles E. Schmidt College of Medicine at Florida Atlantic University.

Focusing on the Future of Cardiovascular Outcomes Research: Highlights From the American Heart Association/American Stroke Association Quality of Care and Outcomes Research 2018 Scientific Sessions.

The American Heart Association/American Stroke Association Quality of Care and Outcomes Research (QCOR) 2018 Scientific Sessions was recently held in Arlington, VA, from April 6 to 7. The 2-day conference featured >50 oral presentations and 170 poster presentations across an array of topics, including the use of big data science in clinical practice, the shifting policy landscape in cardiovascular care, and the expanding role of social media in science. One key theme throughout the conference was the future of cardiovascular outcomes research, which was highlighted by the 2018 QCOR Outstanding Achievement Award recipient and keynote speaker Eric D. Peterson, MD, MPH. Dr Peterson reflected on the progress of cardiovascular outcomes research as a field and the QCOR community in general. What was once a small group of geeks running simple regression models on manually chart-reviewed data has grown into a much larger group of wonks applying machine learning techniques to hundreds of thousands of electronic medical records, he reflected. He also forecasted the future of cardiovascular outcomes research, which included the potential of big data science to improve outcomes, the importance of fostering partnerships with patients who actively participate in research, and the development and use of living clinical registries. Above all, he stressed the importance of mentorship and investing in the future generation of cardiovascular outcomes researchers. Within the context of this theme, we offer several directions of cardiovascular outcomes research that were presented at QCOR 2018 Scientific Sessions. In addition, we present updates on the current and future state of Get With The Guidelines (GWTG) registries and highlight the career development opportunities that QCOR 2018 provided to young investigators. ### Translating Big Data to Clinical Practice The opening plenary session of QCOR 2018 highlighted opportunities that big data science offers, including machine learning, artificial intelligence, and natural language processing. In addition, the challenges to implementing …

Accountability: Challenges to Getting It Right.

Patient safety experts debated accountability in health care at the 2014 annual National Patient Safety Foundation Congress. The debate reflected the struggles organizations are facing with ensuring a responsible workforce committed to patient safety versus the need to redesign flawed systems that are error prone. The question, "is it the systems or the individual?" was at issue. This article proposes that it is the wrong question, and the failure to apply patient safety science in clinical practice is contributing to the ambiguity fueling the debate. To transform accountability from a source of confusion to a powerful tool for fulfilling health care's fiduciary responsibility to protect patients from harm, we need to reframe our approach. This article presents the science and strategies to create clarity that will redirect the dialogue from a debate in which accountability resides to one about learning for improvement when adverse events occur.

Science in clinical practice 1

Science in clinical practice 1

Science in clinical practice 2

Science in clinical practice 2

Science in clinical practice 2

Science in clinical practice 2

Science in clinical practice 1

Science in clinical practice 1

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.

Behavioral Medicine in China: History, Current Status, and Future Development

Behavioral medicine in China has developed quickly in the last three decades. We briefly summarized the history, the main scope and achievements, and the future development of behavioral medicine in China. We did a literature search and discussed with senior scholars in behavioral medicine in China. The concept and main scope of behavioral medicine in China have been developed largely in accordance with the international perspective. Research in behavioral medicine in China significantly contributed to the better understanding of the relationship between various health behavioral factors and psychosomatic disorders and possible mechanisms of this relationship. The following aspects will be the main areas to be further developed in behavioral medicine in China: (1) Basic theories of behavioral medicine and theoretical mechanisms of higher nervous activities in human behavior regulation. (2) Etiology, pathogenesis, and mechanisms of common diseases that are closely related to human lifestyle behaviors. (3) Assessment criteria for unhealthy and disease-related behaviors. (4) Behavioral therapy of psychosomatic disorders, and rehabilitation technologies of disability. (5) Application of major findings from research of behavioral medical science in clinical practice and in health promotion of the whole society. Behavioral medicine in China, as a multidisciplinary subject, plays a relevant role in preventing behavior-related psychosomatic diseases and in promoting health of the public.

Qualitative translational science in clinical practice

Qualitative translational research refers to the "bench-to-bedside" enterprise of harnessing knowledge from the basic sciences to produce new treatment options or nursing interventions for patients. Three evidence-based translational problems related to qualitative translational research discussed this year address the interfaces among the nursing paradigm, the basic sciences, and clinical nursing work. This article illustrates the definition of translational science and translational blocks of evidence-based practice; discusses the qualitative research perspective in evidence synthesis, evidence translation and evidence utilization; and discusses the research questions that must be answered to solve the problems of the three translational gaps from the qualitative research perspective. Qualitative inquiry has an essential role to play in efforts to improve current healthcare-provider nursing interventions, experiences, and contexts. Thus, it is vital to introduce qualitative perspectives into evidence-based practice from the knowledge discovery through to the knowledge implementation process.

Sykepleierstudenters erfaring med relevansen av vitenskapsteori i praksisstudiene

<p class="Toverskrift3" style="margin: 6pt 0cm;"><span style="mso-ansi-language: EN-US;" lang="EN-US"><strong><span style="font-size: large;"><span style="font-family: Times New Roman;">Abstract</span></span></strong></span></p><p class="Toverskrift3" style="margin: 6pt 0cm;"><strong><span style="font-size: large;"><span style="font-family: Times New Roman;"><span style="mso-ansi-language: EN-GB;" lang="EN-GB">N</span><span style="mso-ansi-language: EN-US;" lang="EN-US">ursing students’ experiences of the relevance of the theory of science in </span><span style="mso-ansi-language: EN-GB;" lang="EN-GB">clinical practice</span><span style="mso-ansi-language: EN-US;" lang="EN-US"></span></span></span></strong></p><p style="margin: 0cm 0cm 0pt;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><em style="mso-bidi-font-style: normal;"><span style="color: black; mso-ansi-language: EN-US; mso-themecolor: text1;" lang="EN-US">This article presents nursing students’ experiences of the relevance of the theory of science in </span></em><em style="mso-bidi-font-style: normal;"><span style="color: black; mso-ansi-language: EN-GB; mso-themecolor: text1;" lang="EN-GB">clinical practice. These experiences come to light in focus group interviews with third-year students. The results show that students may perceive the theory of science as vague and meaningless, while at the same time it gives them a perspective on the nursing profession and provides an opportunity to view their own practice from a critical perspective. However, the theory of science becomes more comprehensible through metaphor, more meaningful through narratives, and more concrete via nursing theories. When the students describe their experiences of the relevance of the theory of science, these descriptions are often related to their own life-world and their view of humanity.</span></em></span></span></p><p style="margin: 0cm 0cm 0pt;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><em style="mso-bidi-font-style: normal;"><span style="color: black; mso-ansi-language: EN-GB; mso-themecolor: text1;" lang="EN-GB">The students would nevertheless like an opportunity to discuss the theory of science related to situations in clinical practice. They also accept that they are required to be theoretically prepared. The article concludes that the goal of such discussions, where the students share experiences related to the theory of science, is the process of gaining insight, not coming up with the “right” answers</span></em><span style="color: black; mso-ansi-language: EN-GB; mso-themecolor: text1;" lang="EN-GB">.</span></span></span></p>

Clinical challenges and ongoing role changes for primary health-care nurses

To investigate the perceptions of primary health-care nurses (PHNs) about clinical demands and future challenges. Qualitative content-analysis of open questions from a questionnaire. A total of 121 PHNs from health-care districts in northern Sweden filled in a questionnaire during a mandatory educational day. Key issues that were raised included: defending the specific professional role of the PHNs; strengthening their self-governance and authority; and ensuring adequate care in the future through education that focuses more on nursing practice than on academic work. To ensure that the role of the PHN continues to develop, it is necessary to enable them to articulate, discuss, and evaluate their profession and to learn, in concrete forms, how to implement science in clinical practice.

A Guide for the Assessment and Treatment of Suicidal Patients With Traumatic Brain Injuries

People with traumatic brain injuries (TBIs) are at elevated risk for suicide. Postinjury cognitive limitations, personality factors, and psychological problems may independently or in conjunction with preinjury correlates contribute to suicidal thoughts and behaviors. Rehabilitation practitioners can best serve the needs of this high-risk population by increasing their knowledge and competence in evidence-informed approaches to suicide prevention. This article provides a review of suicide nomenclature, epidemiology, risk and protective factors, as well as evidence-informed assessment, management, and treatment practices for suicidal patients. The science of clinical practice in the area of rehabilitation and suicide prevention is in its infancy. Practitioners who provide treatment for suicidal patients with TBI are encouraged to adapt and individualize existing evidence-informed suicide assessment and prevention practices for implementation within their settings. Each patient with a TBI who endorses suicidal thoughts and/or behaviors presents a complex array of clinical challenges associated with the nature of his or her brain injury, preinjury, and postinjury functioning. Clinical as well as research recommendations are provided in the context of an understanding of such challenges and an overriding objective of minimizing suicide risk during the recovery process and maximizing treatment gains.

Philosophy, ethics, medicine and health care: the urgent need for critical practice

Philosophy, ethics, medicine and health care: the urgent need for critical practice

From the Editors

From the Editors

Preparing the Personal Physician for Practice (P4): Redesigning Family Medicine Residencies: New Wine, New Wineskins, Learning, Unlearning, and a Journey to Authenticity

The family medicine community has come together in the Future of Family Medicine Project in an attempt to be clear about its work and values and to address the frustrations of both its own practitioners and the public. A new model has been proposed, offering several attractive features for both patients and practitioners. The project has generated momentum around the notion that it is really possible to redesign family medicine residency programs. This article reviews assumptions about the redesign and 10 interventions in 3 categories. The categories are both familiar and new, and knowledge, skills, and attitudes are reframed. The interventions include learning portfolios, a curriculum that goes beyond rotations, becoming explicit about locally useful knowledge, getting discretion and discipline right, linking evaluations to system improvement, attention to the science of clinical practice, simulation, validating resident feelings, educating to mastery, and attention to group and individual formation.

Understanding science and evidence-based decision making in orthodontics

The early part of the 1990s ushered in evidencebased decision making for health care. Presently, there is a resurgence in evidence-based decision making with evidence-based dentistry (EBD) the buzzword in dental periodicals. The call for dentists to understand science and research is not new. The Geis Report of the early 1920s petitioned medical and dental schools to become more scientific in their teaching and practice. William Geis’s cry for dentists to be educated and practice in a climate of science was evident in the last part of the 20th century. In orthodontics, several icons in the profession have stressed the importance of science in clinical practice. William Proffit wrote, “The orthodontic practitioner is akin to the scientist who must continually evaluate new research findings.” Furthermore, Peter Vig stated, “orthodontists have lain greater emphasis on mastering their art than mastering their science. . . . There are many orthodontic controversies, past and present, that center on whose art is superior.” Lysle Johnston claimed, “Those who advocate new therapies seem disinclined to provide evidence of efficacy (it may be bad for business); the profession as a whole, perhaps being convinced in dental school of the irrelevance of ‘science,’ seems equally disinclined to demand it.” And it is conceivable that the apparent disregard for the principles of scientific inquiry prompted Alton Moore to write, “Clearly, the promulgation of simple rules and pat formulas and the immediate and uncritical adoption of them prior to testing . . . have inhibited true progress.” It seems, however, that dentistry and orthodontics have lagged behind medicine in the quest to incorporate science into clinical practice. Perhaps the art in the practice of dentistry has overshadowed the need for

Improved Outcome of Fracture Treatment by Early Operative Reduction: Results of a Surgical Audit

An audit is a useful means of examining improvements in the art and science of clinical practice. We applied this to surgery to determine improved outcomes of fracture treatment by early operative reduction. This was carried out at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, by comparing two years, 1997 when there was less emphasis and 1998 when there was a greater emphasis on operative reduction of fractures. Hospital records in the orthopaedic wards, operating rooms and the physiotherapy unit of all patients admitted were reviewed retrospectively. Two years, 1997 and 1998 were analysed for age, sex, type of treatment and quality of outcome. A total of 247 admissions into orthopaedic wards were made in 1997 leading to 79 major operations, 20 of which were operative reduction of fractures (25.3 %). In 1998, 239 patients were admitted out of which 174 major operations were performed, 72 of which were operative reductions (41.4 %, P = 0.014). Patients' stay in hospital was shorter in 1998 with 81% of patients staying 3 months and less compared to 40 % in 1997 (P = 0.000). Improved outcome of stiff knee joints from physiotherapy was judged good and excellent in 66.7 % and 20 % in 1998 compared to 28.3 % (P = 0.00005) and 1.9 % (P = 0.003) in 1997, respectively. These results suggest generally improved outcome when fractures are treated by early operative reduction because of shorter hospital stay, early return to work, improved nursing care and joint function. (Nig J Surg Res 2000; 2:114-122) KEY WORDS: Surgical Audit, Operative reduction, Fractures, Outcome