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Rochel de Camargo K. Disputed expertise and chaotic disinformation: COVID-19 and denialist physicians in Brazil. Transcult Psychiatry 2024:13634615231213835. [PMID: 38234170 DOI: 10.1177/13634615231213835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
This article aims to show how incorrect ideas about COVID-19 were promoted by physicians in Brazil, contributing to a catastrophic response at the cost of hundreds of thousands of lives, and to examine the implications of this episode for the social studies of science, technology and medicine. The literature on the relationship between science and society takes two broad approaches, which are sometimes at odds with each other: (i) there is a traditional critique of science that points to unsupported claims of certainty and thus undue interference in general human affairs; (ii) there are many examples of attempts to undermine reasonable scientific claims, when they clash with economic and/or political interests of certain groups. Navigating those extremes is particularly critical in situations in which accurate knowledge is necessary for intervening in people's lives, as is the case in health-related issues. Determining who has actual epistemic expertise is a key factor in solving this conundrum. This became painfully clear during the unfolding of the COVID-19 pandemic, which highlighted the uncertainties of science in guiding decisions being made in real time, and provided opportunities for many forms of disinformation and conspiracy theories that hampered public health measures and promoted useless or even dangerous "treatments". This article discusses an instructive example of such developments in the chaotic response to the pandemic challenge in Brazil, which saw, among other unfortunate situations, physicians aligned with the denialist federal government advocating for unproven - or proven as ineffective - treatments and disseminating unfounded doubts about vaccines. Presumed expertise on the basis of professional training clearly did not translate into actual expertise in the necessary domains to ascertain the validity of such claims and scientific advice was overridden by ideology.
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Howe EG. New Ways to Help Patients Worst Off. J Clin Ethics 2024; 35:1-7. [PMID: 38373332 DOI: 10.1086/728098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
AbstractThis introduction to The Journal of Clinical Ethics highlights and expands four articles within this issue that propose somewhat new and radical innovations to help and further the interests of patients and families worst off. One article urges us to enable historically marginalized groups to participate more than they have in research; a second urges us to allocate limited resources that can be divided, such as vaccines and even ventilators, in a different way; a third urges us to help families find greater meaning when their loved ones are dying; and a fourth urges us to treat patients who illegally use drugs as caringly as is possible, though there may be limits to what providers can do. This piece also addresses the importance of providers bonding with patients, recognizing that some providers may be better at eliciting patients' trust than others, and thus the importance of connecting these patients with these providers since this may be the sole way these patients can optimally respond and do well. Finally, providers taking time away from their patients to oppose and reduce social stigma is considered.
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Engebretsen E, Baker M. Health Preparedness and Narrative Rationality: A Call for Narrative Preparedness. Int J Health Policy Manag 2023; 12:7532. [PMID: 37579420 PMCID: PMC10461864 DOI: 10.34172/ijhpm.2023.7532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/06/2023] [Indexed: 08/16/2023] Open
Abstract
This conceptual paper argues the need for narrative preparedness, understood as the ability to engage and empathize with peoples' stories and the values they encode, assess them based on the universe in which people live, and acknowledge the narrative rationality of each story - even when it conflicts with the rationality of science. Expanding 'health preparedness' to encompass 'narrative preparedness' complements the ideals of patient centeredness, which are sometimes betrayed when implemented into concrete decisions because the rationality of science that underpins medical practice fails to make sense of patients' stories. We outline the central tenets of narrative preparedness and demonstrate its relevance by discussing various responses to mainstream discourses on COVID-19 as a case in point. We discuss and further develop Fisher's narrative paradigm, which provides a model that complements traditional, scientific rationality with attention to narrative rationality and a radical democratic ground for health political critique. Applying the narrative paradigm to authentic examples of vaccine hesitancy and anti-vaccination demonstrates how closer attention to the way narratives are assessed by different constituencies might help us mitigate some of the sources of resistance and misunderstanding that continue to plague public communication about important medical issues such as pandemics. Health authorities must acknowledge and engage with the stories people believe in and their reasons for doing so. The crucial question for the success of health policy interventions is not only 'what are the facts' but 'how do these facts make sense to people, and why.' To be prepared for the next pandemic, health professionals must learn to engage with people's stories and the processes by which they come to be understood and assessed differently by various constituencies.
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Affiliation(s)
- Eivind Engebretsen
- Centre for Sustainable Healthcare Education, Faculty of Medicine, University of Oslo, Oslo, Norway
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Sundberg T, Leach MJ, Lilje S, Thomson OP, Fryer G, Palmgren PJ, Adams J, Skillgate E. Attitudes, skills and implementation of evidence-based practice: a national cross-sectional survey of licensed naprapaths in Sweden. Chiropr Man Therap 2023; 31:3. [PMID: 36670483 PMCID: PMC9863153 DOI: 10.1186/s12998-023-00473-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/02/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Evidence-based practice (EBP) is fundamental to the delivery of high-quality, safe and effective health care. Naprapaths, manual therapy providers that specialize in the treatment of musculoskeletal pain and dysfunction, became a Swedish licensed health profession in 1994. This study investigated the attitudes, skills and implementation of EBP among licensed naprapaths in Sweden. METHODS Licensed naprapaths (n = 950) of Svenska Naprapatförbundet (the Swedish Naprapathy Association) were invited by email to take part in this cross-sectional anonymous online study using the Evidence-Based Practice Attitude and Utilisation Survey in February 2019. RESULTS Fourteen percent (137/950) of invited naprapaths completed the survey. There was an approximately equal gender divide among responders; most were in the mid-career age range, practiced in city areas, and had a university or college certificate/diploma as their highest qualification. The majority of naprapaths agreed or strongly agreed that EBP was necessary in the practice of naprapathy, assisted them in making care decisions, and improved the quality of patient care. Naprapaths' self-reported skills in EBP were mostly in the moderate to moderate-high range. The majority of participating naprapaths reported infrequent implementation of EBP. Perceived minor or moderate barriers to EBP uptake included a lack of colleague support for EBP and a lack of relevant resources. Access to the internet and free online databases were reported as very useful enablers to improving EBP uptake. CONCLUSIONS The licensed naprapaths participating in this survey reported positive attitudes toward EBP, moderate levels of EBP skills, and infrequent implementation of EBP.
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Affiliation(s)
- Tobias Sundberg
- Musculoskeletal and Sports Injury Epidemiology Center, Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.
| | - Matthew J. Leach
- grid.1031.30000000121532610National Centre for Naturopathic Medicine, Southern Cross University, East Lismore, NSW Australia ,grid.117476.20000 0004 1936 7611Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Stina Lilje
- grid.4714.60000 0004 1937 0626Musculoskeletal and Sports Injury Epidemiology Center, Unit of Intervention and Implementation Research on Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Oliver P. Thomson
- grid.468695.00000 0004 0395 028XResearch Centre, University College of Osteopathy, London, UK
| | - Gary Fryer
- grid.1019.90000 0001 0396 9544College of Health and Biomedicine, Victoria University, Melbourne, Vic Australia
| | - Per J. Palmgren
- grid.4714.60000 0004 1937 0626Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Jon Adams
- grid.117476.20000 0004 1936 7611Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Eva Skillgate
- grid.445308.e0000 0004 0460 3941Musculoskeletal and Sports Injury Epidemiology Center, Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Musculoskeletal and Sports Injury Epidemiology Center, Unit of Intervention and Implementation Research on Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Verma JS, Libertin CR, Gupta Y, Khanna G, Kumar R, Arora BS, Krishna L, Fasina FO, Hittner JB, Antoniades A, van Regenmortel MHV, Durvasula R, Kempaiah P, Rivas AL. Multi-Cellular Immunological Interactions Associated With COVID-19 Infections. Front Immunol 2022; 13:794006. [PMID: 35281033 PMCID: PMC8913044 DOI: 10.3389/fimmu.2022.794006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/24/2022] [Indexed: 02/05/2023] Open
Abstract
To rapidly prognosticate and generate hypotheses on pathogenesis, leukocyte multi-cellularity was evaluated in SARS-CoV-2 infected patients treated in India or the United States (152 individuals, 384 temporal observations). Within hospital (<90-day) death or discharge were retrospectively predicted based on the admission complete blood cell counts (CBC). Two methods were applied: (i) a "reductionist" one, which analyzes each cell type separately, and (ii) a "non-reductionist" method, which estimates multi-cellularity. The second approach uses a proprietary software package that detects distinct data patterns generated by complex and hypothetical indicators and reveals each data pattern's immunological content and associated outcome(s). In the Indian population, the analysis of isolated cell types did not separate survivors from non-survivors. In contrast, multi-cellular data patterns differentiated six groups of patients, including, in two groups, 95.5% of all survivors. Some data structures revealed one data point-wide line of observations, which informed at a personalized level and identified 97.8% of all non-survivors. Discovery was also fostered: some non-survivors were characterized by low monocyte/lymphocyte ratio levels. When both populations were analyzed with the non-reductionist method, they displayed results that suggested survivors and non-survivors differed immunologically as early as hospitalization day 1.
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Affiliation(s)
- Jitender S. Verma
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
- *Correspondence: Jitender S. Verma, ; Prakasha Kempaiah, ; Ariel L. Rivas,
| | | | - Yash Gupta
- Infectious Diseases, Mayo Clinic, Jacksonville, FL, United States
| | - Geetika Khanna
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rohit Kumar
- Respiratory Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Balvinder S. Arora
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Loveneesh Krishna
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Folorunso O. Fasina
- Food and Agriculture Organization of the United Nations, Dar es Salaam, Tanzania
- Department of Veterinary Tropical Diseases, University of Pretoria, Pretoria, South Africa
| | - James B. Hittner
- Psychology, College of Charleston, Charleston, SC, United States
| | | | - Marc H. V. van Regenmortel
- Medical University of Vienna, Vienna, Austria
- Higher School of Biotechnology, University of Strasbourg, Strasbourg, France
| | - Ravi Durvasula
- Infectious Diseases, Mayo Clinic, Jacksonville, FL, United States
| | - Prakasha Kempaiah
- Infectious Diseases, Mayo Clinic, Jacksonville, FL, United States
- *Correspondence: Jitender S. Verma, ; Prakasha Kempaiah, ; Ariel L. Rivas,
| | - Ariel L. Rivas
- Center for Global Health-Division of Infectious Diseases, School of Medicine, University of New Mexico, Albuquerque, NM, United States
- *Correspondence: Jitender S. Verma, ; Prakasha Kempaiah, ; Ariel L. Rivas,
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Rivas AL, Hoogesteijn AL. Biologically grounded scientific methods: The challenges ahead for combating epidemics. Methods 2021; 195:113-119. [PMID: 34492300 PMCID: PMC8423586 DOI: 10.1016/j.ymeth.2021.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 01/12/2023] Open
Abstract
The protracted COVID 19 pandemic may indicate failures of scientific methodologies. Hoping to facilitate the evaluation and/or update of methods relevant in Biomedicine, several aspects of scientific processes are here explored. First, the background is reviewed. In particular, eight topics are analyzed: (i) the history of Higher Education models in reference to the pursuit of science and the type of student cognition pursued, (ii) whether explanatory or actionable knowledge is emphasized depending on the well- or ill-defined nature of problems, (iii) the role of complexity and dynamics, (iv) how differences between Biology and other fields influence methodologies, (v) whether theory, hypotheses or data drive scientific research, (vi) whether Biology is reducible to one or a few factors, (vii) the fact that data, to become actionable knowledge, require structuring, and (viii) the need of inter-/trans-disciplinary knowledge integration. To illustrate how these topics interact, a second section describes four temporal stages of scientific methods: conceptualization, operationalization, validation and evaluation. They refer to the transition from abstract (non-measurable) concepts (such as 'health') to the selection of concrete (measurable) operations (such as 'quantification of ́anti-virus specific antibody titers'). Conceptualization is the process that selects concepts worth investigating, which continues as operationalization when data-producing variables viewed to reflect critical features of the concepts are chosen. Because the operations selected are not necessarily valid, informative, and may fail to solve problems, validations and evaluations are critical stages, which require inter/trans-disciplinary knowledge integration. It is suggested that data structuring can substantially improve scientific methodologies applicable in Biology, provided that other aspects here mentioned are also considered. The creation of independent bodies meant to evaluate biologically oriented scientific methods is recommended.
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Affiliation(s)
| | - Almira L Hoogesteijn
- Human Ecology, Centro de Investigación y de Estudios Avanzados (CINVESTAV), Merida, Mexico.
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Maretic S, Abbey H. “Understanding patients' narratives” A qualitative study of osteopathic educators’ opinions about using Medical Humanities poetry in undergraduate education. INT J OSTEOPATH MED 2021; 40:29-37. [DOI: 10.1016/j.ijosm.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Feeley C, Thomson G, Downe S. Understanding how midwives employed by the National Health Service facilitate women's alternative birthing choices: Findings from a feminist pragmatist study. PLoS One 2020; 15:e0242508. [PMID: 33216777 PMCID: PMC7678977 DOI: 10.1371/journal.pone.0242508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022] Open
Abstract
UK legislation and government policy favour women's rights to bodily autonomy and active involvement in childbirth decision-making including the right to decline recommendations of care/treatment. However, evidence suggests that both women and maternity professionals can face challenges enacting decisions outside of sociocultural norms. This study explored how NHS midwives facilitated women's alternative physiological birthing choices-defined in this study as 'birth choices that go outside of local/national maternity guidelines or when women decline recommended treatment of care, in the pursuit of a physiological birth'. The study was underpinned by a feminist pragmatist theoretical framework and narrative methodology was used to collect professional stories of practice via self-written narratives and interviews. Through purposive and snowball sampling, a diverse sample in terms of age, years of experience, workplace settings and model of care they operated within, 45 NHS midwives from across the UK were recruited. Data were analysed using narrative thematic that generated four themes that described midwives' processes of facilitating women's alternative physiological births: 1. Relationship building, 2. Processes of support and facilitation, 3. Behind the scenes, 4. Birth facilitation. Collectively, the midwives were involved in a wide range of alternative birth choices across all birth settings. Fundamental to their practice was the development of mutually trusting relationships with the women which were strongly asserted a key component of safe care. The participants highlighted a wide range of personal and advanced clinical skills which was framed within an inherent desire to meet the women's needs. Capturing what has been successfully achieved within institutionalised settings, specifically how, maternity providers may benefit from the findings of this study.
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Affiliation(s)
- Claire Feeley
- THRIVE Centre, ReaCH Group, University of Central Lancashire, Preston, United Kingdom
| | - Gill Thomson
- THRIVE Centre, ReaCH Group, University of Central Lancashire, Preston, United Kingdom
- MAINN Group, University of Central Lancashire, Preston, United Kingdom
| | - Soo Downe
- THRIVE Centre, ReaCH Group, University of Central Lancashire, Preston, United Kingdom
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9
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Brennan ML, Arlt SP, Belshaw Z, Buckley L, Corah L, Doit H, Fajt VR, Grindlay DJC, Moberly HK, Morrow LD, Stavisky J, White C. Critically Appraised Topics (CATs) in Veterinary Medicine: Applying Evidence in Clinical Practice. Front Vet Sci 2020; 7:314. [PMID: 32695798 PMCID: PMC7333781 DOI: 10.3389/fvets.2020.00314] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022] Open
Abstract
Critically appraised topics (CATs) are evidence syntheses that provide veterinary professionals with information to rapidly address clinical questions and support the practice of evidence-based veterinary medicine (EBVM). They also have an important role to play in both undergraduate and post-registration education of veterinary professionals, in research and knowledge gap identification, literature scoping, preparing research grants and informing policy. CATs are not without limitations, the primary one relating to the rapid approach used which may lead to selection bias or restrict information identified or retrieved. Furthermore, the narrow focus of CATs may limit applicability of the evidence findings beyond a specific clinical scenario, and infrequently updated CATs may become redundant. Despite these limitations, CATs are fundamental to EBVM in the veterinary profession. Using the example of a dog with osteoarthritis, the five steps involved in creating and applying a CAT to clinical practice are outlined, with an emphasis on clinical relevance and practicalities. Finally, potential future developments for CATs and their role in EBVM, and the education of veterinary professionals are discussed. This review is focused on critically appraised topics (CATs) as a form of evidence synthesis in veterinary medicine. It aims to be a primary guide for veterinarians, from students to clinicians, and for veterinary nurses and technicians (hereafter collectively called veterinary professionals). Additionally, this review provides further information for those with some experience of CATs who would like to better understand the historic context and process, including further detail on more advanced concepts. This more detailed information will appear in pop-out boxes with a double-lined surround to distinguish it from the information core to producing and interpreting CATs, and from the boxes with a single line surround which contain additional resources relevant to the different parts of the review.
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Affiliation(s)
- Marnie L Brennan
- Centre for Evidence-based Veterinary Medicine, University of Nottingham, Loughborough, United Kingdom
| | - Sebastian P Arlt
- Clinic for Animal Reproduction, Faculty of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | | | - Louise Buckley
- Deanery of Clinical Sciences, College of Medicine & Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Louise Corah
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, United Kingdom
| | - Hannah Doit
- Centre for Evidence-based Veterinary Medicine, University of Nottingham, Loughborough, United Kingdom
| | - Virginia R Fajt
- Veterinary Physiology and Pharmacology, Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, TX, United States
| | - Douglas J C Grindlay
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom
| | - Heather K Moberly
- Medical Sciences Library, University Libraries, Texas A&M University, College Station, TX, United States
| | - Lisa D Morrow
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, United Kingdom
| | - Jenny Stavisky
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, United Kingdom
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10
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Abstract
Within the evidence-based medicine (EBM) construct, clinical expertise is acknowledged to be both derived from primary experience and necessary for optimal medical practice. Primary experience in medical practice, however, remains undervalued. Clinicians' primary experience tends to be dismissed by EBM as unsystematic or anecdotal, a source of bias rather than knowledge, never serving as the "best" evidence to support a clinical decision. The position that clinical expertise is necessary but that primary experience is untrustworthy in clinical decision-making is epistemically incoherent. Here we argue for the value and utility of knowledge gained from primary experience for the practice of medicine. Primary experience provides knowledge necessary to diagnose, treat, and assess response in individual patients. Hierarchies of evidence, when advanced as guides for clinical decisions, mistake the relationship between propositional and experiential knowledge. We argue that primary experience represents a kind of medical knowledge distinct from the propositional knowledge produced by clinical research, both of which are crucial to determining the best diagnosis and course of action for particular patients.
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Affiliation(s)
- Mark R Tonelli
- University of Washington, 1959 NE Pacific St., Box 356522, Seattle, WA, 98195-6522, USA.
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11
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Abstract
While the importance of mechanisms in determining causality in medicine is currently the subject of active debate, the role of mechanistic reasoning in clinical practice has received far less attention. In this paper we look at this question in the context of the treatment of a particular individual, and argue that evidence of mechanisms is indeed key to various aspects of clinical practice, including assessing population-level research reports, diagnostic as well as therapeutic decision making, and the assessment of treatment effects. We use the pulmonary condition bronchiectasis as a source of examples of the importance of mechanistic reasoning to clinical practice.
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Affiliation(s)
- Mark R Tonelli
- University of Washington, Box 356522, 1959 NE Pacific St., Seattle, WA, 98195-6522, USA.
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12
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Leach MJ, Sundberg T, Fryer G, Austin P, Thomson OP, Adams J. An investigation of Australian osteopaths' attitudes, skills and utilisation of evidence-based practice: a national cross-sectional survey. BMC Health Serv Res 2019; 19:498. [PMID: 31315615 PMCID: PMC6637614 DOI: 10.1186/s12913-019-4329-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/08/2019] [Indexed: 12/19/2022] Open
Abstract
Background Osteopaths are an integral member of the health care team, playing a pivotal role in the provision of care for patients with musculoskeletal disorders. Osteopaths, like other health care providers, are under increasing pressure to deliver evidence-based health care and to improve patient outcomes. However, the extent to which osteopaths engage in evidence-based practice (EBP), particularly in Australia, is not well understood. This study therefore set out to investigate the attitudes, skills and use of EBP, and perceived barriers and enablers of EBP uptake, among osteopaths practicing in Australia. Methods National cross-sectional survey of Australian registered osteopaths. Eligible participants were invited by email and other digital media recruitment strategies to complete the online Evidence-Based Practice Attitude and Utilisation Survey (EBASE). Results A total of 332 osteopaths completed the survey. The demographic characteristics of respondents were generally consistent with the characteristics of the Australian osteopathy workforce. The respondents were mostly favourable of EBP, with the majority agreeing or strongly agreeing that EBP assists in making decisions about patient care (86.7%) and improves the quality of patient care (75.6%). While most respondents (88.3%) had some training in EBP, most reported a moderate level of perceived skill in EBP. The majority of respondents engaged infrequently (0–5 times) in EBP activities within the last month, and most indicated that a very small or small proportion of their clinical practice was based on clinical research evidence. Leading barriers to the uptake of EBP were lack of time and lack of clinical evidence in osteopathy. Key enablers of EBP uptake were access to the internet and online databases at work, and access to full-text articles and EBP education materials. Conclusions Osteopaths participating in the survey were largely supportive of evidence-based practice, yet engaged infrequently in EBP activities. An important next step in this research is to identify suitable strategies that effectively improve EBP uptake in osteopathy, and perchance, improve patient outcomes.
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Affiliation(s)
- Matthew J Leach
- Department of Rural Health, University of South Australia, Adelaide, Australia.,Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Tobias Sundberg
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Musculoskeletal and Sports Injury Epidemiology Center (MUSIC), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gary Fryer
- College of Health & Biomedicine, Victoria University, Melbourne, Victoria, Australia.
| | - Philip Austin
- Department of Pain Management, Greenwich Hospital, Sydney, Australia
| | - Oliver P Thomson
- University College of Osteopathy, London, United Kingdom.,Clinical-based Human Research Department, Centre for Osteopathic Medicine Collaboration (COME), Pescara, Italy
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Morris JH, Bernhardsson S, Bird ML, Connell L, Lynch E, Jarvis K, Kayes NM, Miller K, Mudge S, Fisher R. Implementation in rehabilitation: a roadmap for practitioners and researchers. Disabil Rehabil 2019; 42:3265-3274. [PMID: 30978129 DOI: 10.1080/09638288.2019.1587013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Despite growth in rehabilitation research, implementing research findings into rehabilitation practice has been slow. This creates inequities for patients and is an ethical issue. However, methods to investigate and facilitate evidence implementation are being developed. This paper aims to make these methods relevant and accessible for rehabilitation researchers and practitioners.Methods: Rehabilitation practice is varied and complex and occurs within multilevel healthcare systems. Using a "road map" analogy, we describe how implementation concepts and theories can inform implementation strategies in rehabilitation. The roadmap involves a staged journey that considers: the nature of evidence; context for implementation; navigation tools for implementation; strategies to facilitate implementation; evaluation of implementation outcomes; and sustainability of implementation. We have developed a model to illustrate the journey, and four case studies exemplify implementation stages in rehabilitation settings.Results and Conclusions: Effective implementation strategies for the complex world of rehabilitation are urgently required. The journey we describe unpacks that complexity to provide a template for effective implementation, to facilitate translation of the growing evidence base in rehabilitation into improved patient outcomes. It emphasizes the importance of understanding context and application of relevant theory, and highlights areas which should be targeted in new implementation research in rehabilitation.Implications for rehabilitationEffective implementation of research evidence into rehabilitation practice has many interconnected steps and a roadmap analogy is helpful in defining them.Understanding context for implementation is critically important and using theory can facilitate development of understanding.Research methods for implementation in rehabilitation should be carefully selected and outcomes should evaluate implementation success as well as clinical change.Sustainability requires regular revisiting of the interconnected steps.
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Affiliation(s)
- Jacqui H Morris
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Susanne Bernhardsson
- Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden.,The Sahlgrenska Academy Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Marie-Louise Bird
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Louise Connell
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | - Elizabeth Lynch
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Victoria, Australia.,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Victoria, Australia
| | - Kathryn Jarvis
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | - Nicola M Kayes
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Kim Miller
- Evidence Centre, Sunny Hill Health Centre for Children, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Suzie Mudge
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Rebecca Fisher
- School of Medicine, University of Nottingham, Nottingham, UK
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14
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Loughlin M, Mercuri M, Pârvan A, Copeland SM, Tonelli M, Buetow S. Treating real people: Science and humanity. J Eval Clin Pract 2018; 24:919-929. [PMID: 30159956 DOI: 10.1111/jep.13024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 12/16/2022]
Abstract
Something important is happening in applied, interdisciplinary research, particularly in the field of applied health research. The vast array of papers in this edition are evidence of a broad change in thinking across an impressive range of practice and academic areas. The problems of complexity, the rise of chronic conditions, overdiagnosis, co-morbidity, and multi-morbidity are serious and challenging, but we are rising to that challenge. Key conceptions regarding science, evidence, disease, clinical judgement, and health and social care are being revised and their relationships reconsidered: Boundaries are indeed being redrawn; reasoning is being made "fit for practice." Ideas like "person-centred care" are no longer phrases with potential to be helpful in some yet-to-be-clarified way: Theorists and practitioners are working in collaboration to give them substantive import and application.
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Affiliation(s)
| | - Mathew Mercuri
- Division of Emergency Medicine, McMaster University, Hamilton, Canada
| | - Alexandra Pârvan
- Department of Psychology and Communication Sciences, University of Piteşti, Piteşti, Romania
| | | | | | - Stephen Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
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15
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Anjum RL, Copeland S, Kerry R, Rocca E. The guidelines challenge-Philosophy, practice, policy. J Eval Clin Pract 2018; 24:1120-1126. [PMID: 30027569 DOI: 10.1111/jep.13004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/11/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Rani Lill Anjum
- Principal Investigator CauseHealth Project, Director Centre for Applied Philosophy of Science, Norwegian University of Life Sciences, Ås, Norway
| | - Samantha Copeland
- CauseHealth Project, Centre for Applied Philosophy of Science, Norwegian University of Life Sciences, Ås, Norway
| | - Roger Kerry
- Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Elena Rocca
- CauseHealth Project, Centre for Applied Philosophy of Science, Norwegian University of Life Sciences, Ås, Norway
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16
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Abstract
BACKGROUND Evidence-based medicine is the application of research findings to inform individual clinical decisions. There is a tension-both philosophical and practical-between the average result from a population study and the circumstances and needs of an individual patient. This personal account of "evidence-based" trauma care illustrates and explores this tension. THE CASE The author, a keen athlete, describes her experience of a high-impact cycle accident that led to limb fractures (which were diagnosed and treated according to evidence-based guidelines) and also an occult injury to the cervical spine (which was not diagnosed at the time). Some evidence-based guidelines are reviewed and applied to the case. The clinical record described the cycle accident as a "fall." Initial assessment directed the clinicians' gaze to the obvious injuries, whose treatment was straightforward. On admission, the patient (aged 55 years at the time) was offered "falls prevention" via a guideline-based checklist. Several months later, neurological sequelae indicated possible damage to the cervical spine. But the NICE Guideline recommending cervical spine imaging in cases of high-impact trauma had not been considered-perhaps because the clinical narrative had been prematurely assigned to the script of "older person with fall." Furthermore, the author, who was (appropriately) treated with neurosurgery, was surprised at the response of clinical colleagues, based on application of an irrelevant section of a guideline, that her cervical discectomy was "nonevidence based." Nonsteroidal anti-inflammatory drugs for postoperative pain were indicated in this patient even though they were not recommended for the average patient. CONCLUSION As Sir John Grimley Evans' warned, we should avoid using evidence-based guidelines in the manner of the fabled drunkard who searched under the lamp post for his key because that was where the light was, even though he knew he had lost his key somewhere else.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
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