Journal of evaluation in clinical practice
-
The use of general clinical guidelines versus customization of patient care presents a dilemma for clinicians managing chronic illness. The objective of this project is to investigate the claim that the performance of customized strategies for the management of chronic illness depends on accurate patient categorization, and inaccurate categorization can lead to worse performance than that achievable using a general clinical guideline. ⋯ Results of the analysis have four implications regarding the design and use of clinical guidelines and customization of care: (i) the balance between the applications of more general strategies versus customization depends on the specificity and accuracy of the strategies; (ii) adoption of clinical guidelines may be stifled as the complexity of guidelines increases to account for growing evidence; (iii) clinical inertia (i.e. the failure to intensify an indicated treatment) can be a rational response to strategy specificity and the probability of misapplication; and, (iv) current clinical guidelines and other decision-support tools may be improved if they accommodate the need for customization of strategies for some patients while providing support for proper categorization of patients.
-
To develop tools for use by teams of point-of-care clinicians to improve access to evidence evaluation. ⋯ LEGEND provides tools for point-of-care clinicians that assist them in synthesizing evidence from published studies. The tools provide a balance between quality processes and simplicity, use terminology friendly to multiple disciplines, assist comprehensively with the evidence evaluation process, incorporate factors familiar to the user, and provide flexibility for a diverse range of evidence evaluation projects and users.
-
Signs and symptoms can be considered as diagnostic tests, updating prior odds by applying Bayes' theorem. In homeopathy, signs and symptoms guide the doctor when prescribing appropriate medicines but the powers of these indicators are largely based on common experience. ⋯ A diagnostic patient-outcome study within homeopathy collecting a large amount of data is demonstrated. Results partly confirm clinical practice at a 95% confidence level. This kind of research could validate knowledge from practical experience.