Journal of evaluation in clinical practice
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Quality medical decision making requires that clinicians and patients incorporate the best available clinical evidence with the patients' values and preferences to develop a mutually agreed upon treatment plan. The interactive process involved in medical decision making is complex and requires patients and clinicians to use both cognitive and communicative skills to reach a shared understanding of the decision. ⋯ Strategies such as providing clear explanations, checking for understanding, eliciting the patient's values, concerns, needs, finding common ground, reaching consensus on a treatment plan, and establishing a mutually acceptable follow-up plan can facilitate collaborative decision making. Future research should explore ways to implement collaborative decision-making processes in existing health care systems.
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This study focused on factors that most concern specialist societies when choosing an evidence grading system, such as methodological strengths and weaknesses, applicability and ease of use. The grading systems chosen were the Scottish Intercollegiate Guidelines Network (SIGN), the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the National Service Framework for long-term neurological conditions critical appraisal tool (NSF-LTC). ⋯ It is recommended that specialist societies consider the type of evidence they will be evaluating and the research experience of the appraisers before selecting a grading system. Additionally, appraisers should have training in appraising and grading evidence using the system to be employed.
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We assessed the quality of a sample of clinical guidelines for thyroid nodules and thyroid cancers, using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. We also evaluated the reliability and validity of the AGREE instrument and summarized the key recommendations of the appraised guidelines. ⋯ We identified three clinical guidelines that obtained high overall assessment scores and were recommended for use in practice. Our findings have important implications for those developing clinical guidelines, especially as clarity and presentation significantly influenced the participants' assessment of the guidelines. The developers should ensure that the recommendations are presented clearly and unambiguously, and flowcharts, algorithms and other tools are developed to help the users in applying the recommendations into practice. The optimal number of appraisers for each guideline is four. Further work is needed to improve the 'applicability' domain of the AGREE.
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Evidence-based medicine (EBM) journal clubs are used by health care practitioners to critique and remain updated on relevant health literature. Vote cards, in three different colours (green/yellow/red), allow participants to express their opinions (agree/doubt/reject) on the quality and possibility of clinical application regarding the article being reviewed. Our aim is to assess the efficacy of using vote cards in EBM journal clubs. ⋯ We suggest the regular and routine use of vote cards in EBM journal clubs.
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A systematic review of the pooled effect of articles presenting current basic life support (BLS) algorithms for the treatment of cardiac arrest has never been carried. ⋯ Educational polymorphisms of BLS algorithms could build unpredictable barriers between rescuers and cardiac arrest victims and might seriously limit instructors' educational effectiveness. These findings might support an alternative trial hypothesis of a simple 'all-in-one algorithm' educational approach in future.