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Journal articles on the topic 'Clinicians'
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Dazzi, Federico, Laura Fonzi, Mauro Pallagrosi, Marina Duro, Massimo Biondi, and Angelo Picardi. "Relationship Between Gender and Clinician’s Subjective Experience during the Interaction with Psychiatric Patients." Clinical Practice & Epidemiology in Mental Health 17, no. 1 (December 22, 2021): 190–97. http://dx.doi.org/10.2174/1745017902117010190.
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Introduction: The clinician’s subjective experience can be a valuable element for diagnosis and treatment. A few factors have been recognized that affect it, such as the patient’s personality, the severity of psychopathology, and diagnosis. Other factors, such as patient’s and clinician’s gender, have not been specifically investigated. The aim of this study is to explore the impact of gender differences on the clinician’s subjective experience in a large sample of psychiatric patients. Methods: The study involved 61 psychiatrists and 960 patients attending several inpatient and outpatient psychiatric settings. The clinicians completed the Assessment of Clinician's Subjective Experience (ACSE) questionnaire after observing each patient for the first time. Results: In multivariate analysis, higher scores on the Difficulty in Attunement (p < 0.001), Engagement (p<0.05), and Impotence (p<0.01) scales were significantly associated with female clinician gender, whereas higher scores on the Tension and Disconfirmation scales were significantly associated with male clinician gender. The scores on all ACSE dimensions were also associated with the severity of psychopathology. Conclusion: The findings suggest that clinician’s gender might affect a clinician’s emotional response toward patients. Specific attention to this issue might be useful in clinical situations, not only in terms of promoting gender-balanced teams but also in terms of enhancing self-observation in clinicians evaluating patients for the first time.
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Sullivan, Gail M. "Resources for Clinicians Becoming Clinician Educators." Journal of Graduate Medical Education 7, no. 2 (June 1, 2015): 153–55. http://dx.doi.org/10.4300/jgme-d-15-00098.1.
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Wilder, Kathryn C. "Clinicians' Expectations and Their Impact on an Athlete's Compliance in Rehabilitation." Journal of Sport Rehabilitation 3, no. 2 (May 1994): 168–75. http://dx.doi.org/10.1123/jsr.3.2.168.
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Researchers have explored instructors' expectations and found them to be matched by students' achievements, as the teachers' expectations became self-fulfilling prophecies. In this paper, the intuitive parallel is drawn between the student-teacher relationship and the athlete-clinician relationship. The purpose of the article is to examine the conceivable implications of a clinician's expectations and an athlete's compliance with a rehabilitation regimen. ThePygmalion effectmay have critical implications for clinicians in the rehabilitation setting. The expectation and compliance relationship is further explored through Martinek's attributional model of teacher expectancy effects, which has been adapted to fit the athlete-clinician relationship. A self-assessment checklist has been constructed to augment the clinician's awareness about the self-fulfilling prophecy and its likely ramifications. Information for clinicians about possible Pygmalion effects in the athletic training room and a framework for future research are presented.
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Kavanaugh, Jill R., and Kristelle Lavallee. "Educating Patients through Clinicians: The CMCH Clinician Toolkit." Journal of Consumer Health on the Internet 24, no. 2 (April 2, 2020): 165–74. http://dx.doi.org/10.1080/15398285.2020.1753998.
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Hamann, Edward E. "Clinicians and Diagnosis: Ethical Concerns and Clinician Competence." Journal of Counseling & Development 72, no. 3 (January 2, 1994): 259–60. http://dx.doi.org/10.1002/j.1556-6676.1994.tb00931.x.
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Rake, Ester A., Dunja Dreesens, Kristie Venhorst, Marjan J. Meinders, Tessa Geltink, Jenny T. Wolswinkel, Michelle Dannenberg, Jan A. M. Kremer, Glyn Elwyn, and Johanna W. M. Aarts. "Potential impact of encounter patient decision aids on the patient–clinician dialogue: a qualitative study on Dutch and American medical specialists’ experiences." BMJ Open 12, no. 2 (February 2022): e048146. http://dx.doi.org/10.1136/bmjopen-2020-048146.
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ObjectivesTo examine the experiences among Dutch and American clinicians on the impact of using encounter patient decision aids (ePDAs) on their clinical practice, and subsequently to formulate recommendations for sustained ePDA use in clinical practice.DesignQualitative study using semi-structured interviews with clinicians who used 11 different ePDAs (applicable to their specialty) for 3 months after a short training. The verbatim transcribed interviews were coded with thematic analysis by six researchers via ATLAS.ti.SettingNine hospitals in the Netherlands and two hospitals in the USA.ParticipantsTwenty-five clinicians were interviewed: 16 Dutch medical specialists from four different disciplines (gynaecologists, ear-nose-throat specialists, neurologists and orthopaedic surgeon), 5 American gynaecologists and 4 American gynaecology medical trainees.ResultsThe interviews showed that the ePDA potentially impacted the patient–clinician dialogue in several ways. We identified six themes that illustrate this: that is, (1) communication style, for example, structuring the conversation; (2) the patient’s role, for example, encouraging patients to ask more questions; (3) the clinician’s role, for example, prompting clinicians to discuss more information; (4) workflow, for example, familiarity with the ePDA’s content helped to integrate it into practice; (5) shared decision-making (SDM), for example, mixed experiences whether the ePDA contributed to SDM; and (6) content of the ePDA. Recommendations to possibly improve ePDA use based on the clinician’s experiences: (1) add pictorial health information to the ePDA instead of text only and (2) instruct clinicians how to use the ePDA in a flexible (depending on their discipline and setting) and personalised way adapting the ePDA to the patients’ needs (e.g., mark off irrelevant options).ConclusionsePDAs contributed to the patient–clinician dialogue in several ways according to medical specialists. A flexible and personalised approach appeared appropriate to integrate the use of ePDAs into the clinician’s workflow, and customise their use to individual patients’ needs.
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Simic, Tijana, Carol Leonard, Laura Laird, Jennifer Cupit, Fiona Höbler, and Elizabeth Rochon. "A Usability Study of Internet-Based Therapy for Naming Deficits in Aphasia." American Journal of Speech-Language Pathology 25, no. 4 (November 2016): 642–53. http://dx.doi.org/10.1044/2016_ajslp-15-0030.
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Purpose This study aimed to evaluate the usability of delivering the Phonological Components Analysis treatment for anomia (Leonard, Rochon, & Laird, 2008) remotely via the Internet to individuals with chronic poststroke aphasia. A secondary aim was to probe the experiences and satisfaction of clinicians in administering treatment at a distance. Method Six individuals with mild–moderate aphasia and 2 trained clinicians participated in this usability study. Participants and clinicians underwent approximately 6 hr of treatment under observation by an independent observer. The usability characteristics of effectiveness, efficiency, and satisfaction were assessed. Results Individuals with aphasia used the Internet-based Phonological Components Analysis therapy successfully, demonstrating independence and very few errors in completing online tasks. Overall, participant satisfaction was high, despite occasional difficulties with technical aspects of the system. Clinicians found the application easy to use but raised concerns about the participant–clinician interaction, perceiving rapport-building and communicating to be more difficult online than face-to-face. Conclusions It is important to consider usability and the clinician's perspective in developing telepractice applications in speech-language pathology. Future directions include assessing the efficacy of remote treatment and collecting a larger sample of clinician data.
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Evison, Hugo, Mercedes Carrington, Gerben Keijzers, Nicole M. Marsh, Amy Lynn Sweeny, Joshua Byrnes, Claire M. Rickard, Peter J. Carr, and Jamie Ranse. "Peripheral intravenous cannulation decision-making in emergency settings: a qualitative descriptive study." BMJ Open 12, no. 3 (March 2022): e054927. http://dx.doi.org/10.1136/bmjopen-2021-054927.
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ObjectivesRates of unused (‘idle’) peripheral intravenous catheters (PIVCs) are high but can vary per setting. Understanding factors that influence the decision-making of doctors, nurses and paramedics in the emergency setting regarding PIVC insertion, and what factors may modify their decision is essential to identify opportunities to reduce unnecessary cannulations and improve patient-centred outcomes. This study aimed to understand factors associated with clinicians’ decision-making on whether to insert or use a PIVC in the emergency care setting.DesignA qualitative descriptive study using in-depth semistructured interviews and thematic analysis.SettingGold Coast, Queensland, Australia, in a large tertiary level emergency department (ED) and local government ambulance service.ParticipantsParticipants recruited were ED clinicians (doctors, nurses) and paramedics who regularly insert PIVCs.ResultsFrom the 15 clinicians interviewed 4 key themes: knowledge and experience, complicated and multifactorial, convenience, anticipated patient clinical course, and several subthemes emerged relating to clinician decision-making across all disciplines. The first two themes focused on decision-making to gather data and evidence, such as knowledge and experience, and decisions being complicated and multifactorial. The remaining two themes related to the actions clinicians took such as convenience and anticipated patient clinical course.ConclusionThe decision to insert a PIVC is more complicated than clinicians, administrators and policy-makers may realise. When explored, clinician decisions were multifaceted with many factors influencing the decision to insert a PIVC. In actual practice, clinicians routinely insert PIVCs in most patients as a learnt reflex with little cognitive input. When considering PIVC insertion, more time needs to be devoted to the awareness of: (1) decision-making in the context of the clinician’s own experience, (2) cognitive biases and (3) patient-centred factors. Such awareness will support an appropriate risk assessment which will benefit the patient, clinician and healthcare system.
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Bohmer, Richard M. J. "Leading Clinicians and Clinicians Leading." New England Journal of Medicine 368, no. 16 (April 18, 2013): 1468–70. http://dx.doi.org/10.1056/nejmp1301814.
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Boucher, J. L. "Clinician Burnout: How Do Clinicians Take Care of Themselves?" Diabetes Spectrum 24, no. 2 (May 1, 2011): 59–60. http://dx.doi.org/10.2337/diaspect.24.2.59.
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McCarthy, Barry, and Lana Wald Ross. "Therapist Values: Assessing and Treating Traditional and Nontraditional Relationships." Family Journal 27, no. 1 (November 19, 2018): 11–16. http://dx.doi.org/10.1177/1066480718811327.
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A common mental health assumption exists that all clinicians should be able to treat all problems and all clients. An unspoken belief among many clinicians is that nontraditional sexual preferences and feelings are driven by psychopathology. In contrast, in order to provide high-quality clinical treatment, a positive sexual health model advocates that the clinician exhibits interest in the client’s sexual issue, be trained and competent with the presenting problem, and provide therapy congruent with the clinician’s personal and professional values. Nontraditional clients and couples deserve that sexuality plays a positive role in their lives and relationship. Although the clinician needs to assess for psychopathology, it is crucial that the therapist not assume that nontraditional sexuality is motivated by psychopathology. All clients/couples deserve to be treated empathically and respectfully and receive high-quality mental health and sex therapy services.
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Courtney, Deborah M. "EMDR to Treat Children and Adolescents: Clinicians’ Experiences Using the EMDR Journey Game." Journal of EMDR Practice and Research 10, no. 4 (2016): 245–55. http://dx.doi.org/10.1891/1933-3196.10.4.245.
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Childhood trauma is a pervasive social issue with profound consequences. Eye movement desensitization and reprocessing (EMDR) therapy is an effective treatment for children. Challenges can arise when using EMDR with children, such as difficulty engaging children and developmental fit of the protocol. Child experts have developed creative tools to address these challenges. The EMDR Journey Game is one such tool that integrates creative modalities with EMDR. This study explored the relationship between use of the game and clinician’s perceived client engagement and clinician confidence. This study employed an observational, cross-sectional design, surveying (online) 69 EMDR-trained clinicians, half of whom had used the game and half of whom had not. Results show clinicians were motivated to use the EMDR Journey Game to engage children in EMDR and to increase their confidence. Findings also suggest the game was perceived to enhance children’s engagement with EMDR; clinicians’ experience (years and frequency of use) with EMDR impacts their confidence using EMDR with adolescents and adults, but not with children. Results support the efforts of child experts to develop appropriate, creative tools to adapt EMDR for children. Further exploration of clinician confidence using EMDR with children is necessary.
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Weichelt, Bryan, Casper Bendixsen, and Timothy Patrick. "A Model for Assessing Necessary Conditions for Rural Health Care’s Mobile Health Readiness: Qualitative Assessment of Clinician-Perceived Barriers." JMIR mHealth and uHealth 7, no. 11 (November 8, 2019): e11915. http://dx.doi.org/10.2196/11915.
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Background Mobile health (mHealth) technology dissemination has penetrated rural and urban areas alike. Yet, health care organization oversight and clinician adoption have not kept pace with patient use. mHealth could have a unique impact on health and quality of life for rural populations. If organizations are prepared to manage mHealth, clinicians may improve the quality of care for their patients, both rural and urban. However, many organizations are not yet prepared to prescribe or prohibit third-party mHealth technologies. Objective This study explored organizational readiness for rural mHealth adoption, the use of patient-reported data by clinical care teams, and potential impact on improving rural health care delivery. Methods Semistructured, open-ended interviews were used to investigate clinicians’ current practices, motivators, and perceived barriers to their use of mHealth technologies in rural settings. Results A total of 13 clinicians were interviewed, and 53.8% (7/13) reported encouraging use of mHealth apps or wearable devices with rural patients. Perceived barriers to adoption were categorized into three primary themes: (1) personal (clinician), (2) patient, and (3) organizational. Organizational was most prominent, with subcodes of time, uniformity, and policy or direction. Thematic analysis revealed code-category linkages that identify the complex nature of a rural health care organization’s current climate from a clinician’s perspective. A thematic map was developed to visualize the flow from category to code. Identified linkages guided the development of a refined rural mHealth readiness model. Conclusions Clinicians (including physicians) have limited time for continuing education, research, or exploration of emerging technologies. Clinicians are motivated to learn more, but they need guidance through organization-led directives. Rural health care institutions should consider investing in mHealth analysis, tool development, and formal recommendations of sanctioned tools for clinicians to use with patients.
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M.S. MFT, Eman Tadros. "How Mental Health Clinicians Can Address Issues of Diversity with Incarcerated Individuals." International Journal of Social Science Studies 6, no. 9 (August 30, 2018): 44. http://dx.doi.org/10.11114/ijsss.v6i9.3536.
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Mental Health Clinicians are accustomed to being confronted with not only difficult situations, but difficult conversations. Although discussing issues of diversity can be challenging, these dialogues are vital to the therapeutic process. In order to work under a multicultural framework, a clinician must minimally have basic knowledge on the culture of the client(s) being treated. Therapists are to use culturally appropriate intervention strategies and be mindful of the rules of the client’s culture. It is advised to work with the client(s) to define their culture, what it means to them, and what it means to society. It is the duty of a clinician to exemplify this for clients and give clients the power, permission, and invitation that they may believe they need, to do the same. This article discusses issues of diversity in the incarcerated system, clarifies the clinician’s role, and empowers clinicians to utilize multicultural techniques in treatment.
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You, John, Japteg Singh, Jessica Simon, Irene W. Y. Ma, Joanna Paladino, Marilyn Swinton, Daniel Kobewka, et al. "A Quality Improvement Initiative to Implement the Serious Illness Care Program on Hospital Medical Wards." Canadian Journal of General Internal Medicine 17, no. 1 (February 8, 2022): 29–51. http://dx.doi.org/10.22374/cjgim.v17i1.528.
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Background: The Serious Illness Care Program (SICP) is a communication intervention that builds clinician capacity to have earlier, more values-based conversations about goals of care with patients experiencing life-limiting illness. We report the impact of its implementation on hospital wards.Methods: In this quality improvement initiative on the medical wards of two Canadian teaching hospitals, we trained physicians, nurse practitioners, and social workers in the use of the Serious Illness Conversation Guide. Between February 2017 and September 2020, we prompted trained clinicians to have serious illness conversations with hospitalized patients or their family member(s), for patients at high risk of dying. Outcomes were the number of clinicians trained, the number of conversations delivered, patient or family experience, including the extent to which they felt heard and understood, and clinician experience.Results: We trained 57 (92%) of 62 eligible clinicians. We delivered conversations to 334 (29%) of 1158 eligible patients (or family members) and documented 274 (82%) of these in the medical record. After a serious illness conversation, 80% of patients or families rated the conversations as mostly or extremely worthwhile and felt more heard and understood (+0.2 on 5-point scale, P = 0.04). The majority (95%) of clinicians agreed (some-what, mostly, or completely) that conversations could be done in an appropriate amount of time and 97% agreed (somewhat, mostly, or completely) that the Guide provided information that enhances clinical care. Interpretation: The SICP can be implemented on medical wards of hospitals and can have a positive impact on patient and clinician experience. RésuméContexte : Le Serious Illness Care Program (SICP) est une intervention de communication qui renforce la capacité du clinicien à avoir des conversations plus précoces et davantage axées sur les valeurs concernant les objectifs des soins avec les patients atteints d’une maladie limitant leur espérance de vie. Nous présentons les répercussions de sa mise en œuvre dans les services hospitaliers.Méthodologie : Dans cette initiative sur l’amélioration de la qualité dans les services médicaux de deux hôpitaux universitaires canadiens, nous avons formé des médecins, des infirmières praticiennes et des travailleurs sociaux à l’utilisation du guide de conversation sur les maladies graves. Entre février 2017 et septembre 2020, nous avons incité les cliniciens formés à avoir des conversations sur les maladies graves avec des patients hospitalisés présentant un risque élevé de décès ou des membres de leur famille. Les critères d’évaluation étaient le nombre de cliniciens formés, le nombre de conversations effectuées, l’expérience des patients ou de leur famille, y compris la mesure dans laquelle ils se sont sentis écoutés et compris, et l’expérience des cliniciens.Résultats : Nous avons formé 57 (92 %) des 62 cliniciens admissibles. Des conversations ont été réalisées auprès de 334 (29 %) des 1158 patients (ou membres de la famille) admissibles et 274 (82 %) de ces conversations ont été consignées dans le dossier médical. Après une conversation sur les maladies graves, 80 % des patients ou de leur famille ont évalué les conversations comme étant plutôt ou extrêmement utiles et ils se sont sentis plus écoutés et compris (+ 0,2 sur une échelle de 5 points, P = 0,04). La majorité (95 %) des cliniciens sont d’accord (quelque peu, plutôt ou complètement) sur le fait que les conversations ont pu avoir lieu dans un laps de temps approprié et 97 % sont d’accord (quelque peu, plutôt ou complètement) sur le fait que le guide fournit des renseignements qui améliorent les soins cliniques.Interprétation : Le SICP peut être mis en œuvre dans les services médicaux des hôpitaux et peut avoir des répercussions positives sur l’expérience des patients et des cliniciens.
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Alonzo, Dana, Claire Moravec, and Benjamin Kaufman. "Individuals at Risk for Suicide." Crisis 38, no. 3 (May 2017): 158–67. http://dx.doi.org/10.1027/0227-5910/a000427.
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Abstract. Background: Individuals experiencing suicidal ideation and/or behaviors are often difficult to engage in treatment. Up to 50% of individuals presenting to an ER for treatment of a suicidal crisis refuse outpatient treatment referrals. This study examined outpatient mental health clinicians' perceptions of the barriers to and facilitators of mental health treatment engagement of individuals at risk for suicide. Method: Thirty-six mental health clinicians working with clients with past and/or current suicidality (ideation, behaviors) in outpatient mental health centers participated in four focus groups. Data were collected using semistructured interview. A process of content analysis was utilized in which data were analyzed thematically. Results: Five main domains of barriers and facilitators emerged including (a) client-level, (b) clinician-level, (c) service-level, (d) agency-level, and (e) intervention-level variables. In all, 38 barriers and 31 facilitators were identified. The most frequently identified facilitator was the clinician's own sense of engagement with the client, identified by 31% of the clinicians. The most frequently identified barrier was housing instability, identified by 34% of the clinicians. Conclusion: Knowledge of clinicians' perspective on treatment engagement of clients at risk for suicide may inform the development and implementation of interventions and guide training/supervision programs for those working with this vulnerable population.
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Miller, Jennifer J., Janet R. Serwint, and Renee D. Boss. "Clinician–family relationships may impact neonatal intensive care: clinicians’ perspectives." Journal of Perinatology 41, no. 9 (June 5, 2021): 2208–16. http://dx.doi.org/10.1038/s41372-021-01120-8.
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Caron, EB, Michela A. Muggeo, Heather R. Souer, Jeffrey E. Pella, and Golda S. Ginsburg. "Concordance between clinician, supervisor and observer ratings of therapeutic competence in CBT and treatment as usual: does clinician competence or supervisor session observation improve agreement?" Behavioural and Cognitive Psychotherapy 48, no. 3 (December 6, 2019): 350–63. http://dx.doi.org/10.1017/s1352465819000699.
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AbstractBackground:Lowering the cost of assessing clinicians’ competence could promote the scalability of evidence-based treatments such as cognitive behavioral therapy (CBT).Aims:This study examined the concordance between clinicians’, supervisors’ and independent observers’ session-specific ratings of clinician competence in school-based CBT and treatment as usual (TAU). It also investigated the association between clinician competence and supervisory session observation and rater agreement.Method:Fifty-nine school-based clinicians (90% female, 73% Caucasian) were randomly assigned to implement TAU or modular CBT for youth anxiety. Clinicians rated their confidence after each therapy session (n = 1898), and supervisors rated clinicians’ competence after each supervision session (n = 613). Independent observers rated clinicians’ competence from audio recordings (n = 395).Results:Patterns of rater discrepancies differed between the TAU and CBT groups. Correlations with independent raters were low across groups. Clinician competence and session observation were associated with higher agreement among TAU, but not CBT, supervisors and clinicians.Conclusions:These results support the gold standard practice of obtaining independent ratings of adherence and competence in implementation contexts. Further development of measures and/or rater training methods for clinicians and supervisors is needed.
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Bauer, Nerissa S., Aaron E. Carroll, Chandan Saha, and Stephen M. Downs. "Experience with decision support system and comfort with topic predict clinicians’ responses to alerts and reminders." Journal of the American Medical Informatics Association 23, e1 (November 13, 2015): e125-e130. http://dx.doi.org/10.1093/jamia/ocv148.
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Abstract Objective Clinicians at our institution typically respond to about half of the prompts they are given by the clinic’s computer decision support system (CDSS). We sought to examine factors associated with clinician response to CDSS prompts as part of a larger, ongoing quality improvement effort to optimize CDSS use. Methods We examined patient, prompt, and clinician characteristics associated with clinician response to decision support prompts from the Child Health Improvement through Computer Automation (CHICA) system. We asked pediatricians who were nonusers of CHICA to rate decision support topics as “easy” or “not easy” to discuss with patients and their guardians. We analyzed these ratings and data, from July 1, 2009 to January 29, 2013, utilizing a hierarchical regression model, to determine whether factors such as comfort with the prompt topic and the length of the user’s experience with CHICA contribute to user response rates. Results We examined 414 653 prompts from 22 260 patients. The length of time a clinician had been using CHICA was associated with an increase in their prompt response rate. Clinicians were more likely to respond to topics rated as “easy” to discuss. The position of the prompt on the page, clinician gender, and the patient’s age, race/ethnicity, and preferred language were also predictive of prompt response rate. Conclusion This study highlights several factors associated with clinician prompt response rates that could be generalized to other health information technology applications, including the clinician’s length of exposure to the CDSS, the prompt’s position on the page, and the clinician’s comfort with the prompt topic. Incorporating continuous quality improvement efforts when designing and implementing health information technology may ensure that its use is optimized.
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Rukmini, Elisabeth, and Kevin Jonathan Bogar. "EXPLORATORY STUDY ON MEDICAL GRADUATES WITH NONCLINICIANS CAREER." Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education 10, no. 1 (March 31, 2021): 86. http://dx.doi.org/10.22146/jpki.61406.
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Background: Medical graduates have diverse career choices. Various factors trigger the motivation and interest of alumni to choose non-clinician careers. Research towards medical graduates who chose non-clinician careers was less than doctors with clinicians. This study aims to explore the reasons for choosing non-clinicians as careers for medical graduates. Methods: This research is a descriptive exploratory study. A total of 10 medical alumni subjects, batch 2011, were selected through purposive sampling. They were rich in information. We performed semi-structured interviews to collect qualitative data. Data were analyzed using content analysis. To ensure transferability and dependability of the data, we performed inter-raters meetings and an audit trail. Triangulation between three inter-raters was administered to get an inter-rater agreement. An external auditor performed an audit trail after the data analysis. Results: This study discussed the reasons for choosing non-clinician careers for medical graduates. Three main themes influence the graduates’ reasons: (1) motivation, (2) experiences, and (3) comparative factors between clinician and non-clinician careers. The motivation could be divided into internal and external motivation. Strong motivation, together with experiences, form a firm decision to take non-clinician careers. When comparing clinician and non-clinician careers, subjects mentioned the condition, including financial situation, risk factors, and seniority. Conclusion: The reasons for choosing non-clinician careers related closely to subjects’ motivation, experiences, and comparative factors between careers as clinicians versus non-clinicians. This research showed the importance of medical education to prepare students for mentorship, the risks factor of and the career choices of clinicians and non-clinicians
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Black, Donald W., Bruce Pfohl, Nancee Blum, Brett McCormick, Jeff Allen, Carol S. North, Katharine A. Phillips, et al. "Attitudes Toward Borderline Personality Disorder: A Survey of 706 Mental Health Clinicians." CNS Spectrums 16, no. 3 (March 2011): 67–74. http://dx.doi.org/10.1017/s109285291200020x.
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AbstractObjectiveWe sought to determine attitudes toward patients with borderline personality disorder (BPD) among mental health clinicians at nine academic centers in the United States.MethodsA self-report questionnaire was distributed to 706 mental health clinicians, including psychiatrists, psychiatry residents, social workers, nurses, and psychologists.ResultsThe study showed that most clinicians consider BPD a valid diagnosis, although nearly half reported that they preferred to avoid these patients. The clinician's occupational subgroup was significantly related to attitude. Staff nurses had the lowest self-ratings on overall caring attitudes, while social workers had the highest. Social workers and psychiatrists had the highest ratings on treatment optimism. Social workers and psychologists were most optimistic about psychotherapy effectiveness, while psychiatrists were most optimistic about medication effectiveness. Staff nurses had the lowest self-ratings on empathy toward patients with BPD and treatment optimism.DiscussionNegative attitudes persist among clinicians toward BPD, but differ among occupational subgroups. Overall, caring attitudes, empathy, and treatment optimism were all higher among care providers who had cared for a greater number of BPD patients in the past 12 months.ConclusionThese findings hold important implications for clinician education and coordination of care for patients with BPD.
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Roberts, Joanne Erwick, and Vicki McCready. "Different Clinical Perspectives of Good and Poor Therapy Sessions." Journal of Speech, Language, and Hearing Research 30, no. 3 (September 1987): 335–42. http://dx.doi.org/10.1044/jshr.3003.335.
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This study investigated differences in causal attributions made by student clinicians taking actor and observer roles in good and poor therapy Sessions. One hundred thirty-four graduate student clinicians in speech-language pathology were asked to imagine a hypothetical good or poor therapy session in which they took either the role of a clinician working with a client in a session or that of a clinician observing the session. To account for the session's hypothesized outcomes, clinicians taking the actor role cited client causes more frequently than other causes while clinicians taking the observer role cited clinician causes. These results are consistent with the actor-observer bias documented extensively in the psychological and educational literatures. Clinicians' causal attributions also differed for good and poor therapy sessions. Implications are discussed in terms of possible impact on the clinical training process in speech-language pathology.
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Wollney, Easton N., Carma L. Bylund, Noheli Bedenfield, Monica Rosselli, Rosie E. Curiel-Cid, Marcela Kitaigorodsky, Ximena Levy, and Melissa J. Armstrong. "Clinician approaches to communicating a dementia diagnosis: An interview study." PLOS ONE 17, no. 4 (April 14, 2022): e0267161. http://dx.doi.org/10.1371/journal.pone.0267161.
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Background Individuals with cognitive impairment and their families place a high value on receiving a dementia diagnosis, but clinician approaches vary. There is a need for research investigating experiences of giving and receiving dementia diagnoses. The current study aimed to investigate clinician approaches to giving dementia diagnoses as part of a larger study investigating patient, caregiver, and clinician experiences during the diagnosis encounter. Method Investigators conducted telephone interviews with Florida-based clinicians who give dementia diagnoses either rarely or commonly. Interviews employed a semi-structured interview guide querying communication practices used by clinicians when giving dementia diagnoses and how clinicians learned to give dementia diagnoses. Investigators used a descriptive qualitative design to conduct a thematic analysis of data. Results Fifteen Florida-based clinicians participated, representing diverse backgrounds related to gender, race/ethnicity, specialty, and practice setting. Participants reported using patient- and family-centered communication practices including checking patient understanding, communicating empathically, and involving family members. Some clinicians explicitly asked patients and/or family members about their preferences regarding diagnosis disclosure; many clinicians tailored their disclosure based on patient and family characteristics or reactions. Some clinicians reported using specific diagnoses, while others used general terms such as “memory disorder.” Clinicians reported positively framing information, including instilling hope, focusing on healthy behaviors, and discussing symptom management. Finally, clinicians provided patient/family education and arranged follow up. Clinicians reported learning approaches to dementia diagnosis disclosure through formal training and self-education. Conclusions Diverse Florida-based clinicians described dementia disclosure practices largely consistent with published guidance, but clinicians varied on approaches relating to soliciting patient disclosure preferences and terminology used. Clinicians caring for diverse populations described that cultural background affects the disclosure process, but more research is needed regarding this finding and best practices for individuals from different backgrounds.
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Sinsheimer, Kathy. "Creating a family state of mind: using psychoanalytic ideas to treat families where children resist or refuse contact with a parent." Couple and Family Psychoanalysis 11, no. 1 (March 19, 2021): 41–52. http://dx.doi.org/10.33212/cfp.v11n1.2021.41.
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Separated families, where children resist or refuse visitation with one parent, present a complex treatment picture for clinicians. Application of psychoanalytic concepts can increase the clinician's understanding of the family members' response to the familial separation and inform the clinician's treatment decisions. The concepts of couple state of mind, projective gridlock, transgenerational transmission of trauma, and Nachträglichkeit, or après coup, are proposed as useful in appreciating the family members' individual and familial psychological responses to the trauma of parental separation. Multiple clinician functions necessary in the treatment of this complex family dynamic are explicated. A case example is included. Family state of mind is proposed as a newly named function for the clinician as well as the family members.
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Cohen-Mekelburg, Shirley, Tony Van, Xianshi Yu, Deena Kelly Costa, Milisa Manojlovich, Sameer Saini, Heather Gilmartin, et al. "Understanding clinician connections to inform efforts to promote high-quality inflammatory bowel disease care." PLOS ONE 17, no. 12 (December 27, 2022): e0279441. http://dx.doi.org/10.1371/journal.pone.0279441.
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Background Highly connected individuals disseminate information effectively within their social network. To apply this concept to inflammatory bowel disease (IBD) care and lay the foundation for network interventions to disseminate high-quality treatment, we assessed the need for improving the IBD practices of highly connected clinicians. We aimed to examine whether highly connected clinicians who treat IBD patients were more likely to provide high-quality treatment than less connected clinicians. Methods We used network analysis to examine connections among clinicians who shared patients with IBD in the Veterans Health Administration between 2015–2018. We created a network comprised of clinicians connected by shared patients. We quantified clinician connections using degree centrality (number of clinicians with whom a clinician shares patients), closeness centrality (reach via shared contacts to other clinicians), and betweenness centrality (degree to which a clinician connects clinicians not otherwise connected). Using weighted linear regression, we examined associations between each measure of connection and two IBD quality indicators: low prolonged steroids use, and high steroid-sparing therapy use. Results We identified 62,971 patients with IBD and linked them to 1,655 gastroenterologists and 7,852 primary care providers. Clinicians with more connections (degree) were more likely to exhibit high-quality treatment (less prolonged steroids beta -0.0268, 95%CI -0.0427, -0.0110, more steroid-sparing therapy beta 0.0967, 95%CI 0.0128, 0.1805). Clinicians who connect otherwise unconnected clinicians (betweenness) displayed more prolonged steroids use (beta 0.0003, 95%CI 0.0001, 0.0006). The presence of variation is more relevant than its magnitude. Conclusions Clinicians with a high number of connections provided more high-quality IBD treatments than less connected clinicians, and may be well-positioned for interventions to disseminate high-quality IBD care. However, clinicians who connect clinicians who are otherwise unconnected are more likely to display low-quality IBD treatment. Efforts to improve their quality are needed prior to leveraging their position to disseminate high-quality care.
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Winitz, H. "Treating Language Disorders: For Clinicians by Clinicians." Child Language Teaching and Therapy 1, no. 1 (January 1985): 114–15. http://dx.doi.org/10.1177/026565908500100114.
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Bittleston, Helen, Jane S. Hocking, Jane L. Goller, Jacqueline Coombe, Deborah Bateson, Sally Sweeney, Kirsteen Fleming, and Wilhelmina M. Huston. "Is there a place for a molecular diagnostic test for pelvic inflammatory disease in primary care? An exploratory qualitative study." PLOS ONE 17, no. 9 (September 19, 2022): e0274666. http://dx.doi.org/10.1371/journal.pone.0274666.
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Introduction There is currently no test for pelvic inflammatory disease (PID) that is non-invasive and sufficiently sensitive and specific. Clinicians must therefore diagnose PID clinically, ruling out medical emergencies and conducting pelvic examinations where possible. While guidelines state that clinicians should be prepared to over-diagnose PID, it remains an under-diagnosed condition, with severe reproductive health impacts when left untreated. This research is the first to consider the perspectives of end-users on the development of a diagnostic test for PID. Methods Semi-structured live video feed online (Zoom) interviews were conducted with 11 clinicians and nine women (aged 18–30 years) in Australia to understand how a diagnostic test might be used, and what characteristics a test would need for it to be acceptable to clinicians and young women. Participants were recruited via researcher and university student networks. Reflexive thematic analysis was used to identify key themes relating to the acceptability and characteristics of a diagnostic test for PID. Results Seven general practitioners, four clinicians working in sexual health clinics, and nine young women (aged 21–27 years) were interviewed. Clinicians were aged between 31–58 years and were predominantly female. Clinicians recognised that the development of an accurate test to diagnose PID would be valuable to themselves and other clinicians, particularly those who lack experience diagnosing PID, and those working in certain settings, including emergency departments. They discussed how they might use a test to enhance their clinical assessment but highlighted that it would not replace clinical judgement. Clinicians also considered how a test would impact the patient experience and time to treatment, emphasising that it should be minimally invasive and have a quick turnaround time. Young women said a test would be acceptable if endorsed by a trustworthy clinician. Conclusions PID remains a challenging diagnosis. Development of a minimally invasive and sufficiently accurate diagnostic test would be acceptable to young women and benefit some clinicians, although no test would completely replace an experienced clinician’s judgement in making a PID diagnosis.
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McFadden, Nikia R., Melissa M. Gosdin, Gregory J. Jurkovich, and Garth H. Utter. "Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study." Trauma Surgery & Acute Care Open 7, no. 1 (January 2022): e000800. http://dx.doi.org/10.1136/tsaco-2021-000800.
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ObjectivesTrauma and acute care surgery (TACS) patients face complex barriers associated with hospitalization discharge that hinder successful recovery. We sought to better understand the challenges in the discharge transition of care, which might suggest interventions that would optimize it.MethodsWe conducted a qualitative study of patient and clinician perceptions about the hospital discharge process at an urban level 1 trauma center. We performed semi-structured interviews that we recorded, transcribed, coded both deductively and inductively, and analyzed thematically. We enrolled patients and clinicians until we achieved data saturation.ResultsWe interviewed 10 patients and 10 clinicians. Most patients (70%) were male, and the mean age was 57±16 years. Clinicians included attending surgeons, residents, nurse practitioners, nurses, and case managers. Three themes emerged. (1) Communication (patient-clinician and clinician-clinician): clinicians understood that the discharge process malfunctions when communication with patients is not clear. Many patients discussed confusion about their discharge plan. Clinicians lamented that poorly written discharge summaries are an inadequate means of communication between inpatient and outpatient clinicians. (2) Discharge teaching and written instructions: patients appreciated discharge teaching but found written discharge instructions to be overwhelming and unhelpful. Clinicians preferred spending more time teaching patients and understood that written instructions contain too much jargon. (3) Outpatient care coordination: patients and clinicians identified difficulties with coordinating ongoing outpatient care. Both identified the patient’s primary care physician and insurance coverage as important determinants of the outpatient experience.ConclusionTACS patients face numerous challenges at hospitalization discharge. Clinicians struggle to effectively help their patients with this stressful transition. Future interventions should focus on improving communication with patients, active communication with a patient’s primary care physician, repurposing, and standardizing the discharge summary to serve primarily as a means of care coordination, and assisting the patient with navigating the transition.Level of evidenceIII—descriptive, exploratory study.
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Peoples, Hayley A., Blair Boone, Jennifer S. Blumenthal-Barby, and Courtenay R. Bruce. "How Clinician–Family Interactions Potentially Impact Clinicians’ Conceptualization and Discussions Regarding Prognostic Uncertainties." Journal of Palliative Care 35, no. 1 (April 30, 2019): 29–33. http://dx.doi.org/10.1177/0825859719845005.
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Objectives: Little is known about how clinicians perceive prognostic uncertainty. Our study objective was to identify factors that influence how prognostic uncertainty is viewed by physicians, as it relates to their communications with families. Design: Thirty semi-structured interviews with qualitative content analysis (9 surgeons, 16 intensivists, 3 nurse practitioners, and 2 “other” clinicians). We analyzed interviews using qualitative description with constant comparative techniques. Setting: Open medical, surgical, neurosurgical, and cardiovascular intensive care units (ICUs) in a 900-bed academic, tertiary Houston hospital. Interventions: None Main Results: We identified 2 main factors that influence how clinicians perceive prognostic uncertainty and their perceptions about whether and why they communicate prognostic uncertainties to families: (1) Communicating Uncertainty to “Soften the Blow”; and (2) Communicating Uncertainty in Response to Clinicians’ Interpretations of Surrogate Decision Makers’ Perceptions of Prognostic Uncertainty. We also identified several subthemes. Conclusions: Clinician–family interactions influence how clinicians perceive prognostic uncertainty in their communications with patients or families. We discuss ethical and clinical implications of our findings.
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Wang, Xiaomei, H. Joseph Blumenthal, Daniel Hoffman, Natalie Benda, Tracy Kim, Shawna Perry, Ella S. Franklin, Emilie M. Roth, A. Zachary Hettinger, and Ann M. Bisantz. "Patient-related Workload Prediction in the Emergency Department: A Big Data Approach." Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 8, no. 1 (September 2019): 33–36. http://dx.doi.org/10.1177/2327857919081008.
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This research is a first stage in developing a method for modeling the clinician workload associated with an emergency medicine patient in order to display workload for purposes of managing clinician workload and emergency department (ED) flow. We proposed a multi-stage approach of predicting patient-related drivers of clinician’s workload in the emergency department. We trained the model from one month of electronic health record data (EHR) records of an ED. The model predicts the amount of work that individual patients contribute to the workload of clinicians. It can potentially help to manage clinician workload by supporting the decision of assigning new patients.
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Amin, Nima, Susan J. Cunningham, Elinor M. Jones, and Fiona S. Ryan. "Investigating perceptions of patient-centred care in orthodontics." Journal of Orthodontics 47, no. 4 (September 15, 2020): 320–29. http://dx.doi.org/10.1177/1465312520952802.
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Objectives: To assess and compare patient and clinician perceptions of patient-centredness for adults about to commence active orthodontic treatment, and to assess whether the following variables affected perceptions of patient-centredness: patient gender and age; clinician gender and grade; and stage of treatment. Design: A prospective, cross-sectional questionnaire study. Setting: Eastman Dental Hospital, UCLH NHS Foundation Trust. Participants: A total of 112 adult patients and 30 clinicians completed 224 questionnaires (112 patient and 112 clinician questionnaires). Methods: A validated, dyadic questionnaire, the ‘9-Item Patient Perception of Patient-Centredness’ (PPPC), was used to collect data from both patients and their corresponding clinicians after initial assessment or records/treatment planning consultations. Total PPPC scores (possible score range = 9–36) were calculated for each patient and clinician to ascertain the extent to which they perceived they were engaging in patient-centredness, where higher scores corresponded with better performance. Results: Patients and clinicians perceived high engagement in patient-centredness with median scores of 32/36 and 29/36, respectively. There was a statistically significant difference between total scores with patients perceiving consultations to be more patient-centred than clinicians ( P < 0.001). None of the variables (patient gender and age, clinician gender and grade, stage of treatment) were statistically significant. Conclusion: Patients and clinicians both perceived high engagement in patient-centredness. Patients perceived consultations to be significantly more patient-centred than clinicians ( P < 0.001).
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Bourne, Elizabeth, Lindy McAllister, Belinda Kenny, and Kate Short. "Speech Pathologists’ Perceptions of the Impact of Student Supervision." International Journal of Practice-based Learning in Health and Social Care 8, no. 2 (October 21, 2020): 1–15. http://dx.doi.org/10.18552/ijpblhsc.v8i2.549.
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Qualitative studies have described clinician perspectives on student placements. These studies highlight likely contributors to placement shortages, but little is documented in speech pathology (SP). This article describes SP clinician perceptions of student impact/s on their clinical and other work tasks, stress levels and time management, and explores factors that may contribute to these perceptions of their experience. Interpretive description was selected to analyse public health sector SP clinician online survey responses. Open-ended questions explored clinician perceptions of student impact on specified components of their work as well as any other aspects clinicians identified. Thirty-four SP clinicians with varying caseloads and experience levels responded. Clinicians perceived that students can positively or negatively impact their clinical and non-clinical activities. Many also identified negative impacts on their stress levels. Some commented on differing impacts for patients and other colleagues. Collective themes of Clinician, Supervision Practices, Workplace, and Student are presented in a model of potential influences on the experience of student impact. SP clinicians perceived that experience of student impact is varied and complex. Influences are likely to be multi-factorial and further research is needed in a range of contexts to guide clinicians, managers and universities in supporting SP student clinical placements.
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Owoyemi, Praise, Sarah Salcone, Christopher King, Heejung Julie Kim, Kerry James Ressler, and Ipsit Vihang Vahia. "Measuring and Quantifying Collateral Information in Psychiatry: Development and Preliminary Validation of the McLean Collateral Information and Clinical Actionability Scale." JMIR Mental Health 8, no. 4 (April 14, 2021): e25050. http://dx.doi.org/10.2196/25050.
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Background The review of collateral information is an essential component of patient care. Although this is standard practice, minimal research has been done to quantify collateral information collection and to understand how collateral information translates to clinical decision making. To address this, we developed and piloted a novel measure (the McLean Collateral Information and Clinical Actionability Scale [M-CICAS]) to evaluate the types and number of collateral sources viewed and the resulting actions made in a psychiatric setting. Objective This study aims to test the feasibility of the M-CICAS, validate this measure against clinician notes via medical records, and evaluate whether reviewing a higher volume of collateral sources is associated with more clinical actions taken. Methods For the M-CICAS, we developed a three-part instrument, focusing on measuring collateral sources reviewed, clinical actions taken, and shared decision making between the clinician and patient. To determine feasibility and preliminary validity, we piloted this measure among clinicians providing psychotherapy at McLean Hospital. These clinicians (n=7) completed the M-CICAS after individual clinical sessions with 89 distinct patient encounters. Scales were completed by clinicians only once for each patient during routine follow-up visits. After clinicians completed these scales, researchers conducted chart reviews by completing the M-CICAS using only the clinician’s corresponding note from that session. For the analyses, we generated summary scores for the number of collateral sources and clinical actions for each encounter. We examined Pearson correlation coefficients to assess interrater reliability between clinicians and chart reviewers, and simple univariate regression modeling followed by multilevel mixed effects regression modeling to test the relationship between collateral information accessed and clinical actions taken. Results The study staff had high interrater reliability on the M-CICAS for the sources reviewed (r=0.98; P<.001) and actions taken (r=0.97; P<.001). Clinician and study staff ratings were moderately correlated and statistically significant on the M-CICAS summary scores for the sources viewed (r=0.24, P=.02 and r=0.25, P=.02, respectively). Univariate regression modeling with a two-tailed test demonstrated a significant association between collateral sources and clinical actions taken when clinicians completed the M-CICAS (β=.27; t87=2.47; P=.02). The multilevel fixed slopes random intercepts model confirmed a significant association even when accounting for clinician differences (β=.23; t57=2.13; P=.04). Conclusions This pilot study established the feasibility and preliminary validity of the M-CICAS in assessing collateral sources and clinical decision making in psychiatry. This study also indicated that reviewing more collateral sources may lead to an increased number of clinical actions following a session.
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Lordon, Ross J., Sean P. Mikles, Laura Kneale, Heather L. Evans, Sean A. Munson, Uba Backonja, and William B. Lober. "How patient-generated health data and patient-reported outcomes affect patient–clinician relationships: A systematic review." Health Informatics Journal 26, no. 4 (June 20, 2020): 2689–706. http://dx.doi.org/10.1177/1460458220928184.
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Introduction: Many patients use mobile devices to track health conditions by recording patient-generated health data. However, patients and clinicians may disagree how to use these data. Objective: To systematically review the literature to identify how patient-generated health data and patient-reported outcomes collected outside of clinical settings can affect patient–clinician relationships within surgery and primary care. Methods: Six research databases were queried for publications documenting the effect of patient-generated health data or patient-reported outcomes on patient–clinician relationships. We conducted thematic synthesis of the results of the included publications. Results: Thirteen of the 3204 identified publications were included for synthesis. Three main themes were identified: patient-generated health data supported patient–clinician communication and health awareness, patients desired for their clinicians to be involved with their patient-generated health data, which clinicians had difficulty accommodating, and patient-generated health data platform features may support or hinder patient–clinician collaboration. Conclusion: Patient-generated health data and patient-reported outcomes may improve patient health awareness and communication with clinicians but may negatively affect patient–clinician relationships.
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Miller, Hope, Alexa Christ, Ewa Grajkowska, Alvina Acquaye, Kendra Adegbesan, Lisa Boris, Eric Burton, et al. "NCOG-40. UTILITY OF THE SEIZURE CONTROL COMPOSITE INDEX (RANO-SCCI) IN EVALUATING SEIZURES IN CNS TUMOR PATIENTS." Neuro-Oncology 24, Supplement_7 (November 1, 2022): vii206. http://dx.doi.org/10.1093/neuonc/noac209.791.
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Abstract BACKGROUND Seizures are a common symptom in patients with CNS tumors. The RANO-Seizure Control Composite Index (RANO-SCCI) was developed to monitor seizures over time by patients and clinicians. We describe the use of the RANO-SCCI as part of the NCI NOB-Natural History Study. METHODS Patients completed a RANO-SCCI prior to their clinic appointment with results shared with clinicians who then completed a RANO-SCCI as part of the same appointment. Seizure reports were tallied by respondent type and further by tumor type and grade. Concordance between patient and clinician report was also investigated. RESULTS One hundred fifty-seven patients underwent 250 clinical evaluations. Participants were primarily white (82%) males (57%) with median age 47 years (range: 19 – 78). Most had high grade (60%) primary brain (86%) tumors, were in surveillance (76%), with no prior recurrence (57%) and KPS ≥ 90 (76%). Half of patients and 62% of clinicians reported the patient ever having a seizure. The 12% discordance were all where the patient did not report a seizure, but clinicians did. There was good agreement on seizure reporting since last visit (74% patients, 78% clinicians), and anti-seizure medication use (51% patients, 57% clinicians). Seizures were reported more frequently in patients with high-grade tumors (WHO Grade 3 or 4) (60% patients, 76% clinicians) versus low-grade (WHO Grade 1 or 2) (51% patients, 59% clinicians), and among patients with oligodendrogliomas (71% patients, 85% clinicians) versus non-oligodendroglioma tumors (54% patients, 68% clinicians). CONCLUSIONS The RANO-SCCI was used for self-report and clinician report of seizure activity. A higher frequency was reported among oligodendroglioma and high-grade tumors. Disparities between patient and clinician responses may reveal a limitation in the patient’s ability to recognize and assess their seizure symptoms. Further work will investigate reporting congruence and associations with clinical and demographic characteristics.
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Razouki, Zayd, Bushra A. Khokhar, Lindsey M. Philpot, and Jon O. Ebbert. "Attributes, Attitudes, and Practices of Clinicians Concerned with Opioid Prescribing." Pain Medicine 20, no. 10 (November 7, 2018): 1934–41. http://dx.doi.org/10.1093/pm/pny204.
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Abstract Background Many clinicians who prescribe opioids for chronic noncancer pain (CNCP) express concerns about opioid misuse, addiction, and physiological dependence. We evaluated the association between the degree of clinician concerns (highly vs less concerned), clinician attributes, other attitudes and beliefs, and opioid prescribing practices. Methods A web-based survey of clinicians at a multispecialty medical practice. Results Compared with less concerned clinicians, clinicians highly concerned with opioid misuse, addiction, and physiological dependence were more confident prescribing opioids (risk ratio [RR] = 1.34, 95% confidence interval [CI] = 1.08–1.67) but were more reluctant to do so (RR = 1.13, 95% CI = 1.03–1.25). They were more likely to report screening patients for substance use disorder (RR = 1.18, 95% CI = 1.01–1.37) and to discontinue prescribing opioids to a patient due to aberrant opioid use behaviors (RR = 1.30, 95% CI = 1.13–1.50). They were also less likely to prescribe benzodiazepines and opioids concurrently (RR = 0.40, 95% CI = 0.25–0.65). Highly concerned clinicians were more likely to work in clinics which engage in “best practices” for opioid prescribing requiring urine drug screening (RR = 4.65, 95% CI = 2.51–8.61), prescription monitoring program review (RR = 2.90, 95% CI = 1.84–4.56), controlled substance agreements (RR = 4.88, 95% CI = 2.64–9.03), and other practices. Controlling for clinician concern, prescribing practices were also associated with clinician confidence, reluctance, and satisfaction. Conclusions Highly concerned clinicians are more confident but more reluctant to prescribe opioids. Controlling for clinician concern, confidence in care and reluctance to prescribe opioids were associated with more conservative prescribing practices.
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Huber, Jacqueline, and David Burke. "Psychogeriatric SOS: A unique clinician-to-clinician web-based service for rural and remote clinicians." International Journal of Integrated Care 16, no. 5 (November 9, 2016): 22. http://dx.doi.org/10.5334/ijic.2571.
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Alawi, Faizan. "Hidden clinicians." Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 132, no. 2 (August 2021): 123. http://dx.doi.org/10.1016/j.oooo.2021.04.055.
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Hoens, Alison M., and Joseph S. Anthony. "Clinicians' Commentary." Physiotherapy Canada 59, no. 2 (April 2007): 129–31. http://dx.doi.org/10.3138/ptc.59.2.129.
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Chesworth, Bert M. "Clinicians' Commentary." Physiotherapy Canada 61, no. 4 (October 2009): 195–96. http://dx.doi.org/10.3138/physio.61.4.195.
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Williams, Jack I., and Aileen M. Davis. "Clinicians' Commentary." Physiotherapy Canada 61, no. 4 (October 2009): 231–33. http://dx.doi.org/10.3138/physio.61.4.231.
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Geddes, Lynne E. "Clinicians' Commentary." Physiotherapy Canada 61, no. 4 (October 2009): 259–60. http://dx.doi.org/10.3138/physio.61.4.259.
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Anderson, Cathy M., and Judy King. "Clinicians' Commentary." Physiotherapy Canada 62, no. 4 (October 2010): 355–57. http://dx.doi.org/10.3138/physio.62.4.355.
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VanGeest, Jonathan B., and Timothy P. Johnson. "Surveying Clinicians." Evaluation & the Health Professions 36, no. 3 (August 23, 2013): 275–78. http://dx.doi.org/10.1177/0163278713498006.
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SINCLAIR, J. D. "Clinicians wanted." Nature 347, no. 6289 (September 1990): 116. http://dx.doi.org/10.1038/347116d0.
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Graber, David R., and Maralynne D. Mitcham. "Compassionate Clinicians." Holistic Nursing Practice 18, no. 2 (March 2004): 87–94. http://dx.doi.org/10.1097/00004650-200403000-00006.
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Endacott, Ruth, Anita Wood, Fiona Judd, Carol Hulbert, Ben Thomas, and Margaret Grigg. "Impact and Management of Dual Relationships in Metropolitan, Regional and Rural Mental Health Practice." Australian & New Zealand Journal of Psychiatry 40, no. 11-12 (November 2006): 987–94. http://dx.doi.org/10.1080/j.1440-1614.2006.01922.x.
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Objective: To explore the extent and impact of professional boundary crossings in metropolitan, regional and rural mental health practice in Victoria and identify strategies mental health clinicians use to manage dual relationships. Method: Nine geographically located focus groups consisting of mental health clinicians: four focus groups in rural settings; three in a regional city and two in a metropolitan mental health service. A total of 52 participants were interviewed. Results: Data revealed that professional boundaries were frequently breached in regional and rural settings and on occasions these breaches had a significantly negative impact. Factors influencing the impact were: longevity of the clinician's relationship with the community, expectations of the community, exposure to community ‘gossip’ and size of the community. Participants reported greater stress when the boundary crossing affected their partner and/or children. Clinicians used a range of proactive and reactive strategies, such as private telephone number, avoidance of social community activities, when faced with a potential boundary crossing. The feasibility of reactive strategies depended on the service configuration: availability of an alternative case manager, requirement for either patient or clinician to travel. The greater challenges faced by rural and regional clinicians were validated by metropolitan participants with rural experience and rural participants with metropolitan experience. Conclusions: No single strategy is used or appropriate for managing dual relationships in rural settings. Employers and professional bodies should provide clearer guidance for clinicians both in the management of dual relationships and the distinction between boundary crossings and boundary violation. Clinicians are clearly seeking to represent and protect the patients' interests; consideration should be given by consumer groups to steps that can be taken by patients to reciprocate.
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Chitty, John R. "Introduction: Avian/Exotic Medicine by Clinicians for Clinicians." Journal of Exotic Pet Medicine 20, no. 2 (April 2011): 84–85. http://dx.doi.org/10.1053/j.jepm.2011.02.002.
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Solomon-Rice, Patti, and Nancy Robinson. "Clinical Supervision and the Use of a Three-Tiered Hierarchical Approach to Evaluate Student Clinician Performance." Perspectives on Administration and Supervision 25, no. 1 (June 2015): 31–41. http://dx.doi.org/10.1044/aas25.1.31.
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Effective university clinical supervision requires the clinical instructor to modify supervisory style based on the student clinician's skill level, experience, and learning style. In addition, clinical education programs provide clinical instructors with an evaluation tool to assess the supervisee's clinical performance. This article reviews the supervisory process and models for modifying supervisory styles and describes various evaluation tools that can be used to evaluate clinical skills. A clinical evaluation tool is then introduced that emphasizes clinical proficiency rather than type of clinical supervision. The tool incorporates hierarchical expectations when evaluating student clinician practicum knowledge and skills across three levels of student clinicians: beginning, intermediate, and advanced. Information is provided about the content of the three-tiered hierarchical evaluation tool and the process used to assess clinical performance. Qualitative feedback from surveys completed by clinical instructors and student clinicians about the tool is reviewed.
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Nandra, Sukbir, Nicola Crawford, Daniel Burford, Nikolaos Pandis, Martyn T. Cobourne, and Jadbinder Seehra. "An investigation into the reliability of a mobile app designed to assess orthodontic treatment need and severity." British Dental Journal 232, no. 10 (May 27, 2022): 721–26. http://dx.doi.org/10.1038/s41415-022-4246-2.
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AbstractAim To investigate reliability of the Easy IOTN app between clinicians with different levels of experience in determining Index of Orthodontic Treatment Need (IOTN) Dental Health Component (DHC) and Aesthetic Component (AC) scores from study models. The accuracy of each clinician in discriminating treatment need using the app against the 'gold standard' conventional assessment at the threshold of treatment acceptance criteria was also explored.Materials and methods In total, 150 sets of pre-treatment study models were assessed by six clinicians using the app on two separate occasions (T1 and T2). A single IOTN-calibrated clinician also scored the models using the conventional technique. Clinician scores for both intra- and inter-rater reliability were assessed using Cohen's Kappa. The performance of each clinician in discriminating treatment need using the app against the conventional assessment method at the threshold of treatment acceptance criteria was also assessed using the area under the curve-receiver operating characteristic.Results The intra-rater agreement for the clinician undertaking the conventional assessment of the models was 1.0. Intra-rater agreement scores for clinicians using the Easy IOTN app ranged between 0.37-0.87 (DHC) and 0.22-0.44 (AC). Inter-rater agreement scores at T2 were 0.59 (DHC) and 0.23 (AC). Based on the IOTN DHC, all clinicians displayed an excellent level of accuracy in determining malocclusions qualifying for treatment (range 81.7-90.0%). Based on the IOTN AC, all clinicians showed an acceptable level of accuracy in determining malocclusions qualifying for treatment (range 71.9-79.2%).Conclusions The Easy IOTN app was shown to have moderate inter-rater reliability. Variation in the intra-rater reliability was evident between clinicians of different grades/level of experience. Importantly, the diagnostic accuracy of the app to discriminate between malocclusions that qualify for NHS treatment was rated as excellent (IOTN DHC) and acceptable (IOTN AC) and independent of clinician grade or level of experience.