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Insight and Judgement

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121. Review of the New Strategic Direction for Alcohol and Drugs – Phase 2

of the review. This component of the review sought to understand the factors influencing the delivery of actions set out in NSD-2. Research approach ? A mixed methods approach was used which focused on process evaluation. Three research tools were employed - an online questionnaire, semi- structured interviews and focus groups. ? The research tools gathered data based on six evaluation criteria. Participants also shared insights on the drug and alcohol landscape, achievements and lost opportunities (...) insights within the evaluation criteria. ? A diverse group of stakeholders with both strategic and operational roles in the delivery of NSD-2 was engaged. ? Nine interviews and four focus groups were conducted, while questionnaires were issued to 77 contacts held on the Department of Health NSD-2 stakeholder list. ? 43 valid responses to the online questionnaire were returned. 165,394 words of free text were returned across the three research tools. Perspectives on trends in the alcohol and drug

2019 Institute of Public Health in Ireland

124. The Collaborative Assessment, OTCA12, on “C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescribing in primary care settings for acute respiratory tract infections (RTIs)

studies investigated the diagnostic accuracy of CRP in combination with signs and symptoms for determining pneumonia in patients presenting with LRTIs. One study found the addition of CRP at a cut-point of 20 mg/L resulted in increased speci- ficity, but reduced sensitivity compared with clinical judgement alone, suggesting it would have limited use in primary care unless the GP was trying to rule in a diagnosis of pneumonia [8]. Four other studies used CRP in combination with a signs and symptoms (...) of the general population. The results of this systematic review do provide important insights into the performance of CRP as a test to help identify patients who will benefit from antibiotic treatment and to aid decision- making for a number of conditions. The evidence in relation to the diagnostic test accuracy of CRP in URTI is inconclusive. Limited evi- dence was found for the use of CRP testing in patients presenting with symptoms of acute sinusitis. Given this, and that current clinical guidelines do

2019 EUnetHTA

125. The economic evaluation of early intervention with Anti-Tumor Necrosis Factor-alpha treatments in pediatric Crohn's disease

-Ellen Hogan, Mr. Austin Nam, Dr. Petros Pechlivanoglou, Dr. Peter Austin, Dr. Jan Barnsley and Dr. Eleanor Pullenayegum for their help and suggestions in tackling this project. Thanks also to Dr. David Naimark, Dr. Lusine Abrahamyan, Dr. Beate Sander, Dr. Walter Wodchis, Dr. Wanrudee Isaranuwatchai, Dr. Murray Krahn, Dr. Myla Moretti, and Ms. Kate Tsiplova for their insight. List of Abbreviations 5-ASA 5-aminosalicylic acid 6-MP 6-mercaptopurine ADA Adalimumab AZA Azathioprine CAD Canadian dollar (...) missing data did not inhibit a health state to be assessed, it was ignored. Where missing data required making assumptions such as in the assignment of peri-rectal scores for calculating the wPCDAI, a scoring scheme was devised to show how judgements were made when scoring was assigned. Where missing data was absent in the RISK-PROKIIDS data such as treatment dose information, clinical practice guidelines were used. A situation where surrogates for missing data could not be used, was if missing values

2019 SickKids Reports

126. Pentosan polysulfate sodium (Elmiron) - bladder pain syndrome characterised by either glomerulations or Hunner’s lesions

, Herschorn S, Whitmore KE, Forrest JB, Hu P, Friedman AJ, et al. Pentosan polysulfate sodium for treatment of interstitial cystitis/bladder pain syndrome: Insights from a randomized, double-blind, placebo controlled study. Journal of Urology. 2015;193(3):857-62. 9. Nickel JC, Egerdie RB, Steinhoff G, Palmer B, Hanno P. A Multicenter, Randomized, Double- blind, Parallel Group Pilot Evaluation of the Efficacy and Safety of Intravesical Sodium Chondroitin Sulfate Versus Vehicle Control in Patients (...) in the exercise of their clinical judgement in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

2019 Scottish Medicines Consortium

128. Implementing routine outcome monitoring in specialist perinatal mental health services

Health Services (SPMHS) work through key elements of implementation. Sally Marriott, Michelle Sleed, Kate Dalzell CORC is the UK's leading membership organisation that collects and uses evidence to enable more effective child-centred support, services and systems to improve children and young people's mental health and wellbeing. CORC has over 15 years' experience in bringing together theoretical knowledge on outcome measurement and relating this to the insights and expertise developed (...) and important for each service to have a consistent plan for how and when measures should be used in routine practice, sound clinical judgement should always be used in the implementation of ROMs. The needs of each individual service user should always take precedence over the need to implement measures at specific times and in specific ways. 082 Fig. 2 Seven elements of implementation #1 Leadership, vision & culture #2 Embedding measures as part of the everyday #3 Building staff confidence and capability

2019 NHS England

129. Sepsis Management

Sepsis Management Sepsis Management National Clinical Guideline No. 6 November 2014National Clinical Guideline No. 6 ISSN 2009-6259 Published November 2014 Supplementary methodological information added (page 57) February 2015 Disclaimer The Guideline Development Group’s expectation is that healthcare staff will use clinical judgement, medical, nursing and midwifery knowledge in applying the general principles and recommendations contained in this document. Recommendations may (...) not be appropriate in all circumstances and the decision to adopt specific recommendations should be made by the practitioner taking into account the individual circumstances presented by each patient/resident and available resources. The National Clinical Guideline recommendations do not replace or remove clinical judgement or the professional care and duty necessary for each specific patient case. Therapeutic options should be discussed with a clinical microbiologist or infectious disease physician on a case

2019 National Clinical Guidelines (Ireland)

130. BTS/SIGN British Guideline on the Management of Asthma

are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge and technology advance and patterns of care evolve. Adherence to guideline recommendations will not ensure a successful outcome in every case, nor should they be construed as including all proper methods of care or excluding other acceptable methods of care aimed at the same results. The ultimate judgement must be made by the appropriate healthcare professional(s) responsible (...) for clinical decisions regarding a particular clinical procedure or treatment plan. This judgement should only be arrived at through a process of shared decision making with the patient, covering the diagnostic and treatment choices available. It is advised, however, that significant departures from the national guideline or any local guidelines derived from it should be fully documented in the patient’s medical records at the time the relevant decision is taken. 1.3.1 Influence of financial and other

2019 British Thoracic Society

131. Management of Irritable Bowel Syndrome (IBS)

-abstract/doi/10.1093/jcag/gwy071/5290372 by guest on 22 January 2019Therefore, the consensus group concluded that routine colo - noscopy is generally not warranted in IBS patients <50 years of age, and alarm symptoms do not appear to increase the risk of CRC sufficiently to warrant routine colonoscopy. However, clinical judgement is important, and colonoscopy and flexible sigmoidoscopy would continue to play a role to investigate specific indications such as a high clinical suspicion of IBD

2019 Canadian Association of Gastroenterology

132. ACC/AHA/SCAI/SIR/SVM 2018 Appropriate Use Criteria for Peripheral Artery Intervention: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Heart Association, Society for Cardiovascular Angiography and Interventions

to thank the writing group for their dedication to the drafting and editing of numerous versionsofthismanuscript,whichresultedinanessential list of clinical scenarios, and to the rating panel for scoring the scenarios numerous times and offering sage input in this process. A special tribute is extended to rating panelist Dr. Alan Hirsch, whose untimely passing created avoidintheperipheralvascularcommunity.Iam also grateful to the parent AUC Task Force, which provided signi?cant guidance and insights (...) insights, might have a natural tendency to rate the indications within their specialty at a higher degree of appropriate- ness than nonprocedural raters. For the scoring, care was takentoprovidetheratingpanelwithobjective,unbiased information, including guidelines and key references in the ?eld (see Guideline Mapping and References). In scoring the clinical scenarios, the rating panel was asked to assess whether the use of a speci?cintervention for each clinical indication should be categorized

2019 Society of Interventional Radiology

133. Cardiovascular Risk Reduction in Patients with Type 2 Diabetes and Atherosclerotic Cardiovascular Disease

and discuss the real-world challenges faced in working toward comanaging T2D and CV disease for improved patient outcomes. Each of the 3 sessions consisted of 3 presentations, followed by individual table discussions. The interactive discussions were facilitated by questions developed by the planning committee with the goal of obtaining deep and broad insights into speci?cissuesineachofthetopic areas, along with recommendations for solutions, to inform the development of practical guidance, support (...) . -,NO. -,2018 CV Risk Reduction in T2D Pathway -,2018:-–- 46. This Expert Consensus Decision Pathway is not inten- ded to supersede good clinical judgement. The treating clinician should seek input as needed from relevant experts (e.g., pharmacists, cardiologists, endocrinologists). 7. This Expert Consensus Decision Pathway is based on the best data currently available. New information is being generated rapidly (e.g., cardiovascular out- comes trials of additional agents), and as these data become

2019 American College of Cardiology

136. Supporting Adults Who Anticipate or Live with an Ostomy

, and policy across a range of health service organizations, practice areas, and sectors. These experts shared their insights on supporting and caring for adults who anticipate or live with an ostomy across the continuum of care (e.g., acute care, rehabilitation, community, and primary care). A systematic and comprehensive analysis was completed by the RNAO Best Practice Guideline Development and Research Team and the RNAO expert panel to determine the scope of this BPG and to prioritize recommendation

2019 Registered Nurses' Association of Ontario

140. Concise practice guidance on the prevention and management of accidental awareness during general anaesthesia

At the meeting stage it is important for the patient and the anaesthetist involved that a potential diagnosis of AAGA is verified or excluded. NAP5 provides a methodology for assessing reported cases. This methodology includes assessing the patient report to help locate any experience to a phase of anaesthesia. For example, a judgement should be made on whether the account is plausible, given what actually occurred during the anaesthesia and surgery. AAGA can occur at induction (the majority of cases (...) . Conceptual and technical insights into the basis of neuromuscular monitoring. Anaesthesia 2017; 72 (Suppl. 1): 16–37. 34. Aranake A, Mashour GA, Avidan MS. Minimum alveolar concentration: ongoing relevance and clinical utility. Anaesthesia 2013; 68: 512–22. 35. Avidan MS, Jacobsohn E, Glick D, et al. BAG-RECALL Research Group. Prevention of intraoperative awareness in a high-risk surgical population. New England Journal of Medicine 2011; 365: 591–600. 36. Popat MT, Mitchell V, Dravid R, Patel

2019 Association of Anaesthetists of GB and Ireland

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