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Insight and Judgement

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143. Principles for effective social regeneration

the ‘solution space’; or the range of activities, innovations, resources and perspectives brought to the pursuit of positive outcomes. Organisations such as Sistema Scotland offer unique contributions and fresh insights as to the types of community-based approaches required to address inequalities and transform lives. Sistema Scotland is a charity “on a mission to transform lives through music” 2 . Through its Big Noise programme Sistema Scotland believes that children from disadvantaged backgrounds can (...) to promote programme engagement for a few especially vulnerable or socially excluded participants detract resources or compromise ‘normal’ provision for the many? Difficult decisions and judgements may need to be made. Based on learning from Sistema Scotland, what is certain is that innovation and flexibility demand a lot from the programme staf f. This often means asking team members ‘to go above and beyond’ and to perhaps change their work patterns, for example, at short notice. Social interventions

2017 Glasgow Centre for Population Health

144. Asset-based approaches in service settings: striking a balance

, who opened their services and day jobs to us, and who shared their learning, insights, opinions and experiences. Thanks also to the staff of the GCPH for their continued support and encouragement, and to Sara Dodds, Lisa Garnham, Lorna Kelly, Lisa Pattoni and Carol Tannahill for helpful comments and feedback on drafts of this report. We continue to be inspired by people working with sensitivity, compassion and the importance of building relationships at the centre of all they do. Photographs (...) and commentary on asset-based working within health and care services, ‘Towards asset-based health and care services’ 20 . The insights and learning from the Animating Assets c programme are also worthy of note. Through a process of engagement, facilitation, co-creation and learning over an 18-month period, Animating Assets aimed to support the development of asset-based approaches to a range of health and social wellbeing issues, as identified by local communities and partnerships in Scotland 24

2017 Glasgow Centre for Population Health

145. Towards tailoring of KCE guidelines to end-users' needs

literature reviews. However, there is a lack of evidence on which would be the crucial components or optimal combination of strategies that would most likely improve adherence to guidelines. Based on insights from literature and interviews, the KCE report recommended a unique platform for the comprehensive dissemination of clinical practice guideline in Belgium including clear messages, various formats and a label for high-quality guidelines. 2.2.3 Uptake The CPG uptake refers to the adoption

2017 Belgian Health Care Knowledge Centre

146. Acute coronary syndrome

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

2016 SIGN

147. Assessment, diagnosis and interventions for autism spectrum disorders

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

2016 SIGN

148. Quantitative study - other: Parent?infant room-sharing is complex and important for breastfeeding

Sullivan Statistics from Altmetric.com Commentary on: Paul IM, Hohman EE, Loken E, et al . Motherinfant room-sharing and sleep outcomes in the INSIGHT study. Pediatrics 2017;140:e20170122. Implications for practice and research Solitary infant sleep and early consolidation of infant sleep are not biologically appropriate. In practice, judgement around infant sleep may create stigma and limit productive patient-provider engagement, a trademark of family-centred care. Effective communication of risk

2018 Evidence-Based Nursing

149. Antidepressants do not help treat depression in people living with dementia

to antidepressant efficacy. We split one study which included two different antidepressants and therefore had nine groups of patients treated with antidepressants compared with nine groups receiving placebo treatment. Information needed to make 'Risk of bias' judgements was often missing.We found high-quality evidence of little or no difference in scores on depression symptom rating scales between the antidepressant and placebo treated groups after 6 to 13 weeks (standardised mean difference (SMD) -0.10, 95 (...) illnesses. Claudia Cooper, Professor of Psychiatry of Older Age, UCL The commentator declares no conflicting interests Related Signals Published 5 March 2019 Published 20 March 2018 Published 27 September 2016 Categories Tools Preview Based on NHS Choices Close Useful Links Related Sites Follow Us Get NIHR Signals by email Stay up to date with the latest health research through our monthly bulletin of new NIHR Signals. | | Powered by Insight Explorer / HaystackLabs © 2015. All Rights Reserved. Please

2019 NIHR Dissemination Centre

150. Psychiatric reports: preparation and use in cases involving asylum, removal from the UK or immigration detention

should be aware that instructing solicitors are unlikely to have any clinical training and that their experience of working with trauma- tised persons will be varied. Instructions are often based on a template and can suggest more insight than is actually the case (e.g. references to suicidal ideation where no clinical indication is present). Psychiatrists should be cautious in assuming that instructions are necessarily drafted in such a way as to direct their enquiries appropriately. They should (...) to be rephrased. This is to be encouraged. The psychiatrist should bear in mind that an interpret- er’s insights are not verifiable, factual information. Breaking speech down into sections is helpful as it minimises the chance of the interpreter forget- ting something that has been said by either of the other parties. For this reason, the psychiatrist should take particular care to avoid asking multiple questions at once. It is almost always inappropriate to use a friend or relative of the applicant

2016 Royal College of Psychiatrists

151. Anabolic Therapies for Osteoporosis in Postmenopausal Women: Effectiveness and Value

. Romosozumab also appears to have anti-resorptive effects. It is given by subcutaneous injection once monthly and requires refrigeration. It has not yet been approved by the FDA, and a decision in 2017 is no longer anticipated while the FDA reviews data from the ARCH trial that includes an unexpected safety signal regarding serious cardiovascular adverse events. 4 Insights Gained from Discussions with Patients and Patient Groups In the NOF’s Bone Health Index Survey in 2016, patients ranked loss

2017 California Technology Assessment Forum

153. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder

). The recommendations made by the APA PTSD Guideline Development Panel (GDP) were developed after careful review of the evidence. The GDP endorses the following statement from the British National Institute for Health and Care Excellence (NICE, 2016) “When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this guideline is not mandatory (...) -informed 4 approach and attending to the role of socio-economic, cultural or other diversity or contextual issues. These may facilitate whether patients find therapist actions and recommendations intelligible, useful, and worthwhile. They may also have a direct impact on the treatment application. Finally, while monitoring PTSD symptoms during treatment can provide insight into progress and treatment targets and guidance when adjusting treatment seems necessary, it is unclear as of yet whether

2017 American Psychological Association

154. Two common operations to fix a broken tibia have similar outcomes

. The findings suggest that surgeons should continue using their judgement to decide which surgical approach is best, in discussion with the patient. Share your views on the research. Why was this study needed? Fractures of the tibia near the ankle can be difficult to treat because the bone lies so close to the skin. Surgery aims to realign the ends of the broken bone and then to hold them securely in place while they heal. There is uncertainty whether fixing a rod inside the bone using nails is better (...) , Clinical Senior Lecturer and Consultant Orthopaedic Surgeon, Imperial College London Related Signals Published 7 August 2018 Published 3 July 2018 Published 7 November 2017 Categories Tools Preview Based on NHS Choices Close Useful Links Related Sites Follow Us Get NIHR Signals by email Stay up to date with the latest health research through our monthly bulletin of new NIHR Signals. | | Powered by Insight Explorer / HaystackLabs © 2015. All Rights Reserved. Please enable JavaScript to view the

2019 NIHR Dissemination Centre

155. Hypertonic saline as effective as normal saline for trauma patients

, favouring this type of fluid. What does current guidance say on this issue? The NICE technology appraisal guidance on pre-hospital initiation of fluid replacement therapy in trauma recommends initiating fluid replacement in the ambulance en route to hospital in patients without a palpable pulse and when clinical judgement in the presence of severely reduced blood volume deems it necessary. It recommends using normal saline (isotonic fluids). The guidance recommends assessing further different protocols (...) a palpable pulse and when clinical judgement in the presence of severely reduced blood volume deems it necessary. It recommends using normal saline (isotonic fluids). The guidance recommends assessing further different protocols for pre-hospital care of trauma patients. What are the implications? Hypertonic solutions seem to produce similar clinical outcomes in hypotensive trauma patients compared with isotonic solutions. These results are in line with previous findings. Hypertonic solutions are given

2019 NIHR Dissemination Centre

156. Checklists are no substitute for experience in spotting patients who are deteriorating

. The availability of standardised protocols empowered experienced nurses to call rapid response teams and to organise the most relevant information when asking for help. Nurses with education and experience of critical care had greater confidence in decision-making and were more likely to refer patients. Experienced nurses tended to use track and trigger protocols flexibly in combination with clinical judgement. Delayed referrals are sometimes caused by nurse uncertainty, especially when their clinical judgment (...) teams and to organise the most relevant information when asking for help. Nurses with education and experience of critical care had greater confidence in decision-making and were more likely to refer patients. Experienced nurses tended to use track and trigger protocols flexibly in combination with clinical judgement. Delayed referrals are sometimes caused by nurse uncertainty, especially when their clinical judgment that a patient is deteriorating is not corroborated by the track and trigger system

2019 NIHR Dissemination Centre

157. Nurses lack confidence in escalating or identifying children at risk of abuse and neglect

and knowledge to report issues. Nurses of any kind can encounter children suspected to be at risk of abuse, from emergency nurses to practice nurses, as well as those working directly with children (such as health visitors). To overcome the barriers, educational programmes for nurses could be better tailored, recognising the complexity of clinical judgement, knowledge and workplace relationships with regards to safeguarding. Citation and Funding Lines L E, Hutton A, Grant J. . Journal of Advanced Nursing (...) to safeguarding children and generally ‘training’ appeared not to be enough to provide sufficient confidence and knowledge to report issues. Nurses of any kind can encounter children suspected to be at risk of abuse, from emergency nurses to practice nurses, as well as those working directly with children (such as health visitors). To overcome the barriers, educational programmes for nurses could be better tailored, recognising the complexity of clinical judgement, knowledge and workplace relationships

2019 NIHR Dissemination Centre

158. Extended hours in primary care linked to reductions in minor A&E attendances

an informed judgement on the best approach to take locally to extend access. It is likely that an extended hour’s scheme will need to be part of a broader system-wide approach to managing hospital pressures. Citation and Funding Whittaker W, Anselmi L, Rud Kristensen S, et al. . PLoS Med. 2016;13(9):e1002113. The study was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester and by NHS England (Greater (...) that extended hours in primary care can reduce visits to emergency departments for minor problems. However, costs may be higher and health outcomes were not assessed. The variations across the communities in this study also demonstrate the potential impact of local constraints, notably capacity within primary care. Commissioners and providers will need comprehensive data on costs and health outcomes to make an informed judgement on the best approach to take locally to extend access. It is likely

2019 NIHR Dissemination Centre

159. One group of drugs used to treat Crohn’s disease is unlikely to prevent relapse

and using a random-effects model. We evaluated the overall quality of the evidence supporting the outcomes using the GRADE criteria. MAIN RESULTS: Twelve studies (2146 participants) that compared 5-ASA to placebo were included. We did not identify any studies that compared sulphasalazine to placebo. Seven studies were judged to be at low risk of bias. The other studies were judged to have an unclear risk of bias for various items due to insufficient details to allow for a judgement (...) , Consultant Gastroenterologist, Joint Clinical Director, Gastrointestinal Medicine and Surgery, Guy's & St Thomas' Hospitals NHS Foundation Trust Categories Tools Preview Based on NHS Choices Close Useful Links Related Sites Follow Us Get NIHR Signals by email Stay up to date with the latest health research through our monthly bulletin of new NIHR Signals. | | Powered by Insight Explorer / HaystackLabs © 2015. All Rights Reserved. Please enable JavaScript to view the

2019 NIHR Dissemination Centre

160. Ultrasound could help diagnose giant cell arteritis

% to 88%). If we scanned all suspected patients and performed biopsies only on negative cases, sensitivity increased to 65% and specificity was maintained at 81%, reducing the need for biopsies by 43%. Strategies combining clinical judgement (clinician’s assessment at 2 weeks) with the tests showed sensitivity and specificity of 91% and 81%, respectively, for biopsy and 93% and 77%, respectively, for ultrasound; cost-effectiveness (incremental net monetary benefit) was £485 per patient in favour (...) nine". Dr Sarah Mackie, Associate Clinical Professor and Honorary Consultant Rheumatologist, University of Leeds Categories Tools Preview Based on NHS Choices Close Useful Links Related Sites Follow Us Get NIHR Signals by email Stay up to date with the latest health research through our monthly bulletin of new NIHR Signals. | | Powered by Insight Explorer / HaystackLabs © 2015. All Rights Reserved. Please enable JavaScript to view the

2019 NIHR Dissemination Centre

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