scholarly journals A realist review of brief interventions for alcohol misuse delivered in emergency departments

2021 ◽  
Author(s):  
Caitlin J Davey ◽  
Meredith SH Landy ◽  
Amanda Pecora ◽  
David Quintero ◽  
Kelly E McShane
Keyword(s):  
Alcohol Use ◽  
Emergency Departments ◽  
Clinical Decision Making ◽  
Alcohol Misuse ◽  
Realist Review ◽  
Clinical Decision ◽  
Brief Interventions ◽  
Future Research ◽  
Healthcare Settings ◽  
Favorable Conditions

Background: Brief interventions (BIs) involve screening for alcohol misuse and providing feedback to patients about their use, with the aim of reducing alcohol consumption and related consequences. BIs have been implemented in various healthcare settings, including emergency departments (ED), where they have been found to contribute mixed results in their ability to address alcohol misuse among adults. Mechanisms through which BIs work and contextual factors impacting BI effectiveness are not clear. The purpose of this review was to understand how, for whom, and under what circumstances BIs work for adults misusing alcohol and who have been admitted to an ED. A realist review was chosen to answer these questions as realist reviews create context-mechanism-outcome configurations, leading to the development of comprehensive and detailed theories; in this case explaining how and for whom BIs work. Methods: Databases including PsycINFO, Healthstar, CINAHL, Medline, and Nursing and Allied Health were searched for articles published until December 2013. The search strategy focused on studies examining BIs that targeted alcohol misuse among adults admitted into the ED. The search identified 145 relevant abstracts, of which 36 were included in the review. The literature was synthesized qualitatively (immersion/crystallization). Results: Four mechanisms were found within reviewed studies, including engagement in/retention of BI materials, resolving ambivalence, increased awareness/insight into consequences of drinking, and increased self-efficacy/empowerment to use skills for change. The following contexts were found to impact mechanisms: emotional state, injury attributed to alcohol use, severity of alcohol use, and baseline stage of change. Conclusions: This realist review provides advances in theories regarding which mechanisms to target during a BI and which contexts create the most favorable conditions for these mechanisms to occur, ultimately leading to optimal BI outcomes. These results can inform future clinical decision-making when delivering BIs in ED settings. Future research should conduct quantitative examination to confirm these findings. Systematic review registration: PROSPERO CRD42013006549

scholarly journals A realist review of brief interventions for alcohol misuse delivered in emergency departments

2021 ◽  
Author(s):  
Caitlin J Davey ◽  
Meredith SH Landy ◽  
Amanda Pecora ◽  
David Quintero ◽  
Kelly E McShane
Keyword(s):  
Alcohol Use ◽  
Emergency Departments ◽  
Clinical Decision Making ◽  
Alcohol Misuse ◽  
Realist Review ◽  
Clinical Decision ◽  
Brief Interventions ◽  
Future Research ◽  
Healthcare Settings ◽  
Favorable Conditions

Background: Brief interventions (BIs) involve screening for alcohol misuse and providing feedback to patients about their use, with the aim of reducing alcohol consumption and related consequences. BIs have been implemented in various healthcare settings, including emergency departments (ED), where they have been found to contribute mixed results in their ability to address alcohol misuse among adults. Mechanisms through which BIs work and contextual factors impacting BI effectiveness are not clear. The purpose of this review was to understand how, for whom, and under what circumstances BIs work for adults misusing alcohol and who have been admitted to an ED. A realist review was chosen to answer these questions as realist reviews create context-mechanism-outcome configurations, leading to the development of comprehensive and detailed theories; in this case explaining how and for whom BIs work. Methods: Databases including PsycINFO, Healthstar, CINAHL, Medline, and Nursing and Allied Health were searched for articles published until December 2013. The search strategy focused on studies examining BIs that targeted alcohol misuse among adults admitted into the ED. The search identified 145 relevant abstracts, of which 36 were included in the review. The literature was synthesized qualitatively (immersion/crystallization). Results: Four mechanisms were found within reviewed studies, including engagement in/retention of BI materials, resolving ambivalence, increased awareness/insight into consequences of drinking, and increased self-efficacy/empowerment to use skills for change. The following contexts were found to impact mechanisms: emotional state, injury attributed to alcohol use, severity of alcohol use, and baseline stage of change. Conclusions: This realist review provides advances in theories regarding which mechanisms to target during a BI and which contexts create the most favorable conditions for these mechanisms to occur, ultimately leading to optimal BI outcomes. These results can inform future clinical decision-making when delivering BIs in ED settings. Future research should conduct quantitative examination to confirm these findings. Systematic review registration: PROSPERO CRD42013006549

scholarly journals A realist review of brief interventions for alcohol misuse delivered in emergency departments

2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Caitlin J Davey ◽  
Meredith SH Landy ◽  
Amanda Pecora ◽  
David Quintero ◽  
Kelly E McShane
Keyword(s):  
Emergency Departments ◽  
Alcohol Misuse ◽  
Realist Review ◽  
Brief Interventions

scholarly journals AI and Big Data in Healthcare: Towards a More Comprehensive Research Framework for Multimorbidity

2021 ◽  
Vol 10 (4) ◽  
pp. 766 ◽  
Author(s):  
Ljiljana Trtica Majnarić ◽  
František Babič ◽  
Shane O’Sullivan ◽  
Andreas Holzinger
Keyword(s):  
Big Data ◽  
Clinical Decision Making ◽  
Big Data Analytics ◽  
Clinical Decision ◽  
Radical Change ◽  
Research Approach ◽  
Classification Problems ◽  
Care Needs ◽  
Healthcare Settings ◽  
Interaction Factors

Multimorbidity refers to the coexistence of two or more chronic diseases in one person. Therefore, patients with multimorbidity have multiple and special care needs. However, in practice it is difficult to meet these needs because the organizational processes of current healthcare systems tend to be tailored to a single disease. To improve clinical decision making and patient care in multimorbidity, a radical change in the problem-solving approach to medical research and treatment is needed. In addition to the traditional reductionist approach, we propose interactive research supported by artificial intelligence (AI) and advanced big data analytics. Such research approach, when applied to data routinely collected in healthcare settings, provides an integrated platform for research tasks related to multimorbidity. This may include, for example, prediction, correlation, and classification problems based on multiple interaction factors. However, to realize the idea of this paradigm shift in multimorbidity research, the optimization, standardization, and most importantly, the integration of electronic health data into a common national and international research infrastructure is needed. Ultimately, there is a need for the integration and implementation of efficient AI approaches, particularly deep learning, into clinical routine directly within the workflows of the medical professionals.

scholarly journals Challenges in treatment of renal echinococcosis with gross hydatiduria and unsalvageable kidney: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Sameera Shuaibi ◽  
Abdelrahman AlAshqar ◽  
Munirah Alabdulhadi ◽  
Wasl Al-Adsani
Keyword(s):  
Clinical Decision Making ◽  
Scientific Evidence ◽  
Renal Involvement ◽  
Clinical Decision ◽  
Response To Treatment ◽  
Standards Of Care ◽  
Future Research ◽  
Positive Serology ◽  
Grape Skin

Abstract Introduction Renal echinococcosis is of rare occurrence, and although often asymptomatic, it can present with various mild to drastic presentations, of which hydatiduria is pathognomonic. Diagnosis can be preliminarily established by imaging, and treatment is primarily surgical. We present a patient with renal echinococcosis treated successfully with exclusive antiparasitic pharmacotherapy after refusing surgery despite extensive renal involvement. We hope through this report to help establish future solid guidelines regarding this uncommon therapeutic approach. Case presentation This is a case of a 49-year-old Syrian shepherd presenting with flank pain and passage of grape-skin-like structures in urine. A diagnosis of renal echinococcosis with hydatiduria and significant parenchymal destruction was established based on exposure history, positive serology, imaging findings, and renal scintigraphy. After proper counseling, the patient refused nephrectomy and was therefore started on dual pharmacotherapy (albendazole and praziquantel) and is having an uneventful follow-up and a satisfactory response to treatment. Conclusion This case embodies the daily challenges physicians navigate as they uphold the ethical principles of their practice and support their patients’ autonomy while delivering the best standards of care and consulting the scientific evidence. Although surgery is the cornerstone of renal echinococcosis treatment, treating physicians should be prepared to tackle situations where surgery cannot be done and offer the best next available option for patients who refuse surgery. As data on exclusive pharmacotherapy are limited, future research should thoroughly investigate the efficacy of this uncommon approach and outline reliable recommendations, facilitating future clinical decision-making in this avenue.

Evaluating Diagnostic Tests

1993 ◽  
Vol 7 (2) ◽  
pp. 66-69 ◽  
Author(s):  
C.W. Douglass
Keyword(s):  
Predictive Value ◽  
Diagnostic Tests ◽  
Clinical Decision Making ◽  
New Technologies ◽  
Clinical Decision ◽  
Future Research ◽  
Scientific Support ◽  
Body Of Knowledge ◽  
Efficacy Parameters ◽  
Sensitivity Specificity

The presentations at this conference will discuss new technologies and rapid scientific developments that have resulted in new diagnostic tests for periodontal disease, musculoskeletal imaging, temporomandibular joint dysfunctions, and incipient coronal and root dental caries. However, for many of these claims, there has been insufficient scientific support regarding the sensitivity and specificity of the tests, or their ability to predict the percent of cases in which the disease or condition progresses to the next state of development. Research is needed that will yield the basic diagnostic parameters of new diagnostic tests, i.e., their accuracy, precision, sensitivity, specificity, positive predictive value, and negative predictive value. The purpose and methods for calculating each of these measures are described in this paper. Five questions are then presented that will need to be addressed in future research regarding new diagnostic tests: (1) Does the scientific theory of the test fit with our current body of knowledge? (2) Have the efficacy parameters of the test been reliably determined? (3) How does the test affect clinical decision-making? (4) Does using the test improve the patient's health? and (5) Is the added expense of the test justified by increased effectiveness or by avoiding other health expenditures?

scholarly journals The experiences of family members witnessing the diminishing drinking of a dying relative: An adapted meta-narrative literature review

2019 ◽  
Vol 33 (9) ◽  
pp. 1146-1157 ◽  
Author(s):  
Annie Pettifer ◽  
Katherine Froggatt ◽  
Sean Hughes
Keyword(s):  
Oral Fluid ◽  
Cancer Cachexia ◽  
Clinical Decision Making ◽  
Family Members ◽  
Clinical Decision ◽  
Future Research ◽  
Inclusion Criteria ◽  
Relevant Research ◽  
Narrative Literature ◽  
Narrative Literature Review

Background:Addressing the concerns of family members is an important aspect of palliative and end-of-life care. One aspect that commonly causes family caregivers concern is the decline of patients’ oral fluid intake in the last few days of life.Aim:To map the narratives in which family members’ experiences of witnessing the diminishing drinking of a dying relative have been researched, review the findings within each narrative and consider directions for future research.Design:An adapted meta-narrative review approach.Data Sources:The Cumulative Index of Nursing and Applied Health Literature, Medline, PsycINFO, Psycharticles and Scopus databases were searched for relevant research published between January 1982 and December 2017. Quality was assessed using the Quality Assessment and Review Instrument.Results:A total of 22 papers met the inclusion criteria. No study focused specifically on the experiences of family members when witnessing the diminishing drinking of dying relatives. However, research about diminishing drinking was identified within studies broadly focusing on cancer cachexia, clinical decision-making about hydration and/or nutrition and support in a hospice context. The research indicates that family members’ experiences of diminishing drinking vary with their views about the significance of drinking, dying well and their expectations of themselves and healthcare professionals.Conclusion:While some understanding of the topic can be inferred from research in related areas, there is a paucity of information specifically about family members’ experiences when witnessing the diminishing drinking of a dying relative.

Nonsuicidal Self-injury: Examining the Relationship Between Diagnosis and Gender

2010 ◽  
Vol 32 (4) ◽  
pp. 324-341 ◽  
Author(s):  
Amanda Healey ◽  
Heather Trepal ◽  
Kelly Emelianchik-Key
Keyword(s):  
Counselor Training ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Future Research ◽  
Counselors In Training ◽  
Counseling Professionals ◽  
Biological Sex ◽  
Normative Expectations ◽  
And Gender ◽  
Societal Expectations

This study examined the perceptions of counselors in training concerning nonsuicidal self-injurious behaviors (NSSI), diagnosis, and the influence of gender-normative expectations on clinical decision making. Participants were asked to respond to a set of questions after reading a randomly assigned case study. The purpose was to determine the process through which counseling professionals diagnosed adolescents who self-injure and whether the sex of the client influenced the decision. Cases presented were identical except that the sex of the client was altered. It appears that societal expectations associated with biological sex may influence counselor diagnostic decisions at the training level. Implications for diagnosis, counselor training, and future research are presented.

scholarly journals Use and impact of smartphone apps in mental health

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Amerio ◽  
A Scardoni ◽  
L Bellini ◽  
S Salvati ◽  
S Buttigieg ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Clinical Decision Making ◽  
Healthcare Providers ◽  
Experimental Studies ◽  
Clinical Decision ◽  
Future Research ◽  
Smartphone Apps ◽  
Health Apps ◽  
The Impact

Abstract As smartphone usage is more and more ubiquitous, the app market is flourishing in all fields, including health. Indeed, the availability and use of smartphone apps (SAs) in health has exponentially grown in recent years. It has been estimated that in 2018 there were over 97,000 health apps available and that, 15% and 8% of US phone users aged 18-29 and 30-49 years respectively had health apps installed on their mobile devices. Health apps might potentially support people health paths in multiple ways: channeling health education, enabling personal health data tracking, self-monitoring and goals setting, facilitating access to health records or compliance to treatment, fostering effective communication with healthcare providers and health services, as well as supporting clinical decision-making. Despite such large potential, still scant evidence is available on the impact of SAs on clinical outcomes in different fields of medicine, including mental health. With an estimated prevalence of around 450 million people currently suffering from mental disorders and 1 in 4 people in the world affected at some point in own life, mental disorders are a leading cause of ill-health and disability worldwide whose prevention and care might be enhanced by mHealth technology. The general aim of the presentation is to provide an overview on the use and impact of SAs in the field of mental health. Specific objectives are: i) to present a conceptual framework on how SAs might support mental disorders prevention, diagnosis and treatment, ii) to report on SAs use in mental health in different settings, iii) to collect and pool available evidence from observational and experimental studies on the impact of SAs use on different mental health outcomes, iv) to explore the quality, effectiveness and attributes of top-rated smartphone mental health apps and lastly, v) to suggest gaps in knowledge to be filled by future research.

scholarly journals Article Commentary: Calling for Help? Considering Function and Meaning when Patients Drunk-Dial Psychotherapists

2013 ◽  
Vol 7 ◽  
pp. SART.S12423
Author(s):  
Kelly Serafini ◽  
Donna LaPaglia ◽  
Matthew Steinfeld
Keyword(s):  
Decision Making ◽  
Substance Use ◽  
Popular Culture ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Substance Use Treatment ◽  
Future Research ◽  
Research And Practice ◽  
Use Of Technology ◽  
Literature Base

Drunk-dialing is a term documented in both popular culture and academic literatures to describe a behavior in which a person contacts another individual by phone while intoxicated. In our collective clinical experience we have found that clients drunk-dial their clinicians too, particularly while in substance use treatment, and yet there is a noticeable absence of research on the topic to guide clinical decision-making within a process-based understanding of these events. As the parameters within which psychotherapy takes place become increasingly technologized, a literature base to document clients’ idiosyncratic use of technology will become increasingly necessary and useful. We provide a brief review of the existing research on drunk-dialing and conclude with specific questions to guide future research and practice.

Sign in / Sign up

Export Citation Format

Share Document