当前位置： SCI文献检索 > JOURNAL OF EVALUATION IN CLINICAL PRACTICE期刊下所有文献 > Reflexivity and metapositions: strategies for appraisal of clinical evidence.

Reflexivity and metapositions: strategies for appraisal of clinical evidence.

Abstract：

:According to Sackett, evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. In this article, clinical reasoning is depicted as multilayered processes of evidence construction by means of social interaction and human interpretation. A basic set of knowledge is the doctors initial capital at the onset of the individual encounter. This is a necessary, but insufficient, presumption for the elaboration of clinical knowledge required to solve the particular problem. A diagnostic conclusion may appear to constitute the most obvious part of knowledge. Yet the formulation of hypotheses and the choice of adequate strategies for the pursuit of evidence are perhaps even more significant dimensions of clinical knowledge. Potential biases affect the ways in which evidence is gathered and used. When clinicians are not committed to appraising the evidence constituting the foundations of their enterprise, quality assessment of clinical practice becomes casual and unreliable. Reflexivity implies having a self-conscious account of the production of knowledge as it is being produced. From metapositions, critical questions can be asked and sometimes answered. Evidence-based practice in the original sense requires that doctors reflect upon their own positions as knowers, in the process of situated knowing, where certain rhetorical spaces rule.

journal_name

J Eval Clin Pract

journal_title

Journal of evaluation in clinical practice

authors

Malterud K

doi

10.1046/j.1365-2753.2002.00353.x

subject

Has Abstract

pub_date

2002-05-01 00:00:00

pages

121-6

issue

2

eissn

1356-1294

issn

1365-2753

journal_volume

8

pub_type

杂志文章

相关文献

JOURNAL OF EVALUATION IN CLINICAL PRACTICE文献大全
  • Using clinical audit to promote evidence-based medicine and clinical effectiveness--an overview of one health authority's experience.

    abstract：:Health care purchasers are facing increasing pressure to make the best use of their limited resources and to purchase only those services known to be clinically effective. This paper describes one health authority's experience of promoting clinical effectiveness through clinical audit and clinical guidelines. It highl...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/j.1365-2753.1997.tb00070.x

    authors： Auplish S

    更新日期：1997-02-01 00:00:00

  • Systematic validation of disease models for pharmacoeconomic evaluations. Swiss HIV Cohort Study.

    abstract：:Pharmacoeconomic evaluations are often based on computer models which simulate the course of disease with and without medical interventions. The purpose of this study is to propose and illustrate a rigorous approach for validating such disease models. For illustrative purposes, we applied this approach to a computer-b...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1046/j.1365-2753.1999.00174.x

    authors： Sendi PP,Craig BA,Pfluger D,Gafni A,Bucher HC

    更新日期：1999-08-01 00:00:00

  • Economic impact of 13-valent pneumococcal conjugate vaccine in Finnish adults ≥50 years with underlying chronic medical conditions.

    abstract：RATIONALE, AIMS AND OBJECTIVES:Invasive pneumococcal diseases (IPD) are associated with substantial burden in adults (≥50 years). Moreover, adults with vascular, metabolic or respiratory diseases have been shown to have a 3-6 times higher risk of IPD when compared with their healthy controls. These persons at higher ri...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/jep.12131

    authors： Martikainen JA,Soini EJ,Laine J,Ahman H,Postila V,Klemets P

    更新日期：2014-08-01 00:00:00

  • The Individual Practice Development Theory: an individually focused practice development theory that helps target practice development resources.

    abstract：BACKGROUND:Research indicates that multifaceted practice development (PD) interventions are more effective than single strategies. However, models of education in health care need to consider cost-effectiveness. OBJECTIVES:This paper presents a research-based, PD theory called the Individual Practice Development Theor...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/j.1365-2753.2010.01618.x

    authors： Melton J,Forsyth K,Freeth D

    更新日期：2012-06-01 00:00:00

  • Managing asthma in primary care through imperative outcomes.

    abstract：RATIONALE, AIMS AND OBJECTIVES:To evaluate asthma management and control in primary care clinics so as to design improvements based on guideline-directed outcomes. METHODS:In this study, all medical records of asthma-diagnosed patients (children as well as adults, entire lifespan, asthma-related visits or not) were re...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/j.1365-2753.2011.01803.x

    authors： du Plessis JM,Gerber JJ,Brand L

    更新日期：2013-04-01 00:00:00

  • The factor structure of the SF-36 in adults with progressive neuromuscular disorders.

    abstract：OBJECTIVE:Quality of life (QoL) is an important consideration in the care of patients with chronic neuromuscular disorder (NMD). The current study sought to determine the factor structure of the Medical Outcomes Study Short-Form 36 (SF-36) version 2 in patients with NMD to determine the appropriateness of using this in...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/j.1365-2753.2010.01513.x

    authors： Banks P,Martin CR,Petty RK

    更新日期：2012-02-01 00:00:00

  • Introducing the Learning Practice--III. Leadership, empowerment, protected time and reflective practice as core contextual conditions.

    abstract：RATIONALE, AIMS AND OBJECTIVES:This paper is the third of three related papers exploring the ways in which the principles of Learning Organizations (LOs) could be applied in Primary Care settings at the point of service delivery. METHODS:Here we provide a systematic literature review of contextual factors that either ...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章,评审

    doi：10.1111/j.1365-2753.2004.00466.x

    authors： Rushmer R,Kelly D,Lough M,Wilkinson JE,Davies HT

    更新日期：2004-08-01 00:00:00

  • Selective prevention of cardiometabolic diseases in general practice: attitudes and working methods of male and female general practitioners before and after the introduction of the Prevention Consultation guideline in the Netherlands.

    abstract：RATIONALE, AIMS AND OBJECTIVES:In 2011 the module cardiometabolic risk of the Prevention Consultation guideline was introduced in the Netherlands in order to prevent cardiometabolic diseases. We aimed to compare attitudes and working methods of Dutch general practitioners (GPs) towards selective prevention of cardiomet...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/jep.12179

    authors： Vos HM,Van Delft DH,De Kleijn MJ,Nielen MM,Schellevis FG,Lagro-Janssen AL

    更新日期：2014-08-01 00:00:00

  • An educational programme for peer review groups to improve treatment of chronic heart failure and diabetes mellitus type 2 in general practice.

    abstract：RATIONALE, AIMS AND OBJECTIVES:Peer review groups are considered helpful for quality improvement in primary care. An interactive educational programme for small peer groups was developed, focusing on the implementation of newly developed treatment guidelines. The aim is to evaluate the effect of the programme on adhere...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章,随机对照试验

    doi：10.1111/j.1365-2753.2005.00625.x

    authors： Kasje WN,Denig P,Stewart RE,de Graeff PA,Haaijer-Ruskamp FM

    更新日期：2006-12-01 00:00:00

  • Assessment of implementability of an adapted clinical practice guideline for surgical antimicrobial prophylaxis at a tertiary care university hospital.

    abstract：RATIONALE, AIMS AND OBJECTIVES:Surgical site infections are the most common healthcare-associated infections. Appropriate surgical antimicrobial prophylaxis (SAP), which is an integral part of surgical site infection SSI prevention, is one of the major preventable risks to surgical patient safety. Several clinical prac...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/jep.12658

    authors： Altokhais TI,Al-Obaid OA,Kattan AE,Amer YS,CPG Collaborative Groups.

    更新日期：2017-02-01 00:00:00

  • Quality improvement opportunities for handover practices in birth centres: A case study from a process perspective.

    abstract：RATIONALE, AIMS AND OBJECTIVES:Handovers within and between health care settings are known to affect quality of care. Health care organizations, struggle how to guarantee best care during handovers. The aim of this paper is to evaluate handover practices in Dutch birth centres from a process perspective, to identify ob...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/jep.12939

    authors： Hitzert M,Boesveld IC,Hermus MAA,de Graaf JP,Wiegers TA,Steegers EAP,Meijboom BR,Akkermans HA

    更新日期：2018-06-01 00:00:00

  • Clinical risk management in hospitals: strategy, central coordination and dialogue as key enablers.

    abstract：OBJECTIVE:The study aims to identify key enablers fostering clinical risk management (CRM) in hospitals to guide health care in this vital area of patient safety. METHOD:A cross-sectional survey was conducted at the national level in 324 Swiss hospitals in 2007-2008 to assess the relationship between key elements and ...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/j.1365-2753.2012.01836.x

    authors： Briner M,Manser T,Kessler O

    更新日期：2013-04-01 00:00:00

  • Current treatment of chronic heart failure in primary care; still room for improvement.

    abstract：UNLABELLED:RATIONAL AND AIMS: In recent years, guidelines for treatment of patients with chronic heart failure (CHF) have been updated. Insight in current pharmacological and non-pharmacological treatment of CHF in primary care, which was non-optimal in earlier studies, is limited. We aim to describe current pharmacolo...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/j.1365-2753.2010.01455.x

    authors： Bosch M,Wensing M,Bakx JC,van der Weijden T,Hoes AW,Grol RP

    更新日期：2010-06-01 00:00:00

  • What is knowledge and when should it be implemented?

    abstract：:A primary purpose of research is to generate new knowledge. Scientific advances have progressively identified optimal ways to achieve this purpose. Included in this evolution are the notions of evidence-based medicine, decision aids, shared decision making, measurement and evaluation as well as implementation. The imp...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/j.1365-2753.2012.01899.x

    authors： O'Grady L

    更新日期：2012-10-01 00:00:00

  • Characteristics and residence of First Nations patients and their use of health care services in Saskatchewan, Canada: informing First Nations and Métis health services.

    abstract：RATIONALE:In Canada, Aboriginal people, particularly First Nations experience significant health disparities and a lower health status compared with the non-Aboriginal population. AIMS AND OBJECTIVES:The purpose of this study was to examine the demographic and clinical characteristics of First Nations patients admitte...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/jep.12601

    authors： Lafond G,Haver CR,McLeod V,Clarke S,Horsburgh B,McLeod KM

    更新日期：2017-04-01 00:00:00

  • Guidelines adherence and hypertension control at a tertiary hospital in Malaysia.

    abstract：RATIONALE, AIMS AND OBJECTIVES:Existing literature suggests that doctors' poor adherence with guidelines is one of the major contributing factors to suboptimal control of hypertension. This study aims to evaluate doctors' adherence with Malaysian clinical practice guideline (CPG 2008) in a tertiary care hospital, and f...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/j.1365-2753.2012.01852.x

    authors： Ahmad N,Hassan Y,Tangiisuran B,Meng OL,Abd Aziz N,Ahmad FU,Atif M

    更新日期：2013-10-01 00:00:00

  • Polanyi's tacit knowing and the relevance of epistemology to clinical medicine.

    abstract：:Most clinicians take for granted a simple, reductionist understanding of medical knowledge that is at odds with how they actually practice medicine; routine medical decisions incorporate more complicated kinds of information than most standard accounts of medical reasoning suggest. A better understanding of the struct...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/j.1365-2753.2010.01387.x

    authors： Henry SG

    更新日期：2010-04-01 00:00:00

  • The relationship between second-year medical students' OSCE scores and USMLE Step 2 scores.

    abstract：RATIONALE, AIMS AND OBJECTIVES:A valid tool to measure clinical competency early in medical school could identify students who may require special educational attention. The overall aim is to assess the relationship between students' scores on an objective structured clinical examination (OSCE) given in the second year...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/j.1365-2753.2006.00768.x

    authors： Simon SR,Bui A,Day S,Berti D,Volkan K

    更新日期：2007-12-01 00:00:00

  • Efficacy and safety of recombinant human interleukin-11 in the treatment of acute leukaemia patients with chemotherapy-induced thrombocytopenia: A systematic review and meta-analysis.

    abstract：RATIONALE, AIMS, AND OBJECTIVES:Current meta-analysis was conducted aiming to assess the efficacy and safety of recombinant human interleukin-11 (rhIL-11) in the treatment of acute leukaemia (AL) patients with chemotherapy-induced thrombocytopenia (CIT). METHODS:We searched PubMed, Embase, Chinese National Knowledge I...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/jep.13152

    authors： Liu Z,Wang Y,Yan J,Liu J,Chen B,Zhang L,Cheng L

    更新日期：2020-02-01 00:00:00

  • Improving detection of familial hypercholesterolaemia in primary care using electronic audit and nurse-led clinics.

    abstract：RATIONALE, AIMS AND OBJECTIVES:In the UK fewer than 15% of familial hypercholesterolemia (FH) cases are diagnosed, representing a major gap in coronary heart disease prevention. We wished to support primary care doctors within the Medway Clinical Commissioning Group (CCG) to implement NICE guidance (CG71) and consider ...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/jep.12481

    authors： Green P,Neely D,Humphries SE,Medway FH Audit Steering Committee.

    更新日期：2016-06-01 00:00:00

  • Delays and errors in abnormal chest radiograph follow-up: a systems approach to promoting patient safety in radiology.

    abstract：RATIONALE, AIMS AND OBJECTIVES:This study aimed to apply the 'systems approach' to patient safety in order to identify causes for delays and errors in lung cancer diagnoses following an abnormal chest radiograph. METHODS:In the first part of this study, the systems approach to patient safety was comprehensively review...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/jep.12178

    authors： Bhaludin BN,Shelmerdine SC,Arora S,Senbanjo T,Parthipun A

    更新日期：2014-08-01 00:00:00

  • Meta-analysis of the effectiveness of chronic care management for diabetes: investigating heterogeneity in outcomes.

    abstract：PURPOSE:The study aims to support decision making on how best to redesign diabetes care by investigating three potential sources of heterogeneity in effectiveness across trials of diabetes care management. METHODS:Medline, CINAHL and PsycInfo were searched for systematic reviews and empirical studies focusing on: (1) ...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章,meta分析

    doi：10.1111/j.1365-2753.2012.01817.x

    authors： Elissen AM,Steuten LM,Lemmens LC,Drewes HW,Lemmens KM,Meeuwissen JA,Baan CA,Vrijhoef HJ

    更新日期：2013-10-01 00:00:00

  • Diagnosis - the limiting focus of taxonomy.

    abstract：RATIONALE, AIMS AND OBJECTIVES:The focus on the diagnosis is a pivotal aspect of medical practice since antiquity. Diagnostic taxonomy helped to categorize ailments to improve medical care, and in its social sense resulted in validation of the sick role for some, but marginalization or stigmatization for others. In the...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/jep.12113

    authors： Sturmberg JP,Martin CM

    更新日期：2016-02-01 00:00:00

  • The struggle of translating science into action: Foundational concepts of implementation science.

    abstract：:RATIONALE, AIMS, AND OBJECTIVES: "Implementation science," the scientific study of methods translating research findings into practical, useful outcomes, is contested and complex, with unpredictable use of results from routine clinical practice and different levels of continuing assessment of implementable interventio...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/jep.12741

    authors： Rapport F,Clay-Williams R,Churruca K,Shih P,Hogden A,Braithwaite J

    更新日期：2018-02-01 00:00:00

  • Implementation of evidence-based falls prevention in clinical services for high-risk clients.

    abstract：RATIONALE, AIMS AND OBJECTIVES:The extent to which best practice for falls prevention is being routinely delivered by health care providers for community-dwelling older adults is unclear. We investigated falls prevention practice among Hospital Admission Risk Programs (HARP) that provide and coordinate specialized heal...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/jep.12119

    authors： Day L,Trotter MJ,Hill KD,Haines TP,Thompson C

    更新日期：2014-06-01 00:00:00

  • Long-term adherence to a local guideline on postoperative body temperature measurement: mixed methods analysis.

    abstract：AIM:To find out whether a successful multifaceted implementation approach of a local evidence-based guideline on postoperative body temperature measurements (BTM) was persistent over time, and which factors influenced long-term adherence. METHODS:Mixed methods analysis. Patient records were retrospectively examined to...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/j.1365-2753.2011.01687.x

    authors： Storm-Versloot MN,Knops AM,Ubbink DT,Goossens A,Legemate DA,Vermeulen H

    更新日期：2012-08-01 00:00:00

  • Diabetic patients with prior specialist care have better glycaemic control than those with prior primary care.

    abstract：OBJECTIVE:To compare glycaemic control, as reflected in the A1c level, of diabetic patients with primary care vs. with specialist care. METHODS:The study used administrative data from eastern Ontario, Canada, and a database containing the results of all A1c tests from this region between 1 September 1999 and 1 Septemb...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/j.1365-2753.2005.00582.x

    authors： Shah BR,Hux JE,Laupacis A,Mdcm BZ,Austin PC,van Walraven C

    更新日期：2005-12-01 00:00:00

  • Poor allocation concealment methods are associated with heterogeneity in age and statistical significance of the primary outcome: Review of recent trials published in four general medical journals.

    abstract：OBJECTIVE:To assess the association of the quality of allocation concealment with heterogeneity in age, the P value of the primary outcome and statistical significance of the primary outcome. STUDY DESIGN AND SETTING:We extracted data from articles published in four major medical journals in 2017 and 2018 that reporte...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章,评审

    doi：10.1111/jep.13313

    authors： Mitchell A,Moe-Byrne T,Cunningham-Burley R,Dean A,Rangan A,Roche J,Torgerson DJ

    更新日期：2020-08-01 00:00:00

  • Reasoning, evidence, and clinical decision-making: The great debate moves forward.

    abstract：:When the editorial to the first philosophy thematic edition of this journal was published in 2010, critical questioning of underlying assumptions, regarding such crucial issues as clinical decision making, practical reasoning, and the nature of evidence in health care, was still derided by some prominent contributors ...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 社论

    doi：10.1111/jep.12831

    authors： Loughlin M,Bluhm R,Buetow S,Borgerson K,Fuller J

    更新日期：2017-10-01 00:00:00

  • Has evidence-based medicine ever been modern? A Latour-inspired understanding of a changing EBM.

    abstract：:Evidence-based health care (EBHC), previously evidence-based medicine (EBM), is considered by many to have modernized health care and brought it from an authority-based past to a more rationalist, scientific grounding. But recent concerns and criticisms pose serious challenges and urge us to look at the fundamentals o...

    journal_title：Journal of evaluation in clinical practice

    pub_type： 杂志文章

    doi：10.1111/jep.12752

    authors： Wieringa S,Engebretsen E,Heggen K,Greenhalgh T

    更新日期：2017-10-01 00:00:00