Abstract:
:The foundationalist and anti-foundationalist conceptions of medical knowledge have been at loggerheads for decades. Evidence-based medicine (EBM), the most prominent form of foundationalism, has attained wide appeal and acceptance among authorities. It proposes that evidence is the "base" upon which all clinical decisions should be grounded. Others have countered that the clinical encounter is far too complex for a singular base, and the different factors that impose on a clinical decision cannot be neatly and permanently ranked a priori. By its very nature, this anti-foundationalist outlook has resisted simplistic description, which is perhaps the reason it has not been as popular. In this paper, I provide a survey of the foundationalist and anti-foundationalist debate in medicine and defend anti-foundationalism on the basis that foundationalist approaches are anachronistic, and in the case of evidence-based medicine ultimately confuses inputs (evidence) for consideration in making a judgement with outputs (conclusions). I further propose that virtue ethics is inseparable from anti-foundationalism and conclude that the current infatuation with EBM implies something rather troubling; that physicians cannot be trusted to utilize their extensive training and skills to make reasonable decisions in the best interests of their patients. If this is in fact true, it suggests a crisis in virtue amongst medical professionals.
journal_name
J Eval Clin Practjournal_title
Journal of evaluation in clinical practiceauthors
Ghinea Ndoi
10.1111/jep.13273subject
Has Abstractpub_date
2020-04-01 00:00:00pages
447-451issue
2eissn
1356-1294issn
1365-2753journal_volume
26pub_type
杂志文章abstract:OBJECTIVE:To evaluate the impact of protocol-based care on nursing roles, practice and service delivery. DESIGN:Case study evaluation informed by realistic evaluation methodology. Qualitative data collection methods were used including non-participant observation, post-observation interviews with nurses and patients, ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2008.01015.x
更新日期:2008-10-01 00:00:00
abstract::The Hawthorne studies in the 1930s demonstrated how difficult it is to understand workplace behaviour, and this includes professional performance. Studies of interventions to improve professional performance, such as audit, can provide useful information for those considering using such methods, but cannot replace jud...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1046/j.1365-2753.2001.00280.x
更新日期:2001-02-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Patient involvement is increasingly recognized as a key component on the international health care agenda. This attention has brought a need for developing generic and standardized open-source methods, tools, and guidelines on how to systematically implement patient involvement initiative...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13217
更新日期:2020-06-01 00:00:00
abstract:RATIONALE, AIMS, AND OBJECTIVES:The Australian National Heart Foundation Guidelines have been developed to guide clinicians on how to best manage chronic heart failure (CHF) patients according to the current best available evidence. The primary aim of this study is to evaluate the proportion of patients prescribed evid...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12760
更新日期:2017-12-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:To evaluate the variation in prescribing by primary care doctors during the morning and the evening clinics and to determine whether these prescribing patterns are influenced by doctors' training background. METHODS:A retrospective prescription-based study was carried out in 17 out of 20...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2006.00642.x
更新日期:2007-02-01 00:00:00
abstract:RATIONALE, AIMS, AND OBJECTIVES:Focusing on the implementation of clinical practice guidelines (CPGs) for the management of adult cancers, the objectives of this study were to (a) describe the intrinsic elements known to influence CPG use; (b) identify the ways in which CPGs are implemented; and (c) explore how CPG cha...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13073
更新日期:2019-08-01 00:00:00
abstract:RATIONALE, AIMS, AND OBJECTIVES:Local health administrators implemented chronic obstructive pulmonary disease and heart failure admission order sets to increase guideline adherence. We explored the impact of these order sets on workflows and guideline adherence in the internal medicine specialty in two Canadian teachin...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13080
更新日期:2019-06-01 00:00:00
abstract:INTRODUCTION:The patient-centred medical home (PCMH) is an important part of health care reform. While there is hope, the PCMH model can facilitate the provision of higher quality care, the extent to which organizational climate within the PCMH supports the implementation of evidence-based practices (EBPs) is unknown. ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13050
更新日期:2019-08-01 00:00:00
abstract::The aim of this study was to determine whether a brief Internet-based education programme could improve physicians' abilities to manage pigmented skin lesions. A pre-test-post-test assessment was used of subjects' knowledge of skin cancer, confidence in their management abilities and actual ability to recommend approp...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1046/j.1365-2753.1999.00194.x
更新日期:1999-05-01 00:00:00
abstract:RATIONALE:Variability in indications for total hip replacement (THR) and unequal waiting times may limit health care access. OBJECTIVE:To analyse the relationship between appropriateness and previously developed surgical priority instruments. METHOD:Multicentre cross-validation study of patients placed on the waiting...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1365-2753.2010.01362.x
更新日期:2011-02-01 00:00:00
abstract:RATIONALE, AIMS, AND OBJECTIVES:The patient-centred medical home (PCMH) is an innovative approach to health care reform. Despite a well-established process for recognizing PCMH practices, fidelity to, and/or adaptation of, the PCMH model can limit health care and population health improvements. This study explored the ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13136
更新日期:2019-12-01 00:00:00
abstract:OBJECTIVES:To describe the practices of physicians on the diagnosis and treatment of antituberculosis drug-induced hepatotoxicity (ATH), and to evaluate the concordance between these practices and the American Thoracic Society (ATS) 2006 guidelines. METHODS:Information was reviewed on 670 new cases of tuberculosis pat...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2011.01706.x
更新日期:2012-12-01 00:00:00
abstract:RATIONALE, AIMS, AND OBJECTIVES:Clinical practice guidelines (CPGs) endeavour to incorporate the best available research evidence together with the clinically informed opinions of leading experts in order to guide clinical practice when dealing with a given condition. There has been increased interest in CPGs that are ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13026
更新日期:2019-08-01 00:00:00
abstract:OBJECTIVE:Models for the structured delivery of care rely on organizational attributes of practice teams. The Survey of Organizational Attributes for Primary Care (SOAPC) is known to be a valid instrument to measure this aspect in the primary care setting. The aim of this study was to determine the validity of a transl...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2009.01330.x
更新日期:2010-12-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:What factors determine the use of an anaesthesia preparation room and shorten non-operative time? METHODS:A logistic regression is applied to 18 751 surgery records from AZ Sint-Jan Brugge AV, Belgium, where each operating room has its own anaesthesia preparation room. Surgeries, in whic...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12288
更新日期:2015-04-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Errors in hospitals during the preparation and administration of intravenous drugs to infants and children have been reported to a rate of 13% to 84%. This study aimed to investigate the potential for hazardous events that may lead to an accident for preparation and administration of drug...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12748
更新日期:2017-08-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:The London Health Sciences Centre found that its emergency room (ER) mental health services were affected by people presenting with problems that did not require psychiatric intervention. Consequently, a second triage using a crisis worker (CW) was introduced in the ER to identify those p...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2006.00759.x
更新日期:2007-04-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Consistent links exist between male alcohol intake and male-perpetrated intimate partner violence (IPV) as well as female alcohol intake and female-perpetrated IPV. However, the nature of the relationship remains unclear. This study attempted to identify unique alcohol-violence patterns w...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,多中心研究
doi:10.1111/jep.12218
更新日期:2014-10-01 00:00:00
abstract::The aim of this study was to utilize an evaluation tool based on Prochaska's model of change in order to assess behaviour change as part of an evaluation process for a research transfer training programme (RTTP). The RTTP was a training programme offered to scientists in a psychiatry department and research institute ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1046/j.1365-2753.2003.00407.x
更新日期:2003-11-01 00:00:00
abstract:RATIONALE AIMS AND OBJECTIVES:Pulmonary aspiration is a feared complication of anaesthesia that is associated with significant morbidity and mortality. Within the small existing body of literature on medical malpractice claims related to periprocedural aspiration, very little information is available regarding the case...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13086
更新日期:2019-10-01 00:00:00
abstract::The American College of Radiology develops evidence-based practice guidelines to aid appropriate utilization of radiological procedures. Panel members use expert opinion to weight trade-offs and consensus methods to rate appropriateness of imaging tests. These ratings include an equivocal range, assigned when there is...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12635
更新日期:2017-02-01 00:00:00
abstract::Often, when conducting programme evaluations or studying the effects of policy changes, researchers may only have access to aggregated time series data, presented as observations spanning both the pre- and post-intervention periods. The most basic analytic model using these data requires only a single group and models...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2010.01504.x
更新日期:2011-12-01 00:00:00
abstract::One knowledge translation method, of putting evidence into practice, is the use of clinical practice guidelines (CPG). The purpose of this brief report is to describe an 8-step process of "how to" contextualize a training programme to increase CPG-uptake for a targeted audience in a clearly defined setting. This proce...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13476
更新日期:2020-09-14 00:00:00
abstract:INTRODUCTION:Non-routine events (NREs) are atypical or unusual occurrences in a pre-defined process. Although some NREs in high-risk clinical settings have no adverse effects on patient care, others can potentially cause serious patient harm. A unified strategy for identifying and describing NREs in these domains will ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13456
更新日期:2020-08-16 00:00:00
abstract::It is important to improve our understanding about what might be the specific characteristics of mental disorders to strengthen the scientific credibility of psychiatry and to clarify its position among other medical and nonmedical sciences. On the other hand, this issue has diagnostic, research, therapeutic, legal, f...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
doi:10.1111/jep.12766
更新日期:2017-10-01 00:00:00
abstract::This paper investigates the translation of medical information into clinical practice and the role of thoughtful dissent by exploring the influence of sociological factors on change, the impact of evidence-based medicine (EBM), and the role of industry. Changing practice related to hormone therapy for menopausal and p...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2005.00608.x
更新日期:2006-02-01 00:00:00
abstract::There have been considerable political and organizational moves to involve 'consumers' (patients, carers, service users, potential users, local communities and the public at large) in the provision, planning and monitoring of health services. Such developments beg the question 'what constitutes good practice in user i...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1365-2753.1996.tb00034.x
更新日期:1996-05-01 00:00:00
abstract:RATIONALE:Data about health care organizations (HCOs) are not useful until they are interpreted. Such interpretations are influenced by the theoretical lenses used by the researcher. OBJECTIVE:Our purpose was to suggest the usefulness of theories of complex adaptive systems (CASs) in guiding research interpretation. S...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2009.01359.x
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:Shared decision making (SDM) is very important from patients' perspective. This process has not yet been evaluated in Romania. The study aims to evaluate SDM from the patients' perspective and to evaluate patients' characteristics that associate with SDM. MATERIAL AND METHODS:A cross-sectional multicentric ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,多中心研究
doi:10.1111/jep.13257
更新日期:2019-12-01 00:00:00
abstract:RATIONALE, AIMS, AND OBJECTIVES:Clinical practice guidelines (CPGs) are significant tools for evidence-based health care quality improvement. The CPG program at King Saud University was launched as a quality improvement program to fulfil the international accreditation standards. This program was a collaboration betwee...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12927
更新日期:2019-08-01 00:00:00