The psychiatrist in charge made the decision regarding the total number of ECT treatments based on experienced clinical judgement; the study protocol did not interfere with that decision.
Decisions to prescribe APC, or not, were at the discretion of the attending physicians based on locally instituted guidelines and their clinical judgement; the research protocol did not influence the use of APC in any measurable way.
In that case, Arafiles allegedly failed to adequately supervise a physician assistant at a weight loss clinic and failed to exercise independent medical judgement when applying protocols written by the clinic's owner.
(3) Professor in ethics: ethical judgement of the study protocol and possible adverse events.
Clinicians are asked to wait 2 to 3 hours prior to escalation of care, however, if they are more concerned, their clinical judgement can override the protocol if a decision is made to escalate care.
Writing on the park's Facebook page, Mr Gill said: "We have made a statement that from the investigations that have taken place it is clear that this tragedy was caused by a sad error of judgement and breach of protocols, in essence, keeper error.
Despite training the observers using the manual of study protocols, judgements may have been influenced by professional training, post qualification clinical experience, and prior expectation.
Perhaps the most important message from this study is that too much fluid in established acute lung injury is harmful and that the iatrogenic effects of hemodynamic support can be reduced by protocols using clinical judgement and central venous pressure – measurement of cardiac output and pulmonary artery occlusion pressures offers no additional benefit in this context.
Physicians' judgement - measured assuming the explicit protocol as standard - proved to be of acceptable sensitivity only when information was 'Thorough' by the protocol.
The event has to be documented by a standardised report protocol, including the following judgements by the physician: medical/non-medical; caused/not caused by exercise; subject may/may not continue exercises.
