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Journal of Evaluation in Clinical Practice

Ingo Gräff, Benjamin Latzel, Procula Glien, Rolf Fimmers, Ramona C Dolscheid-Pommerich
RATIONALE, AIMS, AND OBJECTIVES: The spectrum of cases seen by emergency departments ranges from minor illnesses or injuries to complex diseases with high mortality. Some patients require life-saving interventions (LSIs) or therapeutic treatment for an acute illness to prevent an expected imminent life-threatening condition immediately upon arrival. No published study has evaluated the validity of the Manchester Triage System (MTS) in the context of immediate LSI or acute emergency treatment (AET)...
September 14, 2018: Journal of Evaluation in Clinical Practice
Marlena Klaic, Fiona McDermott, Terry Haines
OBJECTIVE: To explore if there is a relationship between allied health professionals' confidence to perform a range of evidence-based practice (EBP) activities and the time since they graduated from their entry-level degree and the presence of postgraduate qualifications. DESIGN: Cross-sectional survey. SETTING: Allied health professionals from two Australian public metropolitan health services, including acute, subacute, and community settings...
September 4, 2018: Journal of Evaluation in Clinical Practice
Cringu Antoniu Ionescu, Mihai Dimitriu, Elena Poenaru, Mihai Bănacu, Gheorghe Otto Furău, Dan Navolan, Liana Ples
RATIONALE: Defensive caesarean section (CS) has become one of the most common medical procedure worldwide. Additionally, performing CS in accordance with the patient's choice is an appropriate professional practice. AIMS AND OBJECTIVE: This paper reports a prospective, observational, multicenter study to quantify the use of this type of practice that is performed by obstetricians to avoid medico-legal complaints and decrease the frequency of malpractice litigations...
September 4, 2018: Journal of Evaluation in Clinical Practice
Raaj Kishore Biswas, Enamul Kabir, Hafiz T A Khan
RATIONALE, AIMS, AND OBJECTIVES: Bangladesh is an underdeveloped country that has recently joined the ranks of low-middle-income countries. This study aims to investigate how socioeconomic and developmental factors have influenced women towards a shift in their body mass index (BMI). METHODS: The trend was analysed using data on ever-married women from 6 nationwide surveys covering the years 1996 to 2014, conducted by the Bangladesh Demographic and Health Survey (BDHS)...
September 4, 2018: Journal of Evaluation in Clinical Practice
Michael Loughlin, Mathew Mercuri, Alexandra Pârvan, Samantha Marie Copeland, Mark Tonelli, Stephen Buetow
Something important is happening in applied, interdisciplinary research, particularly in the field of applied health research. The vast array of papers in this edition are evidence of a broad change in thinking across an impressive range of practice and academic areas. The problems of complexity, the rise of chronic conditions, overdiagnosis, co-morbidity, and multi-morbidity are serious and challenging, but we are rising to that challenge. Key conceptions regarding science, evidence, disease, clinical judgement, and health and social care are being revised and their relationships reconsidered: Boundaries are indeed being redrawn; reasoning is being made "fit for practice...
August 30, 2018: Journal of Evaluation in Clinical Practice
Samia Addis, Daniella Holland-Hart, Adrian Edwards, Richard D Neal, Fiona Wood
RATIONALE: Prudent Healthcare is a strategy adopted by the Welsh Government in response to the challenge of improving health care during times of austerity and when needs and demand are rising. Four principles underlie Prudent Healthcare: to achieve health and wellbeing through co production; care for those with the greatest health needs first; do only what is needed; and reduce inappropriate variation. For Prudent Healthcare to be implemented in Wales, it is necessary for health professionals to adopt these principles in practice...
August 24, 2018: Journal of Evaluation in Clinical Practice
Benjamin T H Smart, Richard J Stevens, Jan Y Verbakel
Several philosophers of medicine have attempted to answer the question "what is disease?" In current clinical practice, an umbrella term "chronic kidney disease" (CKD) encompasses a wide range of kidney health states from commonly prevalent subclinical, asymptomatic disease to rare end-stage renal disease requiring transplant or dialysis to support life. Differences in severity are currently expressed using a "stage" system, whereby stage 1 is the least severe, and stage 5 the most...
August 24, 2018: Journal of Evaluation in Clinical Practice
Carmen Guadalupe Rodriguez-Gonzalez, Ana Herranz-Alonso, Vicente Escudero-Vilaplana, Maria Aranzazu Ais-Larisgoitia, Irene Iglesias-Peinado, Maria Sanjurjo-Saez
RATIONALE, AIMS AND OBJECTIVES: Implementation of robotic systems in outpatient hospital pharmacies is uncommon. Other than cost, 1 of the barriers to widespread adoption is the lack of definitive evidence that this technology actually reduces dispensing errors and improves inventory management. OBJECTIVE: To identify the frequency of medication dispensing errors before and after the implementation of a robotic original pack dispensing system in an outpatient hospital pharmacy and to analyse the impact of this system on the quality of stock management and staff satisfaction...
August 22, 2018: Journal of Evaluation in Clinical Practice
Ion Copoeru
This paper stems from the concern that, in certain situations, categorization may lead to the annihilation of the subject. It attempts to answer the question whether there is a way of framing addiction without necessarily putting the addicted persons in categories that hurt them. After showing, in the first section, how stigma is part of the process of becoming (and remaining) addicted, I will turn to the phenomenological tradition in order to re-consider the main descriptive categories that have been used so far to capture addiction as a "pathological" or "deviant" experience...
August 21, 2018: Journal of Evaluation in Clinical Practice
Heinz Katschnig
The public stereotype of schizophrenia is characterized by craziness, a split personality, unpredictable and dangerous behaviour, and by the idea of a chronic brain disease. It is responsible for delays in help-seeking, encourages social distance and discrimination, and furthers self-stigmatization. This paper discusses the circumstances of the origins of the idea of a chronic brain disease (Emil Kraepelin, 1856-1926), of the split personality concept derived from the term "schizophrenia" (Eugen Bleuler, 1857-1939), and the craziness idea reflected in the "first rank symptoms", which are all hallucinations and delusions (Kurt Schneider, 1887-1967)...
August 15, 2018: Journal of Evaluation in Clinical Practice
Heinz Katschnig
As a clinician, I can easily agree with the author that a person's own reality of being healthy is independent of physical evidence or clinical categories and that this perspective should be considered to improve clinical care. However, I cannot follow the assumptions about the nature and working of modern medicine and psychiatry as typically using "black box" and one-size-fits-all treatments in daily practice. I outline several working contexts of doctors where this criticism does only marginally apply or not at all and wonder whether the author might wish, if possible at all from a philosophical viewpoint, to differentiate her concepts with regard to these different contexts...
August 15, 2018: Journal of Evaluation in Clinical Practice
Peter C Wyer
For over 30 years, "evidence-based" clinical guidelines remained entrenched in an oversimplified, design-based, framework for rating the strength of evidence supporting clinical recommendations. The approach frequently equated the rating of evidence with that of the recommendations themselves. "Grading Recommendations Assessment, Development and Evaluation (GRADE)" has emerged as a proposed antidote to obsolete guideline methodology. GRADE sponsors and collaborators are in the process of attempting to amplify and extend the framework to encompass implementation and adaptation of guidelines, above and beyond the evaluation and rating of clinical research...
August 15, 2018: Journal of Evaluation in Clinical Practice
Rosy Tsopra, Jeremy C Wyatt, Paul Beirne, Kirsty Rodger, Matthew Callister, Dipansu Ghosh, Ian J Clifton, Paul Whitaker, Daniel Peckham
RATIONALE: One of the key functions of the discharge summary is to convey accurate diagnostic description of patients. Inaccurate or missing diagnoses may result in a false clinical picture, inappropriate management, poor quality of care, and a higher risk of re-admission. While several studies have investigated the presence or absence of diagnoses within discharge summaries, there are very few published studies assessing the accuracy of these diagnoses. The aim of this study was to measure the accuracy of diagnoses recorded in sample summaries, and to determine if it was correlated with the type of diagnoses (eg, "respiratory" diagnoses), the number of diagnoses, or the length of patient stay...
August 14, 2018: Journal of Evaluation in Clinical Practice
Trine Graabaek, Ulla Hedegaard, Mikkel B Christensen, Marianne H Clemmensen, Torben Knudsen, Lise Aagaard
RATIONALE, AIMS, AND OBJECTIVES: Medication-related problems are frequent and can lead to serious adverse events resulting in increased morbidity, mortality, and costs. Medication use in frail older patients is even more complex. The aim of this study was to investigate the effect of a pharmacist-led medicines management model among older patients at admission, during inpatient stay and at discharge on medication-related readmissions. METHOD: A randomized controlled trial conducted at the acute admission unit in a Danish hospital with acutely admitted medical patients, randomized to either a control group or one of two intervention groups...
August 7, 2018: Journal of Evaluation in Clinical Practice
Sietse Wieringa, Eivind Engebretsen, Kristin Heggen, Trish Greenhalgh
In modern philosophy, the concept of truth has been problematized from different angles, yet in evidence-based health care (EBHC), it continues to operate hidden and almost undisputed through the linked concept of "bias." To prevent unwarranted relativism and make better inferences in clinical practice, clinicians may benefit from a closer analysis of existing assumptions about truth, validity, and reality. In this paper, we give a brief overview of several important theories of truth, notably the ideal limit theorem (which assumes an ultimate and absolute truth towards which scientific inquiry progresses), the dominant way truth is conceptualized in the discourse and practice of EBHC...
August 6, 2018: Journal of Evaluation in Clinical Practice
Mathew Mercuri, Amiram Gafni
RATIONALE, AIMS, AND OBJECTIVES: The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework has undergone several modifications since it was first presented as a method for developing clinical practice recommendations. In the previous two articles of this series, we showed that absent, in the first three versions of GRADE, is a justification (theoretical and/or empirical) for why the presented criteria for determining the quality of evidence and the components for determining the strength of a recommendation were included (and others not included) in the framework...
July 31, 2018: Journal of Evaluation in Clinical Practice
Bjørn Hofmann
How can overdiagnosis be defined, explained, and estimated on an individual level? The answers to this question are essential for persons to be able to make informed choices and give valid consents for tests. Traditional conceptions of overdiagnosis tend to depend on counterfactual thinking and prophetic abilities as you would have to know what would happen in the future if you did not test now. To avoid this, overdiagnosis can be defined in terms of the chance of diagnosing a person with a disease when this does not avoid or reduce manifest disease...
July 31, 2018: Journal of Evaluation in Clinical Practice
Jonathan Livingstone-Banks
Nosology is the science of defining and classifying diseases. Meta-nosology is the study of how we do this, on what principles nosological practices are based, the quality of the resulting medical taxonomy, and primarily whether/how diseases can be defined better than they are now. In modern Western medicine, there are a wide variety of ways in which diseases are defined and categorized. Examples include by the symptoms they present with (syndromic), their underlying causes (etiological), the biological mechanisms involved (pathogenetic), available treatments, historical precedent, and through diagnostic exclusion...
July 31, 2018: Journal of Evaluation in Clinical Practice
Diana B Heney
In the Nicomachean Ethics, Aristotle argues that the performance called for by being human is rational flourishing and a life that falls short of flourishing will fail to constitute a life lived in accordance with the norms governing human kind in virtue of its function. Against this constitutivist story, a puzzle arises: On Aristotle's criteria, it looks impossible for a person with a mental disorder to flourish. I consider whether this puzzle can be satisfactorily addressed without abandoning Aristotelian constitutivism...
July 31, 2018: Journal of Evaluation in Clinical Practice
G V Ramesh Prasad
Living donors are the preferred source of organs for kidney transplantation, which is the treatment modality of choice for end-stage kidney disease. Health care systems widely promote living kidney donation. However, women are consistently overrepresented among living donors. The reasons behind the sex-based disparity in living kidney donation remain poorly understood. Compared to women, men possess a greater amount of kidney function, and the higher deceased donation rate among men reflects their higher overall kidney quality...
July 30, 2018: Journal of Evaluation in Clinical Practice
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