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Journal of Evaluation in Clinical Practice

Diogo Telles-Correia
The first time that formally a definition of mental disorder was presented was in DSM-III. This resulted from a complex conceptual analysis carried out by Spitzer, chair of the committee on nomenclature and statistics. The criteria of harm (distress-disability) arise as main defining characteristics for mental illness, being added that "there is an inference" that there is a dysfunction. The distress-disability model was later developed by Wakefield. This author argued that in a medical or psychiatric disorder there had to be a dysfunctional component (value free) and another one of harm (value laden)...
January 11, 2018: Journal of Evaluation in Clinical Practice
Hanan Khalil, Sarah Lee
RATIONALE, AIMS, AND OBJECTIVES: Improving patient safety is now a government priority in many economically developed and underdeveloped countries. Various medication safety interventions and programs that have been described in the literature focus on hospital settings, and only very few studies report on the implementation of such interventions in primary care. The main objectives of this study were firstly to describe the steps involved for the successful implementation of a medication safety program in primary care in rural Australia and secondly to report on its evaluation and provide recommendations for future initiatives...
January 11, 2018: Journal of Evaluation in Clinical Practice
Esther Kuipers, Michel Wensing, Peter A G M De Smet, Martina Teichert
RATIONALE, AIMS, AND OBJECTIVES: Despite recommendations in prevailing guidelines to avoid the use of non-selective (NS) β-blockers in patients with asthma or COPD, on average, 10 patients per community pharmacy receive NS β-blockers monthly. The aim of our study was to identify the reasons of prescribers and pharmacists to treat asthma and COPD patients with NS β-blockers. METHODS: Fifty-three community pharmacists in the Netherlands selected patients with actual concurrent use of inhalation medication and NS β-blockers...
January 10, 2018: Journal of Evaluation in Clinical Practice
Fabrizio Bandini, Stefano Guidi, Silvia Blaszczyk, Antonietta Fumarulo, Michela Pierini, Paolo Pratesi, Stefano Spolveri, Margherita Padeletti, Pasquale Petrone, Paolo Zoppi, Giancarlo Landini
RATIONALE: Complexity is increasingly recognized as a critical variable in health care. However, there is still lack of practical tools to assess it and tackle the challenges that stem from it, particularly within hospitals. AIMS AND OBJECTIVE: To validate a simple novel screening method based on both objective and subjective criteria to identify patients with clinically complex hospitalization events. To evaluate the prevalence of patients with complex events, identify their features, and compare them with those of the other patients and to those of patients with multimorbidities...
January 10, 2018: Journal of Evaluation in Clinical Practice
Mathew Mercuri, Brian Baigrie, Ross E G Upshur
The evidence based medicine movement has championed the need for objective and transparent methods of clinical guideline development. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was developed for that purpose. Central to this framework is criteria for assessing the quality of evidence from clinical studies and the impact that body of evidence should have on our confidence in the clinical effectiveness of a therapy under examination. Grades of Recommendation, Assessment, Development, and Evaluation has been adopted by a number of professional medical societies and organizations as a means for orienting the development of clinical guidelines...
January 5, 2018: Journal of Evaluation in Clinical Practice
Christian D Helfrich, Adam J Rose, Christine W Hartmann, Leti van Bodegom-Vos, Ian D Graham, Suzanne J Wood, Barbara R Majerczyk, Chester B Good, Leonard M Pogach, Sherry L Ball, David H Au, David C Aron
RATIONALE AND OBJECTIVES: One way to understand medical overuse at the clinician level is in terms of clinical decision-making processes that are normally adaptive but become maladaptive. In psychology, dual process models of cognition propose 2 decision-making processes. Reflective cognition is a conscious process of evaluating options based on some combination of utility, risk, capabilities, and/or social influences. Automatic cognition is a largely unconscious process occurring in response to environmental or emotive cues based on previously learned, ingrained heuristics...
January 5, 2018: Journal of Evaluation in Clinical Practice
Martin Reynolds, Eric Sarriot, Robert Chad Swanson, Evan Rusoja
Systems thinking and reference to complexity science have gained currency in health sector practice and research. The extent to which such ideas might represent a mere passing fad or might more usefully be mobilized to tackle wicked problems in health systems is a concern underpinning this paper. Developing the usefulness of the systems idea requires appreciating how systems ideas are used essentially as constructs conceptually bounded by practitioners. Systems are used for purposes of understanding and engaging the reality of health issues, with the intent of transforming the reality into one that is more manageable, equitable, and sustainable...
January 4, 2018: Journal of Evaluation in Clinical Practice
Amir Babiker, Yasser S Amer, Mohamed E Osman, Ayman Al-Eyadhy, Solafa Fatani, Sarar Mohamed, Abdulrahman Alnemri, Maher A Titi, Farheen Shaikh, Khalid A Alswat, Hayfaa A Wahabi, Lubna A Al-Ansary
RATIONALE, AIMS, AND OBJECTIVES: Implementation of clinical practice guidelines (CPGs) has been shown to reduce variation in practice and improve health care quality and patients' safety. There is a limited experience of CPG implementation (CPGI) in the Middle East. The CPG program in our institution was launched in 2009. The Quality Management department conducted a Failure Mode and Effect Analysis (FMEA) for further improvement of CPGI. METHODS: This is a prospective study of a qualitative/quantitative design...
December 29, 2017: Journal of Evaluation in Clinical Practice
Chris O Ifediora
RATIONALE, AIMS, AND OBJECTIVES: Minimizing the risks and distress arising from aggression in after-hours house call (AHHC) services will help improve service quality in the industry. Unfortunately, no national study has ever evaluated this in Australian AHHCs. Apart from reducing this gap, findings from this work will have global relevance given the rising popularity of the AHHC industry worldwide. METHODS: A survey of all 300 doctors employed by the National Home Doctor Service, Australia's largest AHHC service provider...
December 28, 2017: Journal of Evaluation in Clinical Practice
Matthew A Widmer, R Chad Swanson, Brian J Zink, Jesse M Pines
INTRODUCTION: The specialty of emergency medicine is experiencing the convergence of a number of transformational forces in the United States, including health care reform, technological advancements, and societal shifts. These bring both opportunity and uncertainty. 21ST CENTURY CHALLENGES: Persistent challenges such as the opioid epidemic, rising health care costs, misaligned incentives, patients with multiple chronic diseases, and emergency department crowding continue to plague the acute, unscheduled care system...
December 27, 2017: Journal of Evaluation in Clinical Practice
Ariel Linden
RATIONALE, AIMS, AND OBJECTIVES: Interrupted time-series analysis (ITSA) is a popular evaluation methodology in which a single treatment unit's outcome is studied over time and the intervention is expected to "interrupt" the level and/or trend of the outcome, subsequent to its introduction. When ITSA is implemented without a comparison group, the internal validity may be quite poor. Therefore, adding a comparable control group to serve as the counterfactual is always preferred. This paper introduces a novel matching framework, ITSAMATCH, to create a comparable control group by matching directly on covariates and then use these matches in the outcomes model...
December 20, 2017: Journal of Evaluation in Clinical Practice
Mathew Mercuri, Katherine Connolly, Madhu K Natarajan, Michelle Welsford, J D Schwalm
RATIONALE, AIMS, AND OBJECTIVES: Access to timely ST-elevation myocardial infarction (STEMI) care is facilitated by paramedics and emergency medical services (EMS). However, a large proportion of STEMI patients do not access care through EMS. This study sought to identify patient-reported factors for their decision to use (or not use) EMS. METHODS: Semi-structured interviews were conducted with a sample of STEMI patients admitted to a large tertiary care centre between November 2011 and January 2012...
December 13, 2017: Journal of Evaluation in Clinical Practice
Benjamin Chin-Yee, Ross Upshur
Clinical judgement is a central and longstanding issue in the philosophy of medicine which has generated significant interest over the past few decades. In this article, we explore different approaches to clinical judgement articulated in the literature, focusing in particular on data-driven, mathematical approaches which we contrast with narrative, virtue-based approaches to clinical reasoning. We discuss the tension between these different clinical epistemologies and further explore the implications of big data and machine learning for a philosophy of clinical judgement...
December 13, 2017: Journal of Evaluation in Clinical Practice
Ariel Linden, Paul R Yarnold
RATIONALE, AIMS AND OBJECTIVES: A common approach to assessing treatment effects in nonrandomized studies with time-to-event outcomes is to estimate propensity scores and compute weights using logistic regression, test for covariate balance, and then estimate treatment effects using Cox regression. A machine-learning alternative-classification tree analysis (CTA)-used to generate propensity scores and to estimate treatment effects in time-to-event data may identify complex relationships between covariates not found using conventional regression-based approaches...
December 12, 2017: Journal of Evaluation in Clinical Practice
J Palacio-Vieira, L Segura, P Anderson, A Wolstenholme, C Drummond, P Bendtsen, M Wojnar, E Kaner, M N Keurhorst, B van Steenkiste, K Kłoda, A Mierzecki, K Parkinson, D Newbury-Birch, K Okulicz-Kozaryn, P Deluca, J Colom, A Gual
INTRODUCTION AND OBJECTIVE: The ODHIN trial found that training and support and financial reimbursement increased the proportion of patients that were screened and given advice for their heavy drinking in primary health care. However, the impact of these strategies on professional accuracy in delivering screening and brief advice is underresearched and is the focus of this paper. METHOD: From 120 primary health care units (24 in each jurisdiction: Catalonia, England, the Netherlands, Poland, and Sweden), 746 providers participated in the baseline and the 12-week implementation periods...
December 1, 2017: Journal of Evaluation in Clinical Practice
Benjamin Djulbegovic, Shira Elqayam, William Dale
In spite of substantial spending and resource utilization, today's health care remains characterized by poor outcomes, largely due to overuse (overtesting/overtreatment) or underuse (undertesting/undertreatment) of health services. To a significant extent, this is a consequence of low-quality decision making that appears to violate various rationality criteria. Such suboptimal decision making is considered a leading cause of death and is responsible for more than 80% of health expenses. In this paper, we address the issue of overuse or underuse of health care interventions from the perspective of rational choice theory...
December 1, 2017: Journal of Evaluation in Clinical Practice
Maryam Taghizadeh-Ghehi, Alireza Ahmadvand
No abstract text is available yet for this article.
November 28, 2017: Journal of Evaluation in Clinical Practice
Shashi S Seshia, G Bryan Young, Michael Makhinson, Preston A Smith, Kent Stobart, Pat Croskerry
INTRODUCTION: Although patient safety has improved steadily, harm remains a substantial global challenge. Additionally, safety needs to be ensured not only in hospitals but also across the continuum of care. Better understanding of the complex cognitive factors influencing health care-related decisions and organizational cultures could lead to more rational approaches, and thereby to further improvement. HYPOTHESIS: A model integrating the concepts underlying Reason's Swiss cheese theory and the cognitive-affective biases plus cascade could advance the understanding of cognitive-affective processes that underlie decisions and organizational cultures across the continuum of care...
November 23, 2017: Journal of Evaluation in Clinical Practice
Jessica Wilkinson, Morgan Goff, Evan Rusoja, Carl Hanson, Robert Chad Swanson
OBJECTIVES: This review of systems thinking (ST) case studies seeks to compile and analyse cases from ST literature and provide practitioners with a reference for ST in health practice. Particular attention was given to (1) reviewing the frequency and use of key ST terms, methods, and tools in the context of health, and (2) extracting and analysing longitudinal themes across cases. METHODS: A systematic search of databases was conducted, and a total of 36 case studies were identified...
November 20, 2017: Journal of Evaluation in Clinical Practice
Gareth Archer, Alison Colhoun
RATIONALE, AIMS, AND OBJECTIVES: Previous studies have shown a lack of engagement in the reporting process. There is limited evidence about whether attitudes and behaviours of doctors in the UK towards incident reporting have changed following the events at Mid Staffordshire National Health Service Foundation Trust and the recommendations that followed. We conducted a relatively large survey of doctors, aiming to assess whether doctors recognised incidents and reported them accordingly, along with their behaviours towards reporting and their suggestions of how incident reporting may be improved...
November 17, 2017: Journal of Evaluation in Clinical Practice
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