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Journal of Evaluation in Clinical Practice

Andrada Pasc, Dan Navolan, Lucian Pușcașiu, Cringu Antoniu Ionescu, Florin Adrian Szasz, Adrian Carabineanu, Mihai Dimitriu, Daniel Călin, Roxana Bohilțea, Liana Ples, Dragoș Nemescu
RATIONALE, AIMS, AND OBJECTIVES: The aim of this study was to focus attention on episiotomy practice in Romanian maternity units in order to identify factors associated with the very high rate of the procedure in Romania and to consider strategies to reduce it. METHODS: In this clustered cross-sectional study, a total of 11 863 patients were recorded in eight Romanian maternity units to assess the prevalence of episiotomy. A random effects Poisson model was used to estimate the prevalence rate in univariate and multivariate models...
November 13, 2018: Journal of Evaluation in Clinical Practice
Megan A O'Grady, Sandeep Kapoor, Nancy Kwon, Jeanne Morley, Mark Auerbach, Charles J Neighbors, Joseph Conigliaro, Jon Morgenstern
RATIONALE, AIMS, AND OBJECTIVES: There are well-documented barriers that have limited widespread, sustained adoption of screening and brief intervention for risky substance use in health care settings. In order to better inform implementation efforts, this study evaluates whether patient characteristics, screening results, and implementation success indicators differed between two clinical setting types: primary care and emergency. METHODS: Patients presenting to an emergency or primary care setting were screened for risky substance use (n = 41 567)...
November 13, 2018: Journal of Evaluation in Clinical Practice
Seth K A Baffoe, James E Rohrer, James Goes
RATIONALE, AIMS, AND OBJECTIVE: Bariatric surgery is an effective procedure for morbidly obese patients when all else fails. The purpose of this study was to compare the hospital length of stay (LOS) for two surgical procedures, laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG). METHODS: This study was a retrospective cross-sectional analysis of the Nationwide Inpatient Sample (NIS) from 2009 to 2014. Patients who received bariatric surgery as indicated by International Classification of Diseases, Ninth Revision (ICD-9) procedure codes were selected (N = 4001)...
November 13, 2018: Journal of Evaluation in Clinical Practice
Wiwun Tungsubutra, Deachart Ngoenjan
OBJECTIVE: To analyse door-to-balloon (DTB) time and to identify factors significantly associated with delayed DTB in patients with ST-segment elevation myocardial infarction (STEMI) at Thailand's largest tertiary referral centre. BACKGROUND: DTB time is considered an important measure of performance quality. METHODS: This observational study analysed DTB time in patients with STEMI who presented to our institute's emergency department and underwent primary percutaneous coronary intervention (PCI) during June 2008 to May 2011...
November 12, 2018: Journal of Evaluation in Clinical Practice
Zahir Mughal, Iyad Al-Jazieh, Hammad Zaidi
RATIONALE, AIMS, AND OBJECTIVES: The introduction of shift pattern of working in the medical profession has led to an increase in reliance on effective handover of patient information. We evaluated the use of a weekend handover proforma in General Surgical patients at a University Teaching Hospital. METHODS: A standardized weekend handover proforma was implemented. A pre-post survey of medical staff and prospective observational study on the use of the proforma was carried out...
November 8, 2018: Journal of Evaluation in Clinical Practice
Lara Lusa, David Bukovšek
RATIONALE, AIMS, AND OBJECTIVES: Many hospitals provide some type of real time publicly available information about the crowding of the emergency departments (EDs). For example, at the time of writing, the number of patients waiting and in treatment is publicly available for EDs that cover more than half of the Italian population. However, usually, these data do not provide the key information that low-priority patients are seeking, which is the time they might expect to wait before being seen by a doctor...
November 8, 2018: Journal of Evaluation in Clinical Practice
Ariana Pichardo-Lowden, Michelle Farbaniec, Paul Haidet
AIMS: Despite advocacy by diabetes societies and evidence about how to prevent the deleterious consequences of dysglycemia among hospitalized patients, deficits in clinical practice continue to present barriers to care. The purpose of this study was to examine inpatient rounding practices using a qualitative research lens to assess challenges on the care of hospitalized patients with diabetes and to develop ideas for positive changes in hospital management of diabetes and hyperglycemia...
October 31, 2018: Journal of Evaluation in Clinical Practice
Nidhi Gupta, Aida Lteif, Ana Creo, Anoop Mohamed Iqbal, Siobhan Pittock, Peter J Tebben, Janet Hansen, Mary Heyrman, Rebecca Spee, Lori Scanlan-Hanson, Seema Kumar
RATIONALE, AIMS, AND OBJECTIVES: Waist circumference (WC) and waist-to-height ratio (WHtR) are superior surrogate markers of central obesity than body mass index. However, WC is not measured routinely in paediatric clinics. The objective of this study was to implement measurement of WC during routine assessment of children in an ambulatory outpatient clinic setting and subsequent dissemination of cardiometabolic risk counselling in children with central obesity (defined as WHtR ≥0.5)...
October 31, 2018: Journal of Evaluation in Clinical Practice
Christopher Carroll, Faizan Mahmood
RATIONALE, AIMS, AND OBJECTIVES: The potential bias introduced by surgeons' lack of comparable, relevant experience when performing the procedures in different arms of randomized controlled trials (RCTs) is arguably not well-managed or reported. The aim of this work was to review the frequency and nature with which surgeons' relevant experience is reported in RCTs of total hip (THA) and total knee arthroplasty (TKA), and to relate this to other risk of bias domains for this study design...
October 29, 2018: Journal of Evaluation in Clinical Practice
Elin Kjelle, Linn Kleven, Hilde Merete Olerud, Hans Olav Melberg
RATIONALE, AIMS, AND OBJECTIVE: Telemedicine applications, such as a mobile radiography service, provide a new way of organizing healthcare services. In order to provide safe and personalised care for nursing home residents during X-ray examinations, mobile radiography services have been implemented. The objective of this study was to analyse the costs of X-ray examinations and treatments for nursing home residents when comparing hospital-based imaging with a combination of hospital-based imaging and a mobile radiography service in Southeast Norway...
October 26, 2018: Journal of Evaluation in Clinical Practice
Marisa Sklar, Melissa R Hatch, Gregory A Aarons
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. Identifying and addressing factors that facilitate implementation and use of EBPs within the PCMH are crucial for improving the health and health care of the United States...
October 23, 2018: Journal of Evaluation in Clinical Practice
Jeanette M Bennett, Nicolas Rohleder, Joachim P Sturmberg
BACKGROUND: Resilience in the face of adversity is a human experience that leads to better health, both mentally and physically. We briefly review its historical origins rooted in ecological biology and its adoption into health care. Resilience is the common response to adversity or potential traumatic events. Individual differences in emotion regulation and coping skills as well as social capital and one's physical environment influence a person's ability to achieve resilience. PROPOSED MECHANISM: One potential biopsychosocial measure of resilience includes stress habituation to repeated stress as demonstrated in the laboratory, possibly providing a tool to observe mastery of resilience training in the clinic...
October 18, 2018: Journal of Evaluation in Clinical Practice
Dominic Hurst, Trish Greenhalgh
RATIONALE, AIMS, AND OBJECTIVES: Much of the literature concerned with health care practice tends to focus on a decision-making model in which knowledge sits within the minds and bodies of health care workers. Practice theories de-centre knowledge from human actors, instead situating knowing in the interactions between all human and non-human actors. The purpose of this study was to explore how practice arises in the moment-to-moment interactions between general dental practitioners (GDPs), patients, nurses, and things...
October 18, 2018: Journal of Evaluation in Clinical Practice
Andrea Falegnami, Federico Bilotta, Francesco Pugliese, Francesco Costantino, Giulio Di Gravio, Massimo Tronci, Riccardo Patriarca
RATIONALE, AIMS, AND OBJECTIVES: The application of resilience in health care requires the shift from a cause-effect approach to a systemic approach, yet few tools have been developed to measure resilience potential in this specific context. This study tests a resilience assessment grid (RAG) questionnaire to measure the resilience of anaesthesiologists, with a cross-country survey. METHOD: A study was conducted with an analytic hierarchy process (AHP) questionnaire containing 57 detailed questions; 16 nations and 172 respondents were involved in the study...
October 18, 2018: Journal of Evaluation in Clinical Practice
Mihai Dimitriu, Cringu Antoniu Ionescu, Alexandra Matei, Roxana Viezuina, George Rosu, Corina Ilinca, Mihai Banacu, Liana Ples
RATIONALE: The extent of pregnancy in adolescents and young adults, especially in low and middle-income countries, is a source of increasing concern given its social and economic impact. AIMS AND OBJECTIVE: We hypothesized that there would be correlations between female patients becoming pregnant at a young age and practices such as harmful alcohol misuse, cigarette smoking, and drug use, the use of toxic substances, low educational attainment, and an essential absence of health care seeking about the outcome of adolescent pregnancies...
October 17, 2018: Journal of Evaluation in Clinical Practice
Corinne Chmiel, Stephan R Vavricka, Susann Hasler, Gerhard Rogler, Nadine Zahnd, Salomé Schiesser, Ryan Tandjung, Nathalie Scherz, Thomas Rosemann, Oliver Senn
AIMS: Diagnosis of inflammatory bowel disease (IBD) is often associated with a diagnostic delay. Although faecal calprotectin is a helpful screening tool, the widespread use in primary care (PC) may not be appropriate due to the low prevalence of IBD in this setting. To increase pretest probability for a positive calprotectin test, an 8-item questionnaire (CalproQuest) was tested for its feasibility and acceptability in PC. METHODS: Population: PC patients with unspecific gastrointestinal complaints for at least 2 weeks...
October 15, 2018: Journal of Evaluation in Clinical Practice
Ishanka Ayeshwari Talagala, Yasara Samarakoon, Sameera Senanayake, Chrishantha Abeysena
RATIONALE, AIMS, AND OBJECTIVES: Clinical practice guidelines (CPG) play a major role in patient care in Sri Lanka. This study evaluates the methodological quality of the Sri Lankan CPGs developed in 2007. METHODS: A total of 94 CPGs developed by several professional colleges in Sri Lanka in the year 2007 were evaluated by 2 independent reviewers using AGREE II instrument for their methodological quality. Item score being ≤3 points was defined as "poor quality"...
October 15, 2018: Journal of Evaluation in Clinical Practice
Jason D Woodfine, Carl van Walraven
OBJECTIVES: After patients are discharged from the emergency department (ED), follow-up of test results focuses on abnormal values. In the elderly, non-specific symptoms can result in an incorrect diagnosis of urinary tract infection (UTI). This study compared the outcomes of patients discharged from the ED with a diagnosis of UTI based on urine culture results. METHODS: We conducted a retrospective cohort study using linked health databases and chart review of a random sample of elderly patients (age > 65 years) discharged from the Ottawa Hospital ED between 2006 and 2014 with a diagnosis of UTI...
October 12, 2018: Journal of Evaluation in Clinical Practice
Susan P Jacups, Irina Kinchin, Kate M McConnon
RATIONALE, AIMS, AND OBJECTIVES: This costing evaluation compares three service delivery models for ear, nose, and throat (ENT) surgery for remote living Indigenous children to improve their hearing outcomes, with the aim to identify the least costly model. METHODS: The main outcome measure presented was the incremental cost difference between the base case (Model 1) and two alternative models (Model 2, 3). The costs in 2017 Australian dollars are assessed from two viewpoints: (1) health system perspective, and (2) patients and their families including travel out-of-pocket expenses, presented separately according to the funding source...
October 12, 2018: Journal of Evaluation in Clinical Practice
Rocío Fernández-Méndez, Sancho Rodríguez-Villar, Pablo F Méndez, Richard Windle, Gary George Adams
RATIONALE, AIMS, AND OBJECTIVES: The practice of glycaemic control of critically ill patients admitted to intensive care units (ICUs) is guided by clinical management protocols, designed locally by the ICUs. These protocols differ significantly in their aims and methods. The aim of this study was to develop a standardized methodology for the systematic and objective analysis and comparison of protocols for glycaemic control implemented in any ICU. METHOD: The protocols for glycaemic control implemented in seven ICUs of a UK-based ICU network were analysed using techniques of inductive content analysis, through an open coding process and the framework method...
October 11, 2018: Journal of Evaluation in Clinical Practice
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