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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
Aline Richard, Olga Frank, David Schwappach
RATIONALE, AIMS AND OBJECTIVES: Early warning score systems (EWS-S) have been shown to be valuable tools to recognize otherwise unnoticed clinical deterioration (CDET) of patients. They have been associated with fewer unplanned transfers to the intensive care unit (UTICU) and lower in-hospital mortality. Little is known about their current usage in Switzerland and about the attitudes towards such tools among chief physicians. We aimed to assess the use of EWS-S in Switzerland and the attitudes of chief physicians towards EWS-S depending on previously experienced CDET followed by UTICU, reanimation, or death...
November 8, 2017: Journal of Evaluation in Clinical Practice
Ariel Linden, Paul R Yarnold
RATIONALE, AIMS, AND OBJECTIVES: Mediation analysis identifies causal pathways by testing the relationships between the treatment, the outcome, and an intermediate variable that mediates the relationship between the treatment and outcome. This paper introduces classification tree analysis (CTA), a machine-learning procedure, as an alternative to conventional methods for analysing mediation effects. METHOD: Using data from the JOBS II study, we compare CTA to structural equation models (SEMs) by assessing their consistency in revealing mediation effects on 2 outcomes; reemployment (a binary variable) and depressive symptoms (a continuous variable)...
November 3, 2017: Journal of Evaluation in Clinical Practice
Joseph K Kluesner, Darrick J Beckman, Joshua M Tate, Alexis A Beauvais, Maria I Kravchenko, Jana L Wardian, Sky D Graybill, Jeffrey A Colburn, Irene Folaron, Mark W True
RATIONALE: Current guidelines recommend thyroid stimulating hormone (TSH) alone as the best test to detect and monitor thyroid dysfunction, yet free thyroxine (FT4) and free triiodothyronine (FT3) are commonly ordered when not clinically indicated. Excessive testing can lead to added economic burden in an era of rising healthcare costs, while rarely contributing to the evaluation or management of thyroid disease. OBJECTIVE: To evaluate our institution's practice in ordering thyroid function tests (TFTs) and to identify strategies to reduce inappropriate FT4 and FT3 testing...
November 3, 2017: Journal of Evaluation in Clinical Practice
Christopher Mayes, Jane Williams, Ian Kerridge, Wendy Lipworth
AIM: This paper reports on the findings from 6 focus groups conducted with Australian medical students. The focus groups sought students' perspectives on how the influence of commercial interests on medical practice and education could be managed. METHOD: We conducted 6 focus groups with medical students in New South Wales, Australia. Participants were recruited via student-run medical society and faculty e-mail lists. Forty-nine students from 6 medical schools in New South Wales participated...
November 3, 2017: Journal of Evaluation in Clinical Practice
Giovanni Improta, Mario Cesarelli, Paolo Montuori, Liberatina Carmela Santillo, Maria Triassi
RATIONALE, AIMS, AND OBJECTIVES: Lean Six Sigma (LSS) has been recognized as an effective management tool for improving healthcare performance. Here, LSS was adopted to reduce the risk of healthcare-associated infections (HAIs), a critical quality parameter in the healthcare sector. METHODS: Lean Six Sigma was applied to the areas of clinical medicine (including general medicine, pulmonology, oncology, nephrology, cardiology, neurology, gastroenterology, rheumatology, and diabetology), and data regarding HAIs were collected for 28,000 patients hospitalized between January 2011 and December 2016...
November 3, 2017: Journal of Evaluation in Clinical Practice
Amy Price, Loai Albarqouni, Jo Kirkpatrick, Mike Clarke, Su May Liew, Nia Roberts, Amanda Burls
BACKGROUND: Funders encourage lay-volunteer inclusion in research. There are controversy and resistance, given concerns of role confusion, exploratory methods, and limited evidence about what value lay-volunteers bring to research. This overview explores these areas. METHODS: Eleven databases were searched without date or language restrictions for systematic reviews of public and patient involvement (PPI) in clinical trials design. This systematic overview of PPI included 27 reviews from which areas of good and bad practice were identified...
October 27, 2017: Journal of Evaluation in Clinical Practice
Sabine Salloch, Ina Otte, Anke Reinacher-Schick, Jochen Vollmann
BACKGROUND: Physicians' clinical expertise forms an exclusive body of competences, which helps them to find the appropriate diagnostics and treatment for each individual patient. Empirical evidence, however, suggests that there is an inverse relationship between the number of years in practice and the quality of care provided by a physician. Knowledge and adherence to professional standards (such as clinical guidelines) are often used as indicators in previous research. METHODS: Semistructured interviews and the Q method were used for an explorative study on oncologists' views on the interplay between their own clinical expertise, intuition, and the external evidence incorporated in clinical guidelines...
October 27, 2017: Journal of Evaluation in Clinical Practice
Dana Tzur Bitan, Ori Ganor, Lior Biran, Yuval Bloch
OBJECTIVES: This study aimed to assess the feasibility, benefits, and challenges of routine outcome monitoring (ROM) in a public mental health centre in Israel. This is the first initiation of ROM implementation in a setting of a large psychiatric hospital, affiliated with the largest health maintenance organization in Israel, Clalit Health Services. METHODS: Four ambulatory units were invited to participate in the implementation of ROM. Prior to initiation of recruitment, staff meetings were held and broad descriptions of current knowledge regarding benefits and challenges were discussed...
October 25, 2017: Journal of Evaluation in Clinical Practice
Simon Deslauriers, Marie-Hélène Raymond, Maude Laliberté, Amélie Lavoie, François Desmeules, Debbie E Feldman, Kadija Perreault
RATIONALE: The prevalence of musculoskeletal disorders is high and expected to increase in the next decade. Persons suffering from musculoskeletal disorders benefit from early physiotherapy services. However, access to publicly funded physiotherapy services has been shown to be compromised by long waiting times and limited availability of resources in many countries around the world. Decisions on resource allocation may create geographic disparities in provision and access to services, which may result in inequity in access...
October 23, 2017: Journal of Evaluation in Clinical Practice
Kim D Jones, Jonathan H Aebischer, Amanda W St John, Ronald Friend, Robert M Bennett
RATIONALE, AIMS, AND OBJECTIVES: Primary care providers are increasingly expected to recognize and treat fibromyalgia (FM) without significant interaction with rheumatologists. The purpose of this study was to evaluate the potential usefulness of 3 simple measures (tenderness to digital pressure, BP cuff-evoked pain, and a single patient question) as a screening test for possible FM in a patient with chronic pain. METHODS: A total of 352 patients (mean age 50 ± 16...
October 23, 2017: Journal of Evaluation in Clinical Practice
Vassiliki Sinopoulou, Paul Summerfield, Paul Rutter
RATIONALE, AIMS, AND OBJECTIVES: Self-care policies are increasingly directing patients to seek advice from community pharmacists. This means pharmacists need to have sound diagnostic decision-making skills to enable them to recognise a variety of conditions. The aim of this study was to investigate the process by which pharmacists manage patient signs and symptoms and to explore their use of decision-making for diagnostic purposes. METHODS: Data were collected through semi-structured, face-to-face interviews with community pharmacists working in England, between August 2013 and November 2014...
October 8, 2017: Journal of Evaluation in Clinical Practice
Akiko Shibuya, Jimpei Misawa, Yukihiro Maeda, Rie Ichikawa, Michiyo Kamata, Ryusuke Inoue, Tetsuji Morimoto, Masaharu Nakayama, Teruyoshi Hishiki, Yoshiaki Kondo
RATIONALE, AIMS, AND OBJECTIVES: Time is an important element in medical data. Physicians record and store information about patients' disease progress and treatment response in electronic medical records (EMRs). Because EMRs use timestamps, physicians can identify patterns over time regarding a patient's disease and treatment (eg, laboratory values and medications). However, analyses of physicians' use and satisfaction with EMRs have focused on functionality, storage, and system operation rather than the use of time-oriented information...
October 8, 2017: Journal of Evaluation in Clinical Practice
David Roder, Gelareh Farshid, Jim Kollias, Bogda Koczwara, Christos Karapetis, Jacqui Adams, Rohit Joshi, Dorothy Keefe, Caroline Miller, Kate Powell, Kellie Fusco, Marion Eckert, Elizabeth Buckley, Kerri Beckmann, Timothy Price
BACKGROUND: Clinical registry data from major South Australian public hospitals were used to investigate trends in invasive breast-cancer treatment and survival by age. METHODS: Disease-specific survival was calculated for the 1980 to 2013 diagnostic period using Kaplan-Meier product-limit estimates, with a censoring of live cases on December 31, 2014. Cox proportional hazards regression was used to examine differences in survival by age and tumour characteristic...
October 8, 2017: Journal of Evaluation in Clinical Practice
Jacky Jones, Gareth D Jones, Michael Thacker, Sara Faithfull
BACKGROUND: Older adults live with multimorbidity including frailty and cognitive impairment often requiring hospitalization. While physical activity interventions (PAIs) are a normal rehabilitative treatment, their clinical effect in hospitalized older adults is uncertain. OBJECTIVE: To observe PAI dosing characteristics and determine their impact on clinical performance parameters. DESIGN: A single-site prospective observational cohort study in an older persons' unit...
October 8, 2017: Journal of Evaluation in Clinical Practice
David P Glass, Michael H Kanter, Steven J Jacobsen, Paul M Minardi
OBJECTIVES: To measure the size and timing of changes in utilization and costs for employees and dependents who had major access barriers to primary care removed, across an 8-year period (2007 to 2014). STUDY DESIGN AND METHODS: Retrospective observational study examining patterns of utilization and costs before and after the implementation of a worksite medical office in 2010. The worksite office offered convenient primary care services with no travel from work, essentially guaranteed same day access, and no co-pay...
October 6, 2017: Journal of Evaluation in Clinical Practice
M Felicitas Domínguez-Berjón, Myrian Pichiule-Castañeda, M Carmen García-Riolobos, María D Esteban-Vasallo, Sonia M Arenas-González, Mónica Morán-Arribas, José Verdejo-Ortés, Ana Clara Zoni, M Carmen Álvarez-Castillo, Jenaro Astray
RATIONALE AND OBJECTIVES: Late diagnosis of HIV infection is a public health problem. Framed by the international guidelines for improving HIV testing, in 2014, the Spanish Ministry of Health published a guide of recommendations to promote early diagnosis of HIV in health care settings. In the Community of Madrid, in order to implement these recommendations, we defined 3 new HIV testing strategies in primary health care. The objectives of this study were to know the interest of professionals and the acceptability for patients towards these strategies...
October 2, 2017: Journal of Evaluation in Clinical Practice
Jacob West, Garret Johnson, Ashish K Jha
RATIONALE, AIMS, AND OBJECTIVES: The US health care system is marked by a high degree of fragmentation in both delivery and financing. Some evidence suggests that attempts to reduce fragmentation have led to significant provider consolidation, including hospital acquisitions of physician groups, or "vertical integration." The objective was to use time-series data to quantify trends in and characteristics of hospital acquisitions of physician practices. A secondary objective was to use case studies to determine the motivations for these acquisitions and to identify what integration results from these transactions...
October 2, 2017: Journal of Evaluation in Clinical Practice
Karen A Maes, Helene Studer, Jérôme Berger, Kurt E Hersberger, Markus L Lampert
RATIONALE, AIMS, AND OBJECTIVES: During the dispensing process, pharmacists may come across technical and clinical issues requiring a pharmaceutical intervention (PI). An intervention-oriented classification system is a helpful tool to document these PIs in a structured manner. Therefore, we developed the PharmDISC classification system (Pharmacists' Documentation of Interventions in Seamless Care). The aim of this study was to evaluate the PharmDISC system in the daily practice environment (in terms of interrater reliability, appropriateness, interpretability, acceptability, feasibility, and validity); to assess its user satisfaction, the descriptive manual, and the online training; and to explore first implementation aspects...
September 29, 2017: Journal of Evaluation in Clinical Practice
Giovanni Improta, Giovanni Balato, Maria Romano, Alfonso Maria Ponsiglione, Eliana Raiola, Mario Alessandro Russo, Patrizia Cuccaro, Liberatina Carmela Santillo, Mario Cesarelli
RATIONALE, AIMS, AND OBJECTIVES: The work is a part of a project about the application of the Lean Six Sigma to improve health care processes. A previously published work regarding the hip replacement surgery has shown promising results. Here, we propose an application of the DMAIC (Define, Measure, Analyse, Improve, and Control) cycle to improve quality and reduce costs related to the prosthetic knee replacement surgery by decreasing patients' length of hospital stay (LOS) METHODS: The DMAIC cycle has been adopted to decrease the patients' LOS...
September 26, 2017: Journal of Evaluation in Clinical Practice
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