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Clinical practice policy

Jun-Hua Zhang, You-Ping Li, Bo-Li Zhang
The introduction and popularization of evidence-based medicine has opened up a new research field of clinical efficacy evaluation of traditional Chinese medicine(TCM), produced new research ideas and methods, and promoted the progress of clinical research of TCM. After about 20 years assiduous study and earnest practice, the evidence based evaluation method and technique, which conforms to the characteristics of TCM theory and practice, has been developing continuously. Evidence-based Chinese medicine (EBCM) has gradually formed and become an important branch of evidence-based medicine...
January 2018: Zhongguo Zhong Yao za Zhi, Zhongguo Zhongyao Zazhi, China Journal of Chinese Materia Medica
Tammy Toscos, Maria Carpenter, Mindy Flanagan, Kislaya Kunjan, Bradley N Doebbeling
Background: Despite health care access challenges among underserved populations, patients, providers, and staff at community health clinics (CHCs) have developed practices to overcome limited access. These "positive deviant" practices translate into organizational policies to improve health care access and patient experience. Objective: To identify effective practices to improve access to health care for low-income, uninsured or underinsured, and minority adults and their families...
January 2018: Health Services Research and Managerial Epidemiology
Carolyn F Weiniger, Sharon Einav, Uriel Elchalal, Vladislav Ozerski, Daniel Shatalin, Alexander Ioscovich, Yehuda Ginosar
BACKGROUND: Care of pregnant women with concurrent medical conditions can be optimized by multidisciplinary antenatal management. In the current study we describe women with concurrent medical conditions who attended our antenatal anesthesia clinic over a 14-year period, 2002-2015 and, based on the findings, we suggest new policies, strategies and practices to improve antenatal care. METHODS: In 2002, an antenatal anesthesia clinic was established in Hadassah Medical Center...
March 19, 2018: Israel Journal of Health Policy Research
Helen Hall, Matthew J Leach, Caragh Brosnan, Robyn Cant, Melissa Collins
OBJECTIVE: To identify communication patterns of Registered Nurses regarding patients' use of complementary therapies. METHODS: A cross-sectional online survey conducted in 2017 recruited Australian Registered Nurses working in any area of nursing. RESULTS: Responses of 614 Registered Nurses were analysed. Patient-initiated discussion of complementary therapies were common for 77% of nurses; nurse-initiated discussions were perceived by 73% (sometimes/almost always/always)...
March 7, 2018: Patient Education and Counseling
Maria Heckel, Stephanie Stiel, Franziska A Herbst, Johanna M Tiedtke, Alexander Sturm, Thomas Adelhardt, Christian Bogdan, Cornel Sieber, Oliver Schöffski, Frieder R Lang, Christoph Ostgathe
PURPOSE: Palliative care professionals are frequently confronted with patients colonized or infected with MDRO. One major challenge is how to balance necessary isolation measures and social inclusion as one of the main principles of palliative and end-of-life care. To date, MDRO-specific policies and protocols vary widely between institutions. AIM: provide empirical recommendations on how to deal with hospitalized MDRO patients in end-of-life care. METHODS: Recommendations were developed based on (i) initial results of face-to-face interviews and focus groups, (ii) impartial experts' comments and consensus on the draft via online survey and (iii) a face-to-face meeting with consortium members to finalize recommendations...
March 16, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Barbara Miller Williams, Cindy Wright, Katherine H Leigh, Brittney Armstrong, Sabrina Kelley
Tattoos have become increasingly popular in the U.S. among the general population. Furthermore, the popularity of body art, primarily tattoos, among nursing students generates issues about professionalism in academics and in clinical settings. Nursing faculty are faced with conflicting views on cultural awareness, professionalism, and self-expression. With nursing viewed as one of the most trusted professions, the policy of covering tattoos should be discussed, and more research is necessary.
March 15, 2018: Journal of Christian Nursing: a Quarterly Publication of Nurses Christian Fellowship
Pavani Rangachari
In 1999, the Institute of Medicine reported that 98,000 people die each year due to medical errors. In the following years, the focus on hospital quality was intensified nationally, with policymakers providing evidence-based practice guidelines for improving health care quality. However, these innovations (evidence-based guidelines) that were being produced at policy levels were not translating to clinical practice at the hospital organizational level easily, and stark variations continued to persist, in the quality of health care...
2018: Innov Entrep Health
Andras Inotai, Marcell Csanadi, Guenka Petrova, Maria Dimitrova, Tomasz Bochenek, Tomas Tesar, Kristina York, Leos Fuksa, Alexander Kostyuk, Laszlo Lorenzovici, Vitaly Omelyanovskiy, Katalin Egyed, Zoltan Kalo
This policy research aims to map patient access barriers to biologic treatments, to explore how increased uptake of biosimilars may lower these hurdles and to identify factors limiting the increased utilisation of biosimilars. A policy survey was developed to review these questions in 10 Central and Eastern European (CEE) and Commonwealth of Independent States (CIS) countries. Two experts (one public and one private sector representative) from each country completed the survey. Questions were related to patient access, purchasing, clinical practice, and real-world data collection on both original biologics and biosimilars...
2018: BioMed Research International
Samuel Johnson, Sharmala Thuraisingam, John Furler, Jo-Anne Manski Nankervis
Insulin initiation is often delayed in primary care partly because of clinician concerns about the additional clinical work. This study describes health services usage (HSU) pre- and post-insulin initiation in people with type 2 diabetes and out-of-target glycaemic levels. Secondary analysis of participant data from the Stepping Up randomised controlled trial of a model of care for insulin initiation in general practice was undertaken. For 142 people who commenced insulin, HSU in the 6 months prior was compared to that in the 12 months following insulin initiation...
March 16, 2018: Australian Journal of Primary Health
Marie Fallon, Jane Walker, Lesley Colvin, Aryelly Rodriguez, Gordon Murray, Michael Sharpe
Purpose Pain is suboptimally managed in patients with cancer. We aimed to compare the effect of a policy of adding a clinician-delivered bedside pain assessment and management tool (Edinburgh Pain Assessment and management Tool [EPAT]) to usual care (UC) versus UC alone on pain outcomes. Patients and Methods In a two-arm, parallel group, cluster randomized (1:1) trial, we observed pain outcomes in 19 cancer centers in the United Kingdom and then randomly assigned the centers to either implement EPAT or to continue UC...
March 15, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Barry A Farber
The election and postelection policies of Donald Trump have seeped into the psychotherapy sessions of many clients, in ways that are somewhat unique but also somewhat reminiscent of the ways that other dramatic social-political events, including 9/11 and the social divisions that were characteristic of the 1960s, were brought into the treatment room. The nine articles within this issue-seven papers from practicing psychotherapists, one from an executive coach, and one empirical paper-suggest strongly that the political events surrounding the election of 2016 have become a significant part of psychotherapeutic discourse for many clients, that many therapists have been willing participants in such discussions, and that a focus on political issues (broadly speaking) can have important clinical benefits, facilitating the therapeutic alliance and leading to greater understanding of long-standing client problems and interpersonal functioning...
March 15, 2018: Journal of Clinical Psychology
Michael J Annear
OBJECTIVES: Best-evidence dementia knowledge has the potential to improve care practices in aged care settings, although limited research has explored understanding among the Japanese workforce. This study examines the knowledge of dementia and educational needs among aged care professionals across Japan. METHODS: An online survey methodology was used to assess the dementia experiences and knowledge among a national, random sample of 117 Japanese aged care professionals...
March 14, 2018: Australasian Journal on Ageing
Louis M Katz, John J Donnelly, Christopher J Gresens, Jerry A Holmberg, James MacPherson, Peter J K Zacharias, Jean Stanley, Christine Bales
On March 24, 2017, more than 90 experts in blood safety and international development from blood centers, industry, government, and international and nongovernmental organizations gathered in Arlington, Virginia, for the Third International Blood Safety Forum, cosponsored by America's Blood Centers and Global Healing. This report summarizes presentations and major conclusions. The meeting explored ways to increase access to affordable, safe blood for low- and lower-middle-income countries (LMICs) in an era when funding from the US President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund has been redirected from preventing the spread of human immunodeficiency virus (HIV) to diagnosing and treating the 25 million-plus people living with HIV in LMICs...
March 14, 2018: Transfusion
Saad Chahine, Kulamakan Mahan Kulasegaram, Sarah Wright, Sandra Monteiro, Lawrence E M Grierson, Cassandra Barber, Stefanie S Sebok-Syer, Meghan McConnell, Wendy Yen, Andre De Champlain, Claire Touchie
There exists an assumption that improving medical education will improve patient care. While seemingly logical, this premise has rarely been investigated. In this Invited Commentary, the authors propose the use of big data to test this assumption. The authors present a few example research studies linking education and patient care outcomes and argue that using big data may more easily facilitate the process needed to investigate this assumption. The authors also propose that collaboration is needed to link educational and health care data...
March 13, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
Moran N Cabili, Knox Carey, Stephanie O M Dyke, Anthony J Brookes, Marc Fiume, Francis Jeanson, Giselle Kerry, Alex Lash, Heidi Sofia, Dylan Spalding, Anne-Marie Tasse, Susheel Varma, Ravi Pandya
The volume of genomics and health data is growing rapidly, driven by sequencing for both research and clinical use. However, under current practices, the data is fragmented into many distinct datasets, and researchers must go through a separate application process for each dataset. This is time-consuming both for the researchers and the data stewards, and it reduces the velocity of research and new discoveries that could improve human health. We propose to simplify this process, by introducing a standard Library Card that identifies and authenticates researchers across all participating datasets...
March 14, 2018: Scientific Data
Norita Hussein, Stephen F Weng, Joe Kai, Jos Kleijnen, Nadeem Qureshi
BACKGROUND: Globally, about five per cent of children are born with congenital or genetic disorders. The most common autosomal recessive conditions are thalassaemia, sickle cell disease, cystic fibrosis and Tay-Sachs disease, with higher carrier rates in specific patient populations. Identifying and counselling couples at genetic risk of the conditions before pregnancy enables them to make fully informed reproductive decisions, with some of these choices not being available if genetic counselling is only offered in an antenatal setting...
March 14, 2018: Cochrane Database of Systematic Reviews
Marja Visser, Trudie Gerrits, Fulco van der Veen, Monique Mochtar
When intended parents choose to have donor sperm treatment (DST), this may entail wide-ranging and long-lasting psychosocial implications related to the social parent not having a genetic tie with the child, how to disclose donor-conception and future donor contact. Counselling by qualified professionals is recommended to help intended parents cope with these implications. The objective of this study is to present findings and insights about how counsellors execute their counselling practices. We performed a qualitative study that included 13 counsellors working in the 11 clinics offering DST in the Netherlands...
March 14, 2018: Human Fertility: Journal of the British Fertility Society
Hopin Lee, Alix Hall, Nicole Nathan, Kathryn L Reilly, Kirsty Seward, Christopher M Williams, Serene Yoong, Meghan Finch, John Wiggers, Luke Wolfenden
BACKGROUND: The World Health Organization recommends that nations implement evidence-based nutritional guidelines and policies in settings such as schools and childcare services to improve public health nutrition. Understanding the causal mechanism by which implementation strategies exert their effects could enhance guideline implementation. The aim of this study was to assess the mechanisms by which implementation strategies improved schools and childcare services' adherence to nutrition guidelines...
March 12, 2018: Implementation Science: IS
Marta O Soares, Simon Walker, Stephen J Palmer, Mark J Sculpher
In recent years, Health Technology Assessment (HTA) processes specific to diagnostics and prognostic tests have been created in response to the increased pressure on health systems to decide not only which tests should be used in practice but also the best way to proceed, clinically, from the information they provide. These technologies differ in the way value is accrued to the population of users, depending critically on the value of downstream health care choices. This paper defines an analytical framework for establishing the value of diagnostic and prognostic tests for HTA in a way that is consistent with methods used for the evaluation of other health care technologies...
March 1, 2018: Medical Decision Making: An International Journal of the Society for Medical Decision Making
Linda Rainey, Daniëlle van der Waal, Anna Jervaeus, Yvonne Wengström, D Gareth Evans, Louise S Donnelly, Mireille J M Broeders
BACKGROUND: Increased knowledge of breast cancer risk factors provides opportunities to shift from a one-size-fits-all screening programme to a personalised approach, where screening and prevention is based on a woman's risk of developing breast cancer. However, potential implementation of this new paradigm could present considerable challenges which the present review aims to explore. METHODS: Bibliographic databases were searched to identify studies evaluating potential implications of the implementation of personalised risk-based screening and primary prevention for breast cancer...
March 9, 2018: Breast: Official Journal of the European Society of Mastology
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