Journal of evaluation in clinical practice
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Dizziness presentations pose many clinical challenges. The objective of this study is to broadly summarize the evidence base that supports clinical decisions in dizziness presentations. ⋯ The evidence base for the evaluation and management of dizziness seems to be weak. Future work to establish or summarize evidence in clinically meaningful ways could contribute to efforts to optimize patient care and health care utilization for one of the most common presenting symptoms.
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Four maternity/obstetrical care organizations, representing women, midwives, obstetricians and family doctors conducted interdisciplinary policy research under auspices of four key stakeholder groups. These projects teams and key stakeholders subsequently collaborated to develop consensus on strategies for improved maternity services in Ontario. ⋯ This evaluation used an approach comprising scoping, pattern processing and sense making. While the projects produced considerable typical research evidence, the key policy questions could not be addressed by this alone, and a process of synthesis and consensus building with stakeholder engagement was applied. An adaptive system with local needs driving a relationship based network of interdisciplinary groupings or teams with both bottom up and central leadership. A complexity framework enhanced sense making for the system approaches and understandings that emerged.
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Multicenter Study
GPs' perceptions of multiple-medicine use in older patients.
Multiple-medicine use (polypharmacy) is a growing problem for older patients, prescribers and health policy makers. The general practitioner (GP) is most often the main professional care provider; hence, improvements of treatment can only be carried out in concordance with GPs. The aim of this study was, therefore, to explore GPs' perspectives of treating older users of multiple medicines, using a qualitative approach. ⋯ The GPs felt insecure although surrounded by clinical practice guidelines. There is a need for policy makers to appreciate this paradox, as the problem is likely to grow in size and proportion. GPs must be empowered to handle the increasing proportion of older users of multiple medicines with individual agendas, receiving care from multiple specialists.
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Letter Multicenter Study
Exploring risk and ease of use for insulin delivery by nurses.
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Conflict-of-interest (COI) policies have played a vital role in protecting the integrity of science as well as protecting patients' welfare. However, the usefulness of these policies could be enhanced by addressing gaps in disclosure requirements, especially insofar as these gaps may impede the intended neutrality of COI policies. For example, current COI policies have not addressed potential conflicts created by indirect industry funding, such as when pharmaceutical companies provide general funding to researchers' academic departments or to medical educational programmes. Nor do they address the consequent creation of climates of opinion, which may marginalize important criticisms and undermine progress on this important policy issue. ⋯ Taking the position that a more adequate system of checks and balances is needed, the authors offer specific recommendations for improving current policies and for addressing the issue of indirect support.