Journal of evaluation in clinical practice
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Letter Multicenter Study
Exploring risk and ease of use for insulin delivery by nurses.
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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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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.
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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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Data about health care organizations (HCOs) are not useful until they are interpreted. Such interpretations are influenced by the theoretical lenses used by the researcher. ⋯ We suggest that the task of interpreting research observations of HCOs could be improved if researchers take into account that the systems they study are CASs with non-linear relationships among diverse, learning agents. Our analysis points out how interpretation of research results might be shaped by the fact that HCOs are CASs. We described how learning is, in fact, the result of interactions among diverse agents and that learning can, by itself, reduce or increase agent diversity. We encouraged researchers to be persistent in their attempts to reason about complex systems and learn to attend not only to structures, but also to processes and functions of complex systems.