Journal of evaluation in clinical practice
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We systematically reviewed the literature on paediatric frequent emergency department (ED) users to identify and to synthesize characteristics and factors associated with frequent ED utilization among this population in the United States. ⋯ Minimizing unnecessary ED visits by frequent utilizers is a quality improvement and cost-saving priority for health systems. Our findings indicate that many PFED users have greater healthcare needs and face barriers accessing care in a timely manner, even though some have regular providers. To better address the needs of this vulnerable group, health systems should focus on educating caregivers and expanding access to providers in other settings.
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While the quality of medical care delivered by physicians can be very good, it can also be inconsistent and feature behaviours that are entrenched despite updated information and evidence. The "nudge" paradigm for behaviour change is being used to bring clinical practice in line with desired standards. The premise is that behaviour can be voluntarily shifted by making particular choices instinctively appealing. We reviewed studies that are explicit about their use of nudge theory in influencing clinician behaviour. ⋯ Published studies that are explicit about their use of nudge theory are few in number and diverse in their settings, targets, and results. Default and chart re-design interventions reported the most substantial improvements in adherence to evidence and guideline-based practice. Studies that are explicit in their use of nudge theory address the widespread failure of clinical practice studies to identify theoretical frameworks for interventions. However, few studies identified in our review engaged in research to understand the contextual and site-specific barriers to a desired behaviour before designing a nudge intervention.
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It is well known that tests are not 100% accurate at classifying individuals. The actual condition of an individual(e.g. diseased, or not diseased) does not coincide with her test result (positive, or negative). Nevertheless, it is often presupposed, as a rule of thumb, that individuals with negative results can be "ruled out" if screening test is highly sensitive and "ruled in" if screening test is highly specific. This has led to the mnemonic SNNOUT (sensitive negative out) and SPPIN (specific positive in). ⋯ The correct rules of thumb could be of great help to doctors and patients.
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To asses smoking cessation counselling practices (SCC) among health care providers dealing with cancer patients. ⋯ It is essential to provide training, referral facilities, and supportive policies to encourage SCC practices.
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Medication administration is a complex and time-consuming task in residential aged care facilities (RACFs). Understanding the time associated with each administration step may help identify opportunities to optimize medication management in RACFs. This study aimed to investigate the time taken to administer medications to residents, including those with complex care needs such as cognitive impairment and swallowing difficulties. ⋯ Nurses took an average of 5 minutes to administer medications per resident per medication round. Medication administration in memory support units took an additional minute per resident per round, with almost half of tablets and capsules needing to be crushed.