Journal of evaluation in clinical practice
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The efficacy, cost-effectiveness, and safety of a number of endoscopic procedures are largely dependent on optimal preparation. Despite this however, inadequate or suboptimal preparation is relatively common. Most studies have revealed inadequate preparation for between 20% and 30% of patients. This audit sought to examine the impact of English language proficiency, and ethnicity, on endoscopic preparation and procedure success or failure. ⋯ Amongst these patients, we found that a little more than 20% of participants were inadequately prepared for their endoscopic procedure. We found no relationship between language proficiency on preparation. Given the mixed literature on interventions to improve preparation before endoscopic procedures, further directions are identified to work toward the development and testing of a novel intervention amongst this population. In identifying those who may be at risk for inadequate preparation for endoscopic procedures, practice needs to take into account a range of factors beyond language and ethnicity. Furthermore, the persistent reliance on family members to interpret information sheets and preparation advice suggests that revision and/or development of culture and language-specific materials is necessary.
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Our aim was to investigate verbal representations of intervention effect-size, uncertainty of evidence, and possible intervention comparators in statements concerning effects of interventions in Finnish clinical practice guidelines. ⋯ Communicating beneficial intervention effects, effect-sizes, possible comparators, and uncertainty of evidence require much broader attention in the clinical practice guideline context.
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Misunderstanding medication dosage regimen instructions can lead to unintentional misuse of a prescribed medicine, non-adherence to providers' instructions, and other treatment-related issues. We aimed to evaluate the frequency of and factors associated with older patients' misunderstanding of medication dosage regimen instructions after consultation with a general practitioner. ⋯ The results showed that older people's misunderstandings of medication dosage regimen instructions after consultation with a general practitioner was greater than expected due to a range of factors, especially polypharmacy, poor literacy, poor memory, and having a job at the time of the interview. Health services and professionals should implement strategies to increase the quality of the guidance given to elderly individuals and to ensure their adherence to the regimen instructions of their medications.
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Support for the concept of respect for first-person informed consent and patient autonomy, including the negative right of patients to refuse unwanted interventions has grown, but does not generally include a positive right of patients to receive whatever treatment they request or demand without constraint. Despite this, health-care providers in both Canada and the United States are guilty of providing, in their own opinions, futile or probably futile treatments at the request of patients or their substitute decision-makers. ⋯ The initial hypothesis of the researcher in this study was that SDM is not well understood by physicians, and that this lack of understanding, combined with other factors to be discussed in the full text, may result in patients receiving ethically-inappropriate treatment. Results suggest support for this hypothesis, and that SDM should be more closely examined if it is to be pursued as a method of decision making.