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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Clinical decision support (CDS) generates excessive alerts that disrupt the workflow of clinicians. Therefore, inefficient clinical processes that contribute to the misfit between CDS alert and workflow must be evaluated. This study evaluates the appropriateness of CDS alerts in supporting clinical workflow from a socio-technical perspective. ⋯ The design and implementation of CDS alerts should be aligned with and incorporate socio-technical factors. Process improvement methods such as Lean can be used to enhance the appropriateness of CDS alerts by identifying inefficient clinical processes that impede the fit of these alerts into clinical workflow.
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The aim of this study was to investigate in detail the traumatic birth experiences of midwives in the delivery rooms, and their attitudes, reactions, and coping strategies. ⋯ Midwives need to feel valued and be supported by their institutions in coping with emotional stress. Therefore, performing clinical inspections by experienced or specialist midwives may serve as a supporting framework for reducing defensive interventions.
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New therapies are increasingly approved by regulatory agencies such as the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) based on testing in non-randomized clinical trials. These treatments have typically displayed "dramatic effects" (ie, effects that are considered large enough to obviate the combined effects of biases and random errors that may affect the study results). The agencies, however, have not identified how large these effects should be to avoid the need for further testing in randomized controlled trials (RCTs). We investigated the effect size that would circumvent the need for further RCTs testing by the regulatory agencies. We hypothesized that the approval of therapeutic interventions by regulators is based on heuristic decision making whose accuracy can be best characterized by the application of signal detection theory (SDT). ⋯ Drug developers and practitioners alike can use the change in one logarithm of effect size as a benchmark to decide if further testing in RCTs should be pursued, or as a guide to interpreting the results reported in non-randomized studies. However, further research would be useful to better characterize the threshold of effect size above which testing in RCTs is not needed.
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Hospitals were mandated to dramatically increase capacity during the Covid-19 crisis in New York City. Conversion of non-clinical space into medical units designated for Covid-19 patients became necessary to accommodate this mandate. ⋯ Converting non-clinical space to a medical unit was accomplished quickly with staffing, workflow for appropriate patients, few patients who returned to a higher level of care, and no respiratory or cardiac arrests or deaths on the unit.