Journal of evaluation in clinical practice
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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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Although mental health clinics are under increasing pressure to demonstrate value and routine outcome monitoring (ROM) has become a mandated component of care, providers have been slow to adopt ROM into practice, with some estimating that less than 20% of mental health clinicians use it consistently in the United States. This article explores perceived barriers and facilitators to integrating ROM into practice among clinicians and administrators in a large urban US community psychiatry clinic. ⋯ In order for psychiatry clinics to successfully implement ROM into practice, they must diagnose organization-side barriers and translate this knowledge into actionable quality improvement initiatives ranging from the infrastructural to the cultural.
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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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This article aims to identify the factors that affect physicians' experiences of receiving practice data and to use these data to develop a model describing how individuals interact with the data. ⋯ Our novel model depicts the relationship between data feedback systems and individuals' mindsets interact to augment or hinder clinical practice improvement. This model may provide leaders with a framework to examine their academic and administrative structures and how they might interface with performance feedback systems with clinicians.
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Shared decision-making (SDM) is considered the "final stage" that completes the implementation of evidence-based medicine. Yet, it is also considered the most neglected stage. SDM shifts the epistemological authority of medical knowledge to one that deliberately includes patients' values and preferences. Although this redefines the work of the clinical encounter, it remains unclear what a shared decision is and how it is practiced. ⋯ There is a need for a more nuanced understanding of SDM as a "graded" framework that allows for flexibility in decision-making styles to accommodate patient's unique preferences and needs and to expand the manoeuvring space for decision-making. The strategies in this study show how our understanding of SDM as a process of multi-dyadic interactions that spatially exceed the consulting room offers new avenues to make SDM workable in contemporary medicine.