Journal of evaluation in clinical practice
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This scoping review aimed to understand potential barriers and facilitators in transitioning patients from specialty to primary care settings, to inform the implementation of an intervention to promote active consideration of psychiatrically stable patients for transition from the specialty mental health setting back to primary care. ⋯ Findings from this scoping review enable an increased understanding of current practices and considerations regarding care transitions from specialty to primary care settings. The importance of role clarification, shared clinical information systems, confidence in care competency, and adequate organizational support to promote appropriate transitions were themes most widely reported across the reviewed studies. Few studies specifically examined the transition from specialty mental health to primary care. Future studies should account for mental health-specific symptomatic patterns and recovery trajectories, such as prevalent chronicity and frequency of relapse, in planning and conducting transitions from specialty mental health back to primary care.
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Since its publication, the World Health Organization Surgical Safety Checklist (SSC) has been progressively adopted by healthcare providers around the world to monitor and safeguard the delivery of surgeries. In one Italian region's health system, the SSC and other two surgery-specific checklists were supplemented by a document that records any non-conformity (NC) arising from the safety checks. ⋯ Checklist compliance in the LHU was 95%, with the presence of NCs in about 7% of surgeries. The factors that increased the RR were incompleteness of the checklist (adjusted RR = 3.12; 95% confidence interval [CI] = 2.86-3.40), urgent surgeries (adjusted RR [aRR] = 1.59; 95% CI = 1.47-1.72), emergencies (aRR = 2.09; 95% CI = 1.15-3.79), and surgeries with more than four procedures (aRR = 1.64; 95% CI = 1.41-1.92). Most notably, the RR for incomplete checklists showed a negative association with NCs before the COVID-19 outbreak but positive afterwards. Checklist compliance was overall satisfactory, though the observation of noncompliant checklists of about 1000 per year suggests there is still room for improvement. Moreover, attention to the checklist best practices and organization of outpatient workload may have been affected by the exceptional circumstances of the pandemic.
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This paper depicts a Covid science case, that of the AstraZeneca Vaxzevria vaccine, with specific focus on what happened in Italy. Given that we believe acknowledging the role of non-evidential factors in medicine is an important insight into the recent philosophy of science, we illustrate how in the case of Vaxzevria, the interplay between facts, values (both epistemic and non-epistemic) and cognitive biases may have possibly led to different institutional decisions based on the same evidence. The structure of the paper is as follows. ⋯ Second, we sketch a timeline of Vaxzevria's approvals and suspensions by relevant institutional healthcare authorities with special focus on Italy and the Italian Medicines Agency. Then we show the interplay between the evidence base, epistemic as well as non-epistemic values and cognitive biases using a narrative review of political decisions along with newspaper and social media content pertaining to Vaxzevria. We briefly compare Italy with other European countries to show that different political decisions were made on the basis of the same evidence.
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Kilifi County, Kenya, has a modern contraceptive prevalence of 44%, compared to the national prevalence of 61%. In 2018, the Government of Kenya and Population Services Kenya implemented a pilot project in Kilifi to improve contraceptive awareness and access. ⋯ Findings demonstrate the potential for task sharing combined with community engagement efforts to improve contraceptive awareness, knowledge and supply. Community engagement should include men, traditional leaders and other influencers to strengthen norms that position family planning in alignment with community values.
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This study was designed to determine the associations between insurance status and clinical outcomes among patients with hyperglycaemic crisis. ⋯ Insurance status is associated with the outcomes of hospitalisation for hyperglycaemic crisis; uninsured patients with hyperglycaemic crisis face a higher risk of mortality in China.