Journal of evaluation in clinical practice
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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.
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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.
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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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The Getting It Right First Time programme aims to reduce variation in clinical practice that unduly impacts on outcomes for patients in the National Health Service (NHS) in England; often termed "unwarranted variation." However, there is no "gold standard" method for detecting unwarranted variation. The aim of this study was to describe a method to allow such variation in recorded practice or patient outcomes between NHS trusts to be detected using data over multiple time periods. By looking at variation over time, it was hoped that patterns that could be missed by looking at data at a single time point, or averaged over a longer time period, could be identified. ⋯ The time-series method may complement other methods to help identify unwarranted variation.
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Physicians' overconfidence damages the quality of medical care. Due to their high social status and intense impact on people lives, physicians need to develop strategies to avoid overconfidence. Yet until now, the strategies physicians use to avoid overconfidence have not been explored. This study aimed to identify strategies physicians use to minimize potential overconfidence. ⋯ The study demonstrates the on-going nature of establishing physicians' professional identity and implies that it is shaped by a motivation to adapt their identity to fundamental requirements of medical practice. Medical training and education might promote strategies for minimization of potential overconfidence among physicians.