Journal of evaluation in clinical practice
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Much of the literature concerned with health care practice tends to focus on a decision-making model in which knowledge sits within the minds and bodies of health care workers. Practice theories de-centre knowledge from human actors, instead situating knowing in the interactions between all human and non-human actors. The purpose of this study was to explore how practice arises in the moment-to-moment interactions between general dental practitioners (GDPs), patients, nurses, and things. ⋯ Practices are ongoing ecological accomplishments to which people and things skilfully contribute through translation of their respective embodied knowing of multiple practices. Based on this, we argue that practices are more likely to improve if people and things embody practices of improvement.
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For over 50 years, clinical research methodology has wrestled with the problem of the lack of correspondence between tests of treatments and applications of treatments. The former comprise of trials featuring scrupulous control of patient eligibility, treatment compliance, clinician expertise, follow-up intensity, and so on. ⋯ The remedy, going by the name of "pragmatic trials," is to conduct clinical trials in conditions corresponding more closely to everyday practice. This solution has proved easier to utter than to execute, and the paper reviews the extensive literature on pragmatic trials, seeking to assess whether it has terminated in clarity or contestation.
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Evidence-based medicine has claimed to be science on a number of occasions, but it is not clear that this status is deserved. Within the philosophy of science, four main theories about the nature of science are historically recognized: inductivism, falsificationism, Kuhnian paradigms, and research programmes. If evidence-based medicine is science, knowledge claims should be derived using a process that corresponds to one of these theories. ⋯ In the final section, possible counter arguments are considered. It is argued that the knowledge claims valued by evidence-based medicine are not justified using inductivism, falsificationism, Kuhnian paradigms, or research programmes. If these are the main criteria for evaluating if something is science or not, evidence-based medicine does not meet these criteria.
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The aim of this review was to evaluate the implementation of shared decision-making (SDM) in dentistry and the roles of informed consent and patient decision-making aids (PDAs) as part of this process. ⋯ SDM is applied in dentistry and is influenced by many factors. Informed consent is an important part of this process. PDAs in more dental fields need to be further developed, in order to ensure a satisfactory integration of patients in the SDM process.
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This study examined the perspectives of 18 health care providers (nurses, consultant doctors, residents, radiologists, and physiotherapists) and 18 patients regarding best practices for patient-centred care (PCC) in a free private hospital in Pakistan, studying the congruence between provider and patient perspectives. ⋯ We recommend practices of PCC that are congruent with non-Western settings where religion and family play a primary role in matters dealing with patients' illnesses. Our findings suggest the need for recurrent training to improve teamwork among providers; questioning the implicit agreement of patients who may be vulnerable to decision making of authoritarian figures in their family; and the inclusion of peer-support workers or community health workers to offer aftercare support to patients in their home.