Journal of evaluation in clinical practice
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Although courses in acupuncture are increasingly available to doctors, little is known about educational outcomes, or the impact on doctor practices. We sought to characterize doctors who seek acupuncture training, and describe acupuncture practice and referral patterns after training. ⋯ Among doctors enrolling in an acupuncture training programme, half encountered barriers that prevented use in clinical practice. Those who did use acupuncture found it to be helpful for treatment of pain. Given the expanding pool of doctors trained in acupuncture in the USA, outcomes research is needed to further evaluate medical acupuncture practice.
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Safer care is a strategic priority for health care organizations worldwide. Yet, the measurement and evaluation of key processes and outcomes associated with safer care remains challenging, even with existing performance measurement indicators. The multi-national Quality Indicator Project (QI Project) data are analysed to [1] document the patterns of safety indicators used between 1999 and 2006 among hospitals in Asia, Europe and the USA; and [2] to identify trends in using both organization-level and patient-level data in hospital performance improvement. ⋯ Traditional performance measures continue to assist hospitals in identifying crucial aspects of safety in the delivery of care. Building on the findings of a previous study, there are emerging trends in the type of measures used in hospitals in Asia, Europe and the USA pursuing the improvement of overall performance. The increasing use of patient-level data specifically, in tandem with organizational level indicators, may signal the continuum of measurement strategies, now still predominantly in the USA but anticipated to be adopted both in Europe and Asia.
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A systematic review to identify and appraise interactive decision aids that are designed for consumer use, in the field of hereditary breast cancer and genetic testing. ⋯ Although there is a significant amount of interest in genetic testing to determine whether a woman is at high risk of breast cancer, the current genetic services are having difficulty coping with the demand. Alternatives such as decision aids have been suggested. There are many sources of information available, but few are truly interactive or designed for patient use. Of the three evaluated, all were from the USA and are likely to require modification for patients elsewhere.
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Multicenter Study
Modelling survival in acute severe illness: Cox versus accelerated failure time models.
The Cox model has been the mainstay of survival analysis in the critically ill and time-dependent covariates have infrequently been incorporated into survival analysis. ⋯ Time dependence of predictors of survival in ALI/ARDS exists and must be appropriately modelled. The Cox model with time-varying covariates remains a flexible model in survival analysis of patients with acute severe illness.