Journal of evaluation in clinical practice
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The assessment and management of clients with mental illness is an important facet of providing emergency care. In Australian emergency departments, it is usually the generalist registered nurses* without adequate preparation in the assessment and care for clients with mental illness who conduct the initial assessment at triage. A search of the literature revealed a limited number of publications addressing the provision of triage and management guidelines to assist nurses to make objective clinical decisions to ensure appropriate care for clients with mental illness. ⋯ Findings show that these triage scales have led to improvements in staff confidence and attitudes when dealing with clients with mental health problems, resulting in improved outcomes for clients. Strengths and limitations of the evaluations have also been explored. Highlighted is the need for consideration of the inclusion of clients' reactions to the impact of this change to service delivery in future evaluations.
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Randomized Controlled Trial Clinical Trial
Capturing lay perspectives in a randomized control trial of a health promotion intervention for people with osteoarthritis of the knee.
Osteoarthritis (OA) is a common and often disabling condition that predominately affects older adults. It is the commonest cause of locomotor disability and forms a major element of the workload in primary care. Previous studies suggest that there are both deficits in the knowledge patients have about their disease and extensive 'unmet' information needs. ⋯ The combined quantitative and qualitative data provide insight into the patients' perspective on the causes and impact of knee OA, individual goals desired from treatment and the quality of care. There is consistent evidence of unmet needs for information and support and the priority placed by patients on finding strategies to cope with OA and maintaining independence. Even within a tightly defined study sample participating in the intervention, a diversity of experience and goals were revealed, which highlights the importance of taking account of contextual factors and individual differences when evaluating complex interventions.
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Due to its comprehensive and cost-saving design, hospice has become a critical component of health care. Physicians have become the primary gatekeepers to information on hospice and sources of referral to hospice. ⋯ Although physicians, as well as patients and hospice personnel, cite patient and hospice structure factors as barriers, the present article will focus on barriers physicians have more control over, such as their discomfort discussing terminality and fear of losing contact with patients. Focusing on the American hospice model, the present article will review past findings, examine gaps in the research, and propose systematic ways to discern whether the factors physicians claim are barriers actually affect their decision making about hospice referral.
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The growing popularity of qualitative research has led to calls for it to be incorporated into the evidence base. It is argued that, in seeking to respond to this challenge, it is important that we recognize the important differences between qualitative and quantitative research and that we take this into account in developing a distinctive approach. This paper outlines the distinctive contribution made by qualitative research with regard to the nature of the curiosity involved, the iterative research process and its treatment of data, analysis and findings. ⋯ The proposed new model takes a critical look at some of the assumptions underpinning systematic review, such as the process of literature searching and selection of relevant material. Although there is potential for checklist items--such as purposive sampling, respondent validation, multiple coding, triangulation and grounded theory--to be used over-prescriptively in evaluating qualitative papers, it is argued that a more creative engagement with these concepts could yield a distinctive approach more appropriate for this type of work. Moreover, we speculate that some of the questions thereby raised might be usefully applied to consideration of established procedures for reviewing quantitative work.
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An Achilles' heel of Canadian Medicare is long waits for elective services. The Western Canada Waiting List (WCWL) project is a collaboration of 19 partner organizations committed to addressing this issue and influencing the way waiting lists are structured and managed. The focus of the WCWL project has been to develop and refine practical tools for prioritizing patients on scheduled waiting lists. ⋯ While the WCWL project has not 'solved' the problem of waiting lists and times, having a standardized, reliable means of assigning priority for services is an important step towards improved management in Canada and elsewhere.