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Enacting open disclosure in the UK National Health Service: A qualitative exploration.

Enacting open disclosure in the UK National Health Service: A qualitative exploration.

J Eval Clin Pract. 2017 Feb 21;:

Authors: Harrison R, Birks Y, Bosanquet K, Iedema R

Abstract
BACKGROUND: Open and honest discussion between healthcare providers and patients and families affected by error is considered to be a central feature of high quality and safer patient care, evidenced by the implementation of open disclosure policies and guidance internationally. This paper discusses the perceived enablers that UK doctors and nurses report as facilitating the enactment of open disclosure.
METHODS: Semistructured interviews with 13 doctors and 22 nurses from a range of levels and specialities from 5 national health service hospitals and primary care trusts in the UK were conducted and analysed using a framework approach.
RESULTS: Five themes were identified which appear to capture the factors that are critical in supporting open disclosure: open disclosure as a moral and professional duty, positive past experiences, perceptions of reduced litigation, role models and guidance, and clarity.
CONCLUSION: Greater openness in relation to adverse events requires health professionals to recognise candour as a professional and moral duty, exemplified in the behaviour of senior clinicians and that seems more likely to occur in a nonpunitive, learning environment. Recognising incident disclosure as part of ongoing respectful and open communication with patients throughout their care is critical.

PMID: 28220984 [PubMed - as supplied by publisher]




A novel clinical framework: The use of dispositions in clinical practice. A person centred approach.
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A novel clinical framework: The use of dispositions in clinical practice. A person centred approach.

J Eval Clin Pract. 2017 Feb 21;:

Authors: Low M

Abstract
This paper explores a novel clinical framework that is underpinned by a specific philosophical perspective of causation and its utility in clinical practice. A dispositional theory of causation may overcome challenges that clinicians face in complex clinical presentations including those that are medically unexplained. Dispositionalism identifies causes not as regular events necessitating an effect but rather phenomena, which are highly complex, context-sensitive, and which tend toward an effect. Diagnostic uncertainty and causal explanation are significant challenges in terms of clinical reasoning, communication, and the overall therapeutic outcome. This novel framework aims to facilitate improved collaborative clinical reasoning, enhanced patient-practitioner interaction, and supported treatment planning. The paper uses a real case study of a patient with nonspecific spinal pain to demonstrate the clinical framework as used in clinical practice.

PMID: 28220638 [PubMed - as supplied by publisher]




Real world evaluation of the smoking cessation services in the Rio de Janeiro municipality, Brazil.
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Real world evaluation of the smoking cessation services in the Rio de Janeiro municipality, Brazil.

J Eval Clin Pract. 2017 Feb 21;:

Authors: Casado L, Thuler LC

Abstract
INTRODUCTION: In recent years, there has been a growing recommendation for process evaluation of the smoking cessation programmes in the world. This study sought to evaluate smoking cessation services, with special attention to the degree to which public health care facilities adhere to governmental standards of practice.
METHODS: A cross-sectional study examined smoking cessation services by using a key-informant approach. All the services that delivered smoking cessation treatment in 2013 at the National Health System of the Rio de Janeiro municipality, Brazil, were included in the study. The treatment consists of group sessions and pharmacotherapy. Compliance with the standards of inputs, activities, and short-term outcomes was analysed. A descriptive analysis was performed using means and standard deviations for the continuous variables and absolute and relative frequencies for the categorical variables.
RESULTS: Of the 177 services performing smoking cessation treatment in 2013, a total of 81.9% answered the questionnaire. More than 90% of the services met the infrastructure standards. Behavioural approach and pharmacotherapy were available in more than 99% of the services. Of a total of 11 287 patients aged 18 years or older who registered for treatment, 77.6% received tobacco cessation interventions during the first group session. Among those who had access to treatment, 52.8% were not smoking at the fourth group session.
CONCLUSION: Even though more than 20% of the patients did not attend the first group session, the access to treatment was high, and it was observed that the success rate of those who attended the fourth group session was more than 50%.

PMID: 28220577 [PubMed - as supplied by publisher]




Supporting patients with type 1 diabetes using continuous subcutaneous insulin infusion therapy: Difficulties, disconnections, and disarray.
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Supporting patients with type 1 diabetes using continuous subcutaneous insulin infusion therapy: Difficulties, disconnections, and disarray.

J Eval Clin Pract. 2017 Feb 21;:

Authors: Perry L, James S, Gallagher R, Dunbabin J, Steinbeck K, Lowe J

Abstract
RATIONALE, AIMS, AND OBJECTIVES: Use of continuous subcutaneous insulin infusion therapy in type 1 diabetes management is high. However, the incorporation of this technology into self-care is not without challenges, and the support of an appropriately skilled health care team is recommended. This study aimed to examine the support context for patients using continuous subcutaneous insulin infusion therapy from the health care professional perspective, as well as contextual influences for health care professionals and their patients.
METHODS: This ethnographic qualitative study was undertaken in New South Wales, Australia. Recruitment occurred using a snowball sampling technique, beginning with members of an established diabetes service group. Data were collected through the use of semistructured interviews undertaken by telephone and analysed using thematic analysis.
RESULTS: Data were obtained from 26 interviews with staff from diverse professional backgrounds. An overarching theme of difficulties, disconnections, and disarray emerged, with findings indicating that participants perceived difficulties in relation to shortages of health care professional continuous subcutaneous insulin infusion-related expertise, and disconnected and disarrayed service structures and process, with barriers to access to these devices. Individual health care professionals were left to manage somehow or opted not to engage with related care.
CONCLUSIONS: Findings provide insights from health care professionals' perspectives into the complexity of providing support for patients using continuous subcutaneous insulin infusion therapy across diverse contexts, and provide a platform for further research and service development. The need for consistent and coordinated care, and the infrastructure to facilitate this, flags an opportunity to drive integration of care and teamworking across as well as within settings and disciplines.

PMID: 28220558 [PubMed - as supplied by publisher]