Journal of evaluation in clinical practice
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The language used in clinical practice is a key enabler to the success of treatment. Without good communication which is underpinned by values, therapeutic engagement and treatment outcomes will not be as successful.
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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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Although there has been a focus on problematic issues related to health care services and complaints made by patients, individuals who suffer from medically unexplained syndromes continue to report being epistemically marginalized or excluded by health professionals. The aim of this article is to uncover a deeper understanding of the what-ness of experiencing being naked in the eyes of the public while waiting to be recognized as ill. Therefore, a phenomenological approach was chosen to inductively and holistically understand the human experience in this context-specific setting. ⋯ Lack of experienced support can lead to exacerbated feelings of distress. Accordingly, the psychosocial experience of being ill might be as important as its unknown aetiology. Therefore, in the context of these interpersonal relations, both norms, values, and attitudes, and issues of power need to be considered and addressed properly.
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Multicenter Study
Difficulty of the decision-making process in emergency departments for end-of-life patients.
In emergency departments, for some patients, death is preceded by a decision of withholding or withdrawing life-sustaining treatments. This concerns mainly patients over 80, with many comorbidities. The decision-making process of these decisions in emergency departments has not been extensively studied, especially for noncommunicating patients. ⋯ There is little anticipation in end-of-life decisions. Discussion with patients concerning their end-of-life wishes and the writing of advance directives, especially for patients with chronic diseases, must be encouraged early.
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Multicenter Study
Characteristics of shared decision making in Romania from the patient perspective: A cross-sectional multicentric study.
Shared decision making (SDM) is very important from patients' perspective. This process has not yet been evaluated in Romania. The study aims to evaluate SDM from the patients' perspective and to evaluate patients' characteristics that associate with SDM. ⋯ In our study, full anonymity was associated with significantly lower scores for the SDM process. The patients with higher education were most influenced by this condition, while those with the lowest education were the most critical.