Journal of evaluation in clinical practice
-
Ward rounds present opportunities for medical officers, nurses, allied health clinicians, and patients to interact and plan patient care. A recent literature review found eight types of rounding processes. Different purposes, varying levels of representation from clinical professions, and understanding of each others' roles revealed a complex activity. A shared understanding of rounding processes facilitates positive teamwork and improves patient care. We examined how clinicians perceive the nature of rounding processes they undertake within their practice, multidisciplinary team attendance at rounds, and the effectiveness of team communication. ⋯ Rounds are a common yet complex activity. Rounds are revealed to be a taken-for-granted organizational activity with diversity in function, attendance, and participation, yet rounding processes are perceived and experienced differently between health professions. These differences impact on multidisciplinary attendance at rounds amongst peers. Making and communicating explicit round expectations and roles for clinicians supports coordinated teamwork and care planning.
-
Clinical and research evidence suggests that family functioning is an important variable in shaping psychological well-being, despite being often overlooked in the prevailing approaches to mental health. The aim of the present study is to examine the associations between psychological distress and family functioning in a sample of patients accessing a public mental health service. ⋯ This study confirms that family functioning is significantly associated with psychological distress, also in the absence of clear and conspicuous signs of structural imbalances within family relationships.
-
In recent publications, attention has been drawn to the importance of practical wisdom in order to ensure good, individually attuned care in complex clinical practices. However, what remains insufficiently elucidated is how practical wisdom emerges in the workplace. This study aims to describe manifestations of practical wisdom in medical practices within a general hospital. It also seeks to clarify the interruptions that can be considered as triggers for the emergence of practical wisdom. Furthermore, we searched for figurations, which possibly elicit or constrain the emergence of practical wisdom. ⋯ We found that practical wisdom frequently emerged in unexpected and diverse guises in these clinical practices, although the "interruptions" that we discovered did not automatically trigger practical wisdom. We have investigated the figurations mentioned only to a limited degree. More empirical research is needed to make the philosophical concept of practical wisdom better manageable for clinical practices and to gain better understanding of the figurations that elicit or obstruct its manifestation.
-
Anxiety is a mediator for emotional reactivity and acute blood pressure elevations, which are associated with an increased risk of cardiovascular death. Alprazolam is a common medication for anxiolysis. We hypothesized that alprazolam usage can reduce the risk of major adverse cardiovascular events (MACEs) in patients with hypertension. ⋯ Alprazolam usage in patients with hypertension was associated with a slightly reduced risk of MACEs and all-cause mortality, and up to 22% reduced risk of hemorrhagic stroke was observed in alprazolam users aged <65 years.
-
The health care landscape is changing: it has become the largest part of the economy and changes in public management systems will greatly affect how we practice medicine in the future. Medical education will be more important than ever to ensure patients get the best care with empathy. However, new public management systems implemented without thorough analysis might challenge medical education. An increasing number of public health care institutions provide services based on competitive market rules and express their goals in financial terms and have set financial gains as their main goal, which contradicts the fundamental nature of medical ethics and practice. ⋯ Patients and teaching values are not reducible to financial terms only and the acknowledgement of non-financial values is fundamental to achieve quality in health care and education. The most essential step could be selecting managers who will implement public management principles while taking into account both business requirements and medical ethics.