Journal of evaluation in clinical practice
-
Multicenter Study
Multicentre implementation of a nursing competency framework at a provincial scale: A qualitative description of facilitators and barriers.
Nurses are responsible for engaging in continuing professional development throughout their careers. This implies that they use tools such as competency frameworks to assess their level of development, identify their learning needs, and plan actions to achieve their learning goals. Although multiple competency frameworks and guidelines for their development have been proposed, the literature on their implementation in clinical settings is sparser. If the complexity of practice creates a need for context-sensitive competency frameworks, their implementation may also be subject to various facilitators and barriers. ⋯ This study was one of the first to document the large-scale, multi-site implementation of a nursing competency framework in clinical settings. This project represented a unique challenge because it involved two crucial changes: adopting a competency-based approach focused on educational outcomes and accountability to the public and valorizing a learning culture where nurses become active stakeholders in their continuing professional development.
-
When we are faced with health challenges, we have to choose a treatment from several alternatives. Most of the time, we must make a choice even though some information regarding the options is missing. Previous research found that missing information systematically impacts our choices. ⋯ The results highlight the importance of discussing the issue of missing information with healthcare consumers and patients.
-
Network meta-analysis (NMA) quantifies the relative efficacy of three or more interventions from trials evaluating some, but usually not all, treatments. This study applied the analytical approach of NMA to quantify the relative accuracy of prediction models with distinct patient applicability that are evaluated on the same population ('concurrent external validation'). ⋯ The NeRMA Score makes it possible to quantify the relative accuracy of binomial prediction models with distinct applicability in a concurrent external validation.
-
Pragmatic design may facilitate the generalizability of effectiveness of randomized controlled trials (RCTs) in primary health care (PHC). ⋯ Most RCT protocols were rated as intermediate in the pragmatic-explanatory continuum. Future research may guide all stakeholders on how best to incorporate the level of pragmatism in the interpretation of the results so that the trials are more likely to be applicable in real-world settings.
-
Increasing demand for hospital services can lead to overcrowding and delays in treatment, poorer outcomes and a high cost-burden. The medical ambulatory care service (MACS) provides out of hospital patient care, including diagnostic and therapeutic interventions for patients that require urgent attention, but which can be safely administered in the ambulatory environment. The programme is yet to be rigorously evaluated. ⋯ MACS was found to be cost-effective for GP and ward-referred groups, but the expected impact for ED-referred patients is sensitive to assumptions. Expansion of the service for GP-referred patients is expected to reduce hospitalizations the most and generate the largest net cost savings.