Journal of evaluation in clinical practice
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Telehealth navigation programmes have shown potential to improve video visit usage and attendance. However, their effectiveness in safety-net healthcare settings remains uncertain. ⋯ Patients unresponsive to outreach had lower portal activation rates and higher non-attendance, suggesting the presence of distinct engagement subgroups within the population. While volunteer-staffed programmes may provide a practical method to reach patients, telephone outreach alone was insufficient to improve video visit usage or attendance rates. Further research is needed to explore alternative or complementary strategies to enhance telehealth engagement in safety-net settings.
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Peter Drucker pointed out an important distinction between 'doing things right' and 'doing the right thing', which recognised that all problems are embedded in a context and thus can only be understood within their unique contextual setting. Contemporary research practices in clinical medicine often regards contextual factors as potential confounders that will bias effect estimates and thus must be avoided. However rigorous, research devoid of context ultimately deprives users of understanding of the support factors that make research transferable to policy decisions or managing care of individual patients-it stands in the way of 'doing the right thing' in 'real life' settings. ⋯ We discuss the need for researchers to a-priori consider the context of their research question as well as the structural relationships of the variables under investigation, which in turn provides the basis for choosing the most appropriate research design. We have a moral imperative to first 'do the right thing'-ask questions that address the contextual needs of our patients, and then to 'do it right'-choose the best research method to answer this contextually framed need. Only then will our research efforts have meaningful and lasting impacts on patient care.
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Observational Study
The Effect of Lean Hospital Practices on Nurses' Direct Care Activities: Time and Motion Study.
This study investigates the effects of lean management practices on nurses' direct patient care activities and the interruptions they encounter in healthcare settings. The literature indicates that lean management enhances efficiency and improves patient care. Increased nursing time per patient correlates with better outcomes; however, rising patient loads and frequent interruptions hinder nurses' ability to deliver effective care, jeopardising patient safety. Addressing these inefficiencies is essential, given nurses' critical role in ensuring quality care. ⋯ Lean management effectively reduces waste and improves direct patient care time, enhancing patient safety and care quality. Continuous improvement initiatives in nursing practices are essential for success.
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Equating health with complete physical, mental and social well-being, as defined by the WHO, has played an important role in the development of healthcare systems in Western countries. However, this definition has contributed to the rise of the myth of well-being, increasing the demand on healthcare systems and raising the risk of medicalizing all aspects of life. Additionally, equating health with complete well-being is conceptually flawed for two important reasons. ⋯ While there are various approaches to defining health, the crucial issue is that each definition should include states of unwell-being. Incorporating this perspective would represent a paradigm shift in the field of health, fostering more realistic expectations and reducing the risk of medicalization.
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NICE guidelines recommend offering computerised Cognitive Behavioural Therapy (cCBT) to young people with mild mental health issues to ensure early treatment access and reduce service demand. Emerging evidence suggests cCBT reduces symptoms, but further evaluation is needed. SilverCloud is a recommended digital CBT programme. ⋯ This evaluation suggests tentative pessimism regarding SilverCloud's benefits. However, due to significant challenges and limitations, further analysis is recommended. Recommendations were given for local services.