Journal of evaluation in clinical practice
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Neck pain is a major cause of disability worldwide, and current rehabilitation strategies show limited effectiveness. Subgrouping patients by their primary pain and disability drivers can help tailor treatments. At this end, the Pain and Disability Drivers Management (PDDM) was developed and has demonstrated preliminary effectiveness in the management of low back pain. Nevertheless, the PDDM model was only validated for this population. Adapting this framework to patients with neck pain would provide a more global view of the patient's experience of pain and support a genuine biopsychosocial intervention. ⋯ Through a modified DELPHI study, the PDDM model was updated and adapted to people with neck pain. Subsequent steps include clinical integration and measures of efficacy when used for assessment/treatment.
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The development of clinical practice guidelines (CPG) has evolved into a rigorous and complex process. There is a need for training of CPG developers including methodologists, panel members and patient representatives. This study explored the educational needs and experiences of CPG developers, with specific attention to the patient perspective and economic considerations. ⋯ This study underscores the importance of tailored CPG development training programmes addressing the specific competencies required for the different roles in CPG development. Thereby, recognising a holistic approach encompassing both content- and process-related aspects. Addressing economic considerations and the patient perspective in training will contribute to CPGs that support a patient-centred and sustainable healthcare system.
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This commentary on Sturmberg and Mercuri's paper 'Every Problem is Embedded in a Greater Whole' [1] argues that those authors have approached complexity from a largely mathematical perspective, drawing on the work of Sumpter. Whilst such an approach allows us to challenge the simple linear causality assumed in randomised controlled trials, it is itself limited. ⋯ It overlooks, for example, how science itself is historically and culturally shaped and how values-driven misunderstandings and conflicts are inevitable when people with different world views come together to try to solve a problem. This paper argues that the mathematical version of complexity thinking is necessary but not sufficient in medical research, and that we need to enhance such thinking further with attention to human values.
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To apply the Ottawa Model of Research Use to translate the Guidelines for the Prevention and Control of Vascular Catheter-Associated Bloodstream Infections. ⋯ Through this clinical change, a perfect prevention and control system has been established, and the level of knowledge, belief, and behavior of medical staff in preventing CLABSI has been improved, while the incidence of CLABSI has been reduced.
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Comparative Study
Comparison of forearm and intra-arterial blood pressure measurements according to body and arm positions in obese patients.
Noninvasive blood pressure (BP) monitoring is very important also difficult for accurate diagnosis and monitor of obese patients. ⋯ Forearm systolic BP measurement, especially in the supine and half-sitting position with the arm below the heart level position, was best agreement with intra-arterial measurement, regarded as the gold standard. For this reason, it is more appropriate to use forearm BP measurement in obese patients monitored in intensive care to obtain accurate results.