Journal of evaluation in clinical practice
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The 2007 article 'Why buprenorphine is so successful in treating opiate addiction in France' has been widely cited to promote various solutions to growing opioid-related harms across multiple jurisdictions globally. However, selective promotion of aspects of the French experience or promotion of the French experience without considering relevant contextual factors may inform policies that will not bring the same outcomes as in France, including the introduction of possible unintended negative consequences. The scientific literature is one important arena in which policy solutions are identified, evaluated, promoted and disseminated. Scientific communication of the French opioid use disorder care model offers a timely and relevant example through which to examine how problem representations travel and to consider the effects of these representations. ⋯ US studies, by focusing on less stringent buprenorphine regulation as the primary solution of concern, have constructed opioid-related harms as a problem of restrictive regulations for buprenorphine. This selective focus on regulation, as opposed to other aspects of the French Model elucidated in the index article such as changes pertaining to the values and financing that structure health service delivery, represents an important missed opportunity for evidence-informed policy learning across jurisdictions.
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Women with previous gestational diabetes mellitus (GDM) are more than eight times more likely to develop type 2 diabetes (T2DM) compared to women without GDM. Annual follow-up T2DM-screening is recommended, but participation rates decrease rapidly after the first year. In the North Denmark Region, an electronic reminder has been tested with the aim of improving follow-up care for women with prior GDM. The aim of this study was to explore women's perspectives on receiving an electronic reminder, and the role of reminders in both women's decision-making and informed choice regarding participation in follow-up screening. ⋯ The reminder indicated both concern and co-responsibility for women's follow-up care after GDM and was well received by the women. It supported participation in follow-up screening through an emphasis on shared decision-making and informed choice. Women's interaction with their GP played a significant role.
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Bureaucratic African governments need to trust their health workers and populations on the way to the Africa Agenda 2063. Small defined populations cared for by a team with an appropriate mix of healthcare workers (from public and private sectors) and delivered in a comprehensive, continuous, coordinated manner can be the complex adaptive system to deliver better PHC and health for all in Africa.
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Following the onset of the COVID-19 pandemic, a clinical practice guideline (CPG) around virtual hearing aid practices was developed to fill a knowledge gap within the field of audiology. Details outlining the development and mobilization of this draft guideline were outlined as Phase 1 (described in a paired paper). ⋯ Findings reported across six domains suggest high mean scores, ranging from 78% to 81%, in order of scope and purpose (highest rated), stakeholder involvement, rigour of development, applicability, clarity of presentation, and editorial independence. Specific recommendations made by in international co-creation team during the evaluation informed the final version of the CPG. Future development and evaluation efforts should aim to include greater representation from nontraditional practice contexts to strengthen global applicability.
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Question Storming offers a method that enables one to hold the condition of uncertainty in reflection without the need for resolution. Global interdependencies and unprecedented access to information, social media and multiple forms of communications challenge our ability to see, understand and influence change effectively and efficiently. The tension and need to cope effectively with massive uncertainties cannot be resolved with current methods leading to a necessity for people to seek new ways to transform their understanding and explore new options for action. Problem-solving and facilitation of the past are not flexible or rapid enough to meet the current demands of decision making and action taking in the face of massive uncertainties. As a result, people face 'wicked unsolvable' issues in their personal and professional lives. ⋯ Question Storming has helped people see their wicked issues from new perspectives, understand them in useful ways and generate new options for action. This paper introduces Question Storming-the Power of Questions as a practical method for group inquiry in the presence of individual and group uncertainties/wicked issues. The Container, Difference, Exchange (CDE) model and Pattern Logic are presented to explain the paradigm-shifting dynamics experienced by participants, both individuals and members of the group. It concludes with emerging questions for future consideration. Question Storming generates a divergent problem space that decreases constraint and increases degrees of freedom to allow practical exploration of new and often surprising options for action.