Journal of evaluation in clinical practice
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Randomized Controlled Trial
Clinician's use of the Statin Choice decision aid in patients with diabetes: a videographic study nested in a randomized trial.
To describe how clinicians use decision aids. ⋯ Unintended decision aid use in the context of videotaped encounters in a practical randomized trial was common. These instances offer insights to researchers seeking to design and implement effective decision aids for use during the clinical visit, particularly when clinicians may prefer to proceed in ways that the decision aid apparently contradicts.
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The purpose of this paper is to argue the importance of contemporary analysis of the modern social construction of chronicity--encapsulating the world views of the chronically ill, and the medical and health system constructions of chronic disease, through the nature of care for chronic conditions. It is argued that chronic diseases are themselves, socially constructed, despite widely accepted disease classification systems. Thus, there is a need to examine how different ideas have permeated our clinical and health system developments and their social context and vice versa. ⋯ Health care systems cannot afford to avoid, and should actively embrace the critiques of social theory and analyses in the transformations of health systems to improve chronic care. Creative tensions between empirical and intellectual critique, and a synthetic middle ground are likely to lead to more realistic and innovative approaches spanning the nature of chronicity and the transformation of Primary Care.
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Review Meta Analysis
Supplemental perioperative oxygen for reducing surgical site infection: a meta-analysis.
To assess the efficacy of supplemental perioperative oxygenation for prevention of surgical site infection (SSI). Data sources Computerized PUBMED and MEDLINE search supplemented by manual searches for relevant articles. Study selection Randomized, controlled trials evaluating efficacy of supplemental perioperative oxygenation versus standard care for prevention of SSI in patients' undergoing colorectal surgery. Data synthesis Data on incidence of SSI were abstracted as dichotomous variables. Pooled estimates of the relative risk (RR) and 95% confidence interval (CI) were obtained using the DerSimonian and Laird random effects model and the Mantel-Haenzel fixed effects model. Heterogeneity was assessed using the Cochran Q statistic and I(2). ⋯ Our analysis showed that supplemental perioperative oxygenation is beneficial in preventing SSI in patients undergoing colorectal surgery. Because of heterogeneity in study design and patient population, additional randomized trials are needed to determine whether this confers benefit in all patient populations undergoing other types of surgery. Supplemental perioperative oxygenation is a low-cost intervention that we recommend be implemented in patients undergoing colorectal surgery pending the results of further studies. Further research is needed to determine whether or not supplemental hyperoxia may cause unanticipated adverse effects.
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Randomized Controlled Trial
A randomized controlled trial of an at-home preparation programme for Japanese preschool children: effects on children's and caregivers' anxiety associated with surgery.
To determine whether the implementation of at-home psychological preparation programme for children and family prior to surgery can reduce anxiety for Japanese preschool children undergoing herniorrhaphy and their caregivers assessed as an appropriate outpatient care. ⋯ A specially designed at-home preparation programme as an outpatient care is effective to encourage parent-child verbal interaction concerning surgery and reduce both children and caregivers' anxiety associated with surgery.
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To investigate the presence and rates of anxiety and depression in postsurgical patients. ⋯ The results suggest that post-operative depression does occur in orthopaedic surgery. The prevalence may be higher than that reported in other surgical specialities. These findings emphasize the need for evaluation of patients' psychiatric state post-operatively.