Journal of evaluation in clinical practice
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The humanities and arts are appropriate areas of study within interdisciplinary medicine. Medicine has long been considered to be both a science and an art. Within each patient, the psychological, emotional, spiritual, and the physical are all inextricably linked. ⋯ Literature also offers dynamic ethical issues with which to grapple. Expressive and explorative writing is used in professional development, and undergraduate courses. Medical humanities, literature and medicine and narrative medicine are established in the USA and developing fast in Britain.
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Anecdotal case reports contribute about one-third of the published literature on adverse drug reactions and interactions, but are regarded as providing poor-quality evidence. However, they can occasionally provide proof of cause and effect, and there are many other reasons for publishing them. Because an anecdote is a narrative, narratological paradigms from literature, art, and music can show how we can make evidential use of anecdotes. ⋯ A high background incidence of the effect (the medical equivalent of subplots, which violate the unity of action) makes it more difficult to detect adverse drug effects using anecdotal reports. To make best evidential use of the corpus of anecdotal reports of adverse drug reactions, comprehensiveness is important: each suspected adverse reaction should be reported in detail and reactions should be reported in sufficient numbers for proper classification and for patterns to be recognized. One form of pattern recognition, teleoanalysis of data, should, when possible, include not only randomized controlled trials and observational studies, but also case series and anecdotal reports.
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Modified early warning scoring (MEWS) uses abnormalities in routine observations to identify patients at risk of critical illness. Nurses recorded scores at or above the medical response score of 3 on a hospital clinical information system during the first year of introducing MEWS to 10 wards in a university hospital. A total of 619 triggers were recorded in 365 patients. ⋯ Mean ages of survivors and non-survivors were 64 years (SD 18) and 74 years (SD 17), respectively. Addition of a score for age did not significantly increase the area under a receiver operator characteristic curve for the predictive value of MEWS scores. The study shows that increasing MEWS score is associated with worse outcome across a range of specialties and that nursing staff will use a patient information system to audit MEWS scores.
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To identify potential factors leading to discontinuation of angiotensin-converting enzyme (ACE) inhibitors because of adverse drug events. ⋯ Although further validation is necessary, these risk factors should help doctors identify patients with elevated risk for adverse drug events because of ACE inhibitors.
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Randomized Controlled Trial Clinical Trial
Involving patients in decision making and communicating risk: a longitudinal evaluation of doctors' attitudes and confidence during a randomized trial.
Important barriers to the wider implementation of shared decision making (SDM) and risk communication in practice remain. The attitudes of professionals undergoing training in these approaches may inform how to overcome these barriers, but there are few such data yet available. ⋯ Professionals appear receptive to patient involvement, and willing to acquire the relevant skills. SDM and risk communication training did not appear to contribute differentially to this. Practical barriers such as time constraints should probably be addressed with greater priority than the precise content of training or continuing professional development initiatives if 'involvement' is to become a commoner experience for patients in primary care.