CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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Comparative Study
No magic bullets: a systematic review of 102 trials of interventions to improve professional practice.
To determine the effectiveness of different types of interventions in improving health professional performance and health outcomes. ⋯ There are no "magic bullets" for improving the quality of health care, but there are a wide range of interventions available that, if used appropriately, could lead to important improvements in professional practice and patient outcomes.
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Review Practice Guideline Guideline
Hemophilia and von Willebrand's disease: 1. Diagnosis, comprehensive care and assessment. Association of Hemophilia Clinic Directors of Canada.
To present current strategies for the assessment and comprehensive care of patients with hemophilia and von Willebrand's disease. ⋯ These recommendations were developed at the request of the Canadian Blood Agency, which funds the provision of all coagulation-factor concentrates for people with congenital bleeding disorders, and were developed and endorsed by the AHCDC and the Medical and Scientific Advisory Committee of the Canadian Hemophilia Society.
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How reasonable are expectations that patients will participate in care decisions? The previous article in this series reviewed models of the patient-physician relationship and views on the extent to which patients want to be informed; it also described one information tool--the interactive videodisc. This article reviews literature on the extent to which patients wish to be involved in making decisions about their care. ⋯ The author suggests a distinction between two elements of choice: problem solving and decision making. This distinction helps in identifying appropriate roles for patient and provider, thereby leading to genuine shared decision making.
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Historical views of the patient-physician relationship assumed that the physician's role was to act in the best interests of the patient and to direct care and make decisions about treatment on the patient's behalf. However, under current legal and ethical principles, beneficence is no longer sufficient; respect for autonomy is paramount, necessitating patient participation. None the less, physicians question whether patient participation is realistic in actual clinical situations. ⋯ To be understood, health information must be presented in a way that is appropriate to the patient. Format, content and timing of the material are all important. Mechanisms for incorporating such information into busy clinical practices are crucial.