Articles: professional-practice.
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Annals of family medicine · Aug 2019
Multicenter StudyA Longitudinal Study of Trends in Burnout During Primary Care Transformation.
The quadruple aim of primary care transformation includes promoting well-being among the primary care workforce. We longitudinally assessed burnout among clinicians and staff in 2 health delivery organizations engaged in primary care redesign guided by a shared transformation model. ⋯ The divergent trends of steady reduction in clinician burnout in one system and clinician burnout getting worse before getting better in the other system suggest that the effects of primary care transformation are influenced by the organizational context. Moreover, practice changes that reduce clinician burnout may not decrease-and may potentially even worsen-burnout among staff. Primary care transformation requires continuing efforts to promote meaningful work and sustainable workloads among all members of the primary care team.
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Bmc Health Serv Res · Sep 2018
Multicenter StudyPhysiotherapy for injured workers in Canada: are insurers' and clinics' policies threatening good quality and equity of care? Results of a qualitative study.
In recent years, significant efforts have been made to improve the provision of care for compensated injured workers internationally. However, despite increasing efforts at implementing best practices in this field, some studies show that policies overseeing the organisation of care for injured workers can have perverse influences on healthcare providers' practices and can prevent workers from receiving the best care possible. The influence of these policies on physiotherapists' practices has yet to be investigated. Our objectives were thus to explore the influence of 1) workers' compensation boards' and 2) physiotherapy clinics' policies on the care physiotherapists provide to workers with musculoskeletal injuries in three large Canadian provinces. ⋯ In Canada, workers' compensation play a significant role in financing physiotherapy care for people injured at work. Despite the best intentions in promoting evidence-based guidelines and procedures regarding rehabilitation care for injured workers, complex policy factors currently limit the application of these recommendations in practice. Research that targets these policies could contribute to significant changes in clinical settings.
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Jornal de pediatria · Jan 2016
Multicenter Study Observational StudyPainful procedures and analgesia in the NICU: what has changed in the medical perception and practice in a ten-year period?
To compare the use of analgesia versus neonatologists' perception regarding analgesic use in painful procedures in the years 2001, 2006, and 2011. ⋯ Despite an increase in the medical perception of neonatal pain and in analgesic use during painful procedures, the gap between clinical practice and neonatologist perception of analgesia need did not change during the ten-year period.
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Multicenter Study
Sedation practice in six acute hospitals - a snapshot survey.
The number of UK hospital patients receiving procedural sedation remains unknown. Our trainee research network recorded all procedural sedation given over a 48-h period at six acute hospitals in the South West of England. Three hundred and sixty patients aged between 1 and 96 years old were sedated. ⋯ The most frequent sedative combination was midazolam and fentanyl, with median (IQR [range]) doses of 2 (2-3 [1-10]) mg and 50 (50-100 [10-300]) μg used, respectively. We tested a methodology that could be used in a UK-wide denominator survey to describe sedation practice across the NHS. A national audit collecting serious adverse outcomes of sedation (severe harm or death) could then identify hotspots of sedation risk (clinical areas, patient groups, procedures and sedation techniques) where consistent application of current and improved standards might reduce harm.
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Arch. Dis. Child. Fetal Neonatal Ed. · Sep 2014
Multicenter StudyChange in practice after the Surfactant, Positive Pressure and Oxygenation Randomised Trial.
To test the hypothesis that the proportion of endotracheal intubation (ETI) in the delivery room (DR) decreased in Neonatal Research Network (NRN) centres after the National Institute of Child Health and Human Development NRN Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT). ⋯ This study shows that DR ETI changed after SUPPORT only in NRN centres that had not participated in a similar trial.