Patient safety is a persistent problem in telephone triage research; however, studies have not differentiated between clinicians' and non-clinicians' respective safety. Currently, four groups of decision makers perform aspects of telephone triage: clinicians (physicians, nurses), and non-clinicians (emergency medical dispatchers (EMD) and clerical staff). Using studies published between 2002-2012, we applied Donabedian's structure-process-outcome model to examine groups' systems for evidence of system completeness (a minimum measure of structure and quality). We defined system completeness as the presence of a decision maker and four additional components: guidelines, documentation, training, and standards. Defining safety as appropriate referrals (AR) - (right time, right place with the right person), we measured each groups' corresponding AR rate percentages (outcomes). We analyzed each group's respective decision-making process as a safe match to the telephone triage task, based on each group's system structure completeness, process and AR rates (outcome). Studies uniformly noted system component presence: nurses (2-4), physicians (1), EMDs (2), clerical staff (1). Nurses had the highest average appropriate referral (AR) rates (91%), physicians' AR (82% average). Clerical staff had no system and did not perform telephone triage by standard definitions; EMDs may represent the use of the wrong system. Telephone triage appears least safe after hours when decision makers with the least complete systems (physicians, clerical staff) typically manage calls. At minimum, telephone triage decision makers should be clinicians; however, clinicians' safety calls for improvement. With improved training, standards and CDSS quality, the 24/7 clinical call center has potential to represent the national standard.
BackgroundAuthors of systematic reviews have difficulty obtaining unpublished data for their reviews. This project aimed to provide an in-depth description of the experiences of authors in searching for and gaining access to unpublished data for their systematic reviews, and to give guidance on best practices for identifying, obtaining and using unpublished data.MethodsThis is a qualitative study analyzing in-depth interviews with authors of systematic reviews who have published Cochrane reviews or published systematic reviews outside of The Cochrane Library. We included participants who 1) were the first or senior author of a published systematic review of a drug intervention, 2) had expertise in conducting systematic reviews, searching for data, and assessing methodological biases, and 3) were able to participate in an interview in English. We used non-random sampling techniques to identify potential participants. Eighteen Cochrane authors were contacted and 16 agreed to be interviewed (89% response rate). Twenty-four non-Cochrane authors were contacted and 16 were interviewed (67% response rate).ResultsRespondents had different understandings of what was meant by unpublished data, including specific outcomes and methodological details. Contacting study authors was the most common method used to obtain unpublished data and the value of regulatory agencies as a data source was underappreciated. Using the data obtained was time consuming and labor intensive. Respondents described the collaboration with other colleagues and/or students required to organize, manage and use the data in their reviews, generally developing and using templates, spreadsheets and computer programs for data extraction and analysis. Respondents had a shared belief that data should be accessible but some had concerns about sharing their own data. Respondents believed that obtaining unpublished data for reviews has important public health implications. There was widespread support for government intervention to ensure open access to trial data.ConclusionsRespondents uniformly agreed that the benefit of identifying unpublished data was worth the effort and was necessary to identify the true harms and benefits of drugs. Recent actions by government, such as increased availability of trial data from the European Medicines Agency, may make it easier to acquire critical drug trial data.
The lack of a traditional employment infrastructure has important implications for vulnerable workers' health and the sustainability of consumer-directed PAS programs. We provide recommendations for improving workers' access to workers' compensation and injury-related medical care.
BackgroundExposure to pollution is a significant risk to human health. However few studies have attempted to identify the types of policy interventions that can reduce the health risks of pollution exposure in the United States. The study objective was to conduct a realist review of policy interventions conducted or aimed at reducing chemical exposures in humans or the environment where exposure was measured.MethodsA systematic literature search identified published articles that assessed policy interventions using exposure data. Two coders independently extracted data from the studies, assessing methods, context, details of interventions, outcomes, and risks of bias. Data were analyzed iteratively and manually to identify the most effective and transferrable types of interventions. The reasons for variability in the success of different interventions were explored.ResultsThe review found that regulatory interventions that eliminate point sources of pollution appeared to reduce exposure to environmental hazards. Regular monitoring to provide environmental and human exposure data helped assess compliance with the regulatory standards. Educational and economic interventions were less successful.ConclusionsAlthough some types of regulatory interventions appear to reduce exposures, our findings are limited by the nature of existing interventions, the weaknesses of the study designs used in the literature, and the lack of details on implementation. Information on contextual factors that influence implementation would assist with future reviews and could help identify effective interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3461-7) contains supplementary material, which is available to authorized users.
Th e jwsr Book Review department publishes reviews of books on the same topics for which jwsr solicits articles, as described in the jwsr editorial policy. We also disseminate reviews of reference works and other books containing quantitative or qualitative data useful for world systems research. We solicit volunteers to review books. If you would like to write book
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