Evidence-based Medical Practice Research Articles

Overview of Clinical Trials

A key component of medical research is clinical trials, which assess the potential uses, safety, and effectiveness of novel medications, therapies, or medical equipment. These studies adhere to a set protocol that includes stages where therapies are tested on patients and healthy volunteers while adhering to strict legal and ethical guidelines. They provide critical data to inform evidence-based medical practices and foster innovations in healthcare. Clinical trials continue to be essential for enhancing patient outcomes, expanding medical knowledge, and meeting unmet health needs globally, despite obstacles like recruitment, ethical issues, and resource constraints. Clinical trials, a crucial part of modern healthcare innovation, are carefully designed to assess the efficacy, safety, and optimal usage of medical interventions, including drugs, therapies, and equipment.These trials are conducted in stages, ranging from small-scale safety investigations to extensive assessments of efficacy and adverse consequences. They provide dependable and repeatable outcomes since they are carried out under strict ethical standards and regulatory supervision. Clinical trials continue to be crucial for converting scientific discoveries into workable medicines, despite obstacles such patient recruiting, ethical standards compliance, and high expenses. Their findings influence medical procedures, enhance patient care, and advance efforts to solve global health issues

Rhazes' insights on abortion and abortogenic drugs in relation to modern concepts.

Abortion remains one of the most prevalent complications of pregnancy, contributing significantly to maternal mortality and presenting a substantial public health challenge. This study aimed to explore Rhazes' perspective on abortion and abortifacient medicinal plants he mentioned in Kitāb al-Ḥāwī fī al-Ṭibb. A detailed analysis of his seminal work, Kitāb al-Ḥāwī fī al-Ṭibb, was conducted. Relevant keywords such as abortion, stillbirth, fetus, drugs, and abortifacients were examined within Kitāb al-Ḥāwī fī al-Ṭibb. The analysis included Rhazes' viewpoints on abortion and the abortogenic drugs he mentioned, as well as their methods of administration, including oral dosage forms and vaginal formulations. Furthermore, relevant current literature was used to find the potential scientific rationales for Rhazes' insights. Our findings indicate that Rhazes contributed to obstetrics and gynecology as he discussed abortion, its prevention, and management in his book. Also, he identified various medicinal plants with potential abortogenic properties. Rhazes explained various administration methods, including rub, decoction, inhalation, suppository, enema, incense, and water bath. Even though his clinical practices and detailed observations provide a rich context for understanding the historical use of these agents, evidence-based medical practices need to be conducted to cleave potentially usable parts of Rhazes' perspectives and his approaches to the prevention and treatment of abortion. Moreover, there is a pressing need for well-designed randomized clinical trials to rigorously evaluate the potential efficacy and safety of the medical insights and the potential therapeutic herbal agents he described.

The cornerstones of randomized clinical trials.

Randomized clinical trials (RCTs) are pivotal in medical research, offering critical evidence on the efficacy and safety of treatments. This paper explores the distinct purposes and designs of superiority, non-inferiority, equivalence, and pragmatic trials, each addressing unique research questions. Superiority trials aim to demonstrate a new treatment's effectiveness over existing standards, while non-inferiority and equivalence trials focus on ensuring new treatments are not significantly worse or are similar to existing ones, respectively. Pragmatic trials assess interventions in real-world settings. A fundamental ethical principle in RCTs is clinical equipoise, ensuring unbiased treatment allocation. The CONSORT statement provides guidelines for transparent reporting of RCTs, enhancing the reliability of findings. Key methodological considerations include sample size calculation, randomization, blinding, and the choice between intention-to-treat and per-protocol analyses. Stratified analysis and forest plots further aid in understanding treatment effects across diverse populations. By adhering to these principles, RCTs remain a cornerstone of evidence-based medical practice, advancing patient care and outcomes.

The next generation of physician-researchers: undergraduate medical students’ and residents’ attitudes, challenges, and approaches towards addressing them

BackgroundUndergraduate medical education and residency training are critical periods for conducting research. Medical diagnoses and therapies are direct results of successful research efforts that have advanced several scientific fields. This review highlights the importance of incorporating scientific research training into the curricula of undergraduate medical education and residency programs.MethodsWe utilized key databases such as PubMed, Web of Science, and Google Scholar to conduct a narrative review of English-language articles published between 2002 and 2024. Ultimately, we selected 49 studies that examined the attitudes of undergraduate medical students and residents toward research, the common challenges they encounter while participating in research activities, and the strategies that support and encourage their involvement, all in alignment with our study objectives and keywords. In addition, we identified several relevant themes, including the value of research experience in shaping well-rounded medical professionals; the integrity of research practices in residency selection, which addresses concerns such as the arms race and misrepresentation, as well as the balance between quality and quantity; striking a balance between research and clinical training while promoting equity and inclusion; and effective programs and mentorship strategies to enhance research engagement.ResultsTranslating the positive attitudes of undergraduate medical students and residents into improved knowledge and practice necessitates the development of structured mentoring programs and advanced training systems. Institutions must provide the necessary tools, guidance, and support to overcome research barriers. This will help establish an environment in undergraduate medical education and residency training that values research, facilitates access to it, and integrates it into the curriculum.ConclusionsTo address the critical shortage of physician-researchers and improve evidence-based medical practice, it is crucial for medical schools to focus on research education and create avenues for student involvement. By tackling research challenges and implementing supportive strategies, these efforts empower the next generation of physician-researchers to embrace research, contribute to medical progress, and uphold the highest standards of patient care.

Addressing barriers to post-graduate research training in low resource settings: an innovative approach in an institution of higher learning in Kenya.

Numerous barriers hinder health research training in Post-Graduate Medical Education Programs, especially in developing countries. Research training is pivotal for medical residency, providing essential knowledge and skills for dissertation completion, fostering evidence-based medical practice, and nurturing future independent clinical researchers. A holistic approach to research education is imperative to surmount these barriers. We describe here a dissertation-centric research curriculum, delivered longitudinally, an innovative strategy undertaken by Aga Khan University's Medical College in East Africa (AKU-MCEA) to deliver postgraduate research. A review of AKU-MCEA post-graduate research methods curriculum was conducted based on implementing Departments' experience, institutional policies, and residency program output. The Master of Medicine program requires a well-executed dissertation for graduation. Residents undergo structured research training across four modules, with interactive sessions and workshops supporting their research milestones. Protected time allows residents to develop and report on their dissertation work. Faculty receive specialized training in dissertation supervision to ensure residents benefit from expert guidance in producing high-quality research. This approach achieves a dissertation completion and graduation rate of 98-100%. Notably, 68.5% (n = 126) of those who graduated in 2013-2023 have published two or more papers (i.e., range 2-36) in their current portfolio, demonstrating a commitment to ongoing research endeavors even after graduation. Residents' research covers diverse themes and is disseminated through departmental presentations, university-wide Faculty Academic Rounds, peer-reviewed journals, conferences, and the Annual Early Career Researchers symposium. A comprehensive approach featuring a structured research curriculum, longitudinal delivery with predetermined milestones, dedicated supervision, financial and resource support, protected research time, ongoing faculty development in dissertation supervision, and clear institutional research policies accelerates dissertation completion and enhances effective research dissemination.

Visualizing the landscape of urolithiasis research from 1979-2023: a global bibliometric analysis of randomized clinical trials.

Urolithiasis is the most prevalent benign urological condition, imposing a significant burden on morbidity, disability, and healthcare costs globally. Despite its impact, comprehensive bibliometric analyses of randomized clinical trials (RCTs) related to urolithiasis, which are essential for advancing evidence-based medical practices, are lacking. This study aimed to examine the global research landscape and trends in RCTs focused on urolithiasis. This study used bibliometric techniques to analyze a selection of RCTs on urolithiasis published between 1979 and 2023. VOSviewer software version 1.6.20 was used to visualize international collaborations and perform a keyword analysis of the included articles. The main objective was to identify key research areas and focal points within the field of urolithiasis RCTs. Between 1979 and 2023, a comprehensive search identified 16,716 research articles on urolithiasis. A total of 693 relevant RCTs were found in the Scopus database. The number of publications has significantly increased over time, indicating a strong positive correlation (R² = 0.9303; P < 0.001). China was the top contributor, with 166 publications (23.95%), followed by the United States, with 130 publications (18.76%). Turkey and Iran contributed 44 (6.35%) and 62 (8.95%) publications, respectively. Citation analysis revealed an average of 28.13 citations per article, an h-index of 70, and a total of 19,493 citations. The co-occurrence analysis highlighted current research trends and key topics in urolithiasis RCTs, including 'comparative effectiveness of surgical and laser techniques and patient outcomes', 'medical expulsive therapy (MET) for ureteral calculi and clinical outcomes', 'systematic reviews and meta-analyses of RCTs investigating urolithiasis', and 'dietary interventions and correlations between stone composition and the risk of recurrence.' The bibliometric analysis provides an overview of research on urolithiasis RCTs. It examines global research trends and identifies new developments in the field. Our review identified key research themes, including systematic reviews and meta-analyses, dietary interventions, medical therapy for the expulsion of ureteral stones, and comparisons of surgical techniques-areas that will remain focal points in future research. This bibliometric analysis is an invaluable resource for researchers, clinicians, and policymakers, providing a complete overview of past and present research trends. Informed decision making can be promoted and guided in future research, ultimately improving management and understanding.

Enhancing Healthcare Information Systems in Ethiopian Hospitals: Exploring Challenges and Prospects of a Cloud-based Model for Smart and Sustainable Information Services

Hospitals are the primary hubs for healthcare service providers in Ethiopia; however, hospitals face significant challenges in adopting digital health information systems solutions due to disparate, non-interoperable systems and limited access. Information technology, especially via cloud computing, is crucial in healthcare for efficient data management, secure storage, real-time access to critical information, seamless provider communication, enhanced collaboration, and scalable IT infrastructure. This study investigated the challenges to standardizing smart and green healthcare information services and proposed a cloud-based model for overcoming them. We conducted a mixed-methods study in 11 public hospitals, employing quantitative and qualitative approaches with diverse stakeholders (N = 103). The data was collected through surveys, interviews, and technical observations by purposive quota sampling with the Raosoft platform and analyzed using IBM SPSS. Findings revealed several shortcomings in existing information systems, including limited storage, scalability, and security; impaired data sharing and collaboration; accessibility issues; no interoperability; ownership ambiguity; unreliable data recovery; environmental concerns; affordability challenges; and inadequate policy enforcement. Notably, hospitals lacked a centralized data management system, cloud-enabled systems for remote access, and modern data recovery strategies. Despite these challenges, 90.3% of respondents expressed interest in adopting cloud-enabled data recovery systems. However, infrastructure limitations, inadequate cloud computing/IT knowledge, lack of top management support, digital illiteracy, limited innovation, and data security concerns were identified as challenges to cloud adoption. The study further identified three existing healthcare information systems: paper-based methods, electronic medical catalog systems, and district health information systems2. Limitations of the paper-based method include error-proneness, significant cost, data fragmentation, and restricted remote access. Growing hospital congestion and carbon footprint highlighted the need for sustainable solutions. Based on these findings, we proposed a cloud-based model tailored to the Ethiopian context. This six-layered model, delivered as a Software-as-a-Service within a community cloud deployment, aims to improve healthcare services through instant access, unified data management, and evidence-based medical practices. The model demonstrates high acceptability and potential for improving healthcare delivery, and implementation recommendations are suggested based on the proposed model.

Data quality assessment of interventional trials in public trial databases

ObjectiveHigh-quality data entry in clinical trial databases is crucial to the usefulness, validity, and replicability of research findings, as it influences evidence-based medical practice and future research. Our aim is to assess the quality of self-reported data in trial registries and present practical and systematic methods for identifying and evaluating data quality. Study Design and SettingWe searched ClinicalTrials.Gov (CTG) for interventional total knee arthroplasty (TKA) trials between 2000 and 2015. We extracted required and optional trial information elements and used the CTG's variables' definitions. We performed a literature review on data quality reporting on frameworks, checklists, and overviews of irregularities in healthcare databases. We identified and assessed data quality attributes as follows: consistency, accuracy, completeness, and timeliness. ResultsWe included 816 interventional TKA trials. Data irregularities varied widely: 0%–100%. Inconsistency ranged from 0% to 36%, and most often nonrandomized labeled allocation was combined with a “single-group” assignment trial design. Inaccuracy ranged from 0% to 100%. Incompleteness ranged from 0% to 61%; 61% of finished TKA trials did not report their outcome. With regard to irregularities in timeliness, 49% of the trials were registered more than 3 months after the start date. ConclusionWe found significant variations in the data quality of registered clinical TKA trials. Trial sponsors should be committed to ensuring that the information they provide is reliable, consistent, up-to-date, transparent, and accurate. CTG's users need to be critical when drawing conclusions based on the registered data. We believe this awareness will increase well-informed decisions about published articles and treatment protocols, including replicating and improving trial designs.

Peculiarities of approaches to the treatment of arterial hypertension in the Maldives in the practice of general practitioners from the point of view of evidence-based medicine

Background: Arterial Hypertension (AH), commonly known as high blood pressure, is a significant chronic condition affecting millions globally and is a primary cause of cardiovascular diseases (CVD). In the Maldives, the management of AH by general practitioners (GPs) is crucial due to its high prevalence and associated health complications. This study examines the approaches of GPs in treating AH, emphasizing evidence-based medicine (EBM) to ensure effective management and prevention strategies. Methods and Materials: The study involves a comprehensive review of current evidence-based methods used for AH management in the Maldives. It focuses on lifestyle modifications, dietary changes, increased physical activity, stress reduction techniques, and pharmacotherapy. Data were collected through clinical guidelines, patient records, and interviews with GPs to understand the practical application of these methods in Maldivian healthcare settings. Results: The findings indicate that lifestyle modifications, including healthier diets and increased physical activity, are critical in managing AH. Traditional Maldivian diets and community-based exercise programs play significant roles. Pharmacotherapy, involving antihypertensive medications, is essential but faces challenges such as limited access and patient adherence. GPs also highlighted the importance of stress reduction techniques and individualized treatment plans tailored to patient needs and cultural sensitivities. Conclusion: Effective management of AH in the Maldives requires a multifaceted approach combining evidence-based medical practices with local context sensitivity. GPs play a pivotal role in diagnosing, treating, and educating patients about AH. Addressing socioeconomic barriers, enhancing healthcare resources, and promoting cultural competence are essential for improving AH management and overall public health

Integrating Medical Librarians in Evidence-Based Medical Practice in Africa: A Survey of Current Practices and Challenges

Librarians’ involvement in Evidence-Based Medical Practice (EBMP) has been widely reported from the Global North. The cross-sectional study designed a survey to investigate how African medical librarians integrate into EBMP. The respondents comprised medical librarians from 12 African countries. Findings revealed that African medical librarians are mostly involved in EBMP activities related to resource use, management, and evidence dissemination. The leading EBMP tools reportedly used or promoted by the librarians include UpToDate and Cochrane Library, while the leading challenges encountered in offering support for EBMP are related to skill deficiency, poor funding, and poor internet connectivity.

Expert consensus on the diagnosis and treatment of respiratory diseases exacerbated by nonsteroidal anti-inflammatory drugs （2024, Chengdu）

Non-steroidal anti-inflammatory drugs-exacerbated respiratory disease （N-ERD） is a chronic respiratory disease characterized by eosinophilic inflammation, featuring chronic rhinosinusitis （CRS）, asthma, and intolerance to cyclooxygenase 1 （COX-1） inhibitors. The use of these medications can lead to an acute worsening of rhinitis and asthma symptoms. This condition has not yet received sufficient attention in China, with a high rate of misdiagnosis and a lack of related research. The Chinese Rhinology Research Group convened a group of leading young experts in otolaryngology from across the country, based on the latest domestic and international evidence-based medical practices to formulate this consensus.The consensus covers the epidemiology, pathogenesis, clinical manifestations, diagnostic methods, and treatment strategies for N-ERD, including pharmacotherapy, surgery, biologic treatments, and desensitization therapy. The goal is to improve recognition of N-ERD, reduce misdiagnosis, and enhance treatment outcomes.

Simulation-based interprofessional education for teaching evidence-based medical practice.

Objective: To achieve consensus on opinions of expert medical educationist on utilization of simulation-based interprofessional education as teaching strategy for evidence based practice teaching in undergraduate medical education. Study Design: Qualitative Case study. Setting: Bahria University Health Sciences Campus. Period: March 2023 to August 2023. Methods: Research using modified Delphi technique was done under ERC 16/2023-BUMDC. Communities of practice and transformative learning theory were used for guiding research design. Non-probability, snow-ball sampling technique was used to select expert panel as participants. Inclusion criteria were medical educationist with masters in health professional education and ten year of experience in department of medical education. Content analysis was used for analyzing data and atlas ti-9 was used for organizing data collected through online email interviews. Results: Final consensus of participants was attained on, third year, Simulation-based interprofessional education/ Assignments/ Journal Clubs/Case-based discussions, Fourth year, Simulation-based interprofessional education/ Journal Clubs/Case-based discussions, Content: Final year, Simulation-based interprofessional education/ Clinical setting/ Journal Clubs. Conclusion: Expert showed ninety percent consensus that simulation-based interprofessional education is good teaching strategies for teaching evidence –based practice in undergraduate medical.

Clinical Research Primer for Medical Students: Overview and Illustrative Experiences

Abstract Background The ability to participate in clinical scholarship is a foundational component of modern evidence-based medical practice, empowering improvement across essentially every aspect of clinical care. In tandem, the need for comprehensive exposure to clinical research has been identified as a critical component of medical student training and preparation for residency that is underserved by traditional undergraduate medical education models. The goal of the current work was to provide guidelines and recommendations to assist novice medical students in taking ownership of their research education. Methods The Clinical Research Primer was composed from pooled research documents compiled by the study authors and our institutional neurosurgery student research group. The Primer was then structured as the natural evolution of a research project from its inception through the submission process. Results We divided the foundational components of the Clinical Research Primer into seven domains, each representing a landmark in the development of a peer-reviewed study, and a set of skills critical for junior scholars to develop. These vital components included the following: pitching and designing clinical studies, developing a research workflow, navigating the Institutional Review Board, data collection and analysis, manuscript writing and editing, submission mechanics, and tracking research projects for career development. Conclusion We anticipate that the tools included in the Clinical Research Primer will increase student research productivity and preparedness for residency. Although our recommendations are informed by our experiences within neurosurgery, they have been written in a manner that should generalize to almost any field of clinical study.

A Multi-Objective Approach Optimizing Pharmacy Industry Decisions through MOORA Method

The pharmacy industry, a crucial pillar of the healthcare sector, encompasses the discovery, development, production, distribution, and sale of pharmaceutical drugs and medications. With an intricate interplay of scientific innovation, medical expertise, and commercial activities, this industry plays an indispensable role in safeguarding and improving human health. From the inception of groundbreaking drugs to their widespread distribution, the pharmacy industry integrates various stakeholders, including pharmaceutical companies, researchers, healthcare professionals, regulators, and consumers. It strives to address a wide spectrum of health conditions, from acute ailments to chronic diseases, by developing innovative treatments, generic medicines, and over-the-counter drugs. The pharmacy industry's evolution has been marked by technological advancements, research breakthroughs, and regulatory frameworks to ensure drug safety and efficacy. As the global population continues to grow and age, the industry faces the challenges of maintaining affordability, accessibility, and quality of medications. Furthermore, the pharmacy industry is a catalyst for economic growth, creating jobs, fostering research collaborations, and contributing to national and international healthcare systems. Its multifaceted nature, ranging from drug research to patient care, underscores its significance in the broader landscape of healthcare and public well-being. Research within the pharmacy industry holds immense significance due to its pivotal role in advancing medical knowledge and improving patient outcomes. Pharmaceutical research drives the development of new medications, innovative therapies, and treatment protocols, enhancing the efficacy and safety of drugs. It also uncovers insights into disease mechanisms, fostering a deeper understanding of health conditions. Furthermore, research guides regulatory decisions, ensuring drugs' quality, and promotes evidence-based medical practices. Through ongoing investigation, the pharmacy industry continually evolves, addressing emerging health challenges, optimizing drug utilization, and ultimately contributing to the overall enhancement of global healthcare standards. MOORA (Multi-Objective Optimization by Ratio Analysis) is a decision-making method used to evaluate and prioritize alternatives based on multiple conflicting criteria. It involves comparing alternatives' performance ratios against reference alternatives, considering both benefits and drawbacks. By assigning weights to criteria, MOORA quantifies their importance and ranks alternatives accordingly. This technique assists in complex decision scenarios where various factors must be balanced. MOORA's systematic approach aids in reaching well-informed decisions by quantifying trade-offs and providing a structured framework for considering multiple objectives simultaneously. Product Innovation, Market Share (%), Research Investment ($ billion), Patient Satisfaction, Drug Efficacy (%), Global Reach (countries). Pfizer, Johnson &amp; Johnson, Roche, Novartis, GlaxoSmithKline, CVS Health, Walgreens Boots Alliance, Rite Aid.From the result it is seen that Novartisis got the first rank where as is the Rite Aidis having the lowest rank.

Is Induced Abortion Evidence-Based Medical Practice?

Leaders of medical schools and health professional associations in the United States have affirmed their commitment to induced abortion by persistently asserting that the procedure is evidence-based medical practice. There is an objective structured process by which the status of “evidence-based” is attained. It requires a detailed description and documentation of the patient’s disease, illness or condition; an explanation for how the treatment intervention ameliorates the problem; the outcomes by which the effectiveness of the treatment is measured; and the comparison of the treatment with other alternative interventions available. We provide historical context which indicates that staunch abortion advocate thought leaders considered the right to abortion on demand to be inconsistent with the concept of evidence-based practice. We summarize the research on the reasons why women choose abortion, and we review the questions, designs and findings available in the relevant Cochrane Library systematic reviews. Our conclusion is that the quality of abortion science in general is quite weak, that the data necessary for valid research is scarce, and that the claims of evidence-based induced abortion are unsupported by the existing body of published knowledge.

Current landscape of gastrointestinal radiation oncology in Spain: a multicenter real-life survey and comparison with key clinical guidelines.

The GI Tumors Workgroup, a division of the Spanish Society of Radiation Therapy, conducted a survey in December 2020 to assess the adherence of radiation oncologists in Spain to international guidelines for gastrointestinal tumors. Using Google Forms, we designed a survey covering treatments for esophageal, gastric, pancreatic, and rectal cancers. In esophageal cancer treatment, neoadjuvant chemoradiation was the standard in 76.7% of institutions. Radiation doses range from 41.1 to 50.4 Gy in conventional fractionation. Planning positron emission tomography-computed tomography (PET-CT) was performed in 83.3% of centers, and intensity-modulated radiation therapy/volumetric-arc radiation therapy (IMRT/VMAT) was the preferred technique in 86.7% of institutions. For gastric cancer, 71.4% followed perioperative chemotherapy guidelines. In the case of adjuvant radiotherapy, the majority prescribed 45-50.4 Gy, and 82.1% used IMRT/VMAT for treatment. For pancreas cancer, neoadjuvant chemotherapy followed by surgery in borderline resectable tumors and induction chemotherapy followed by radical radiotherapy for non-resectable tumors were the most frequent approaches. IMRT/VMAT was the primary technique. Locally advanced rectal cancer treatment is mainly based on neoadjuvant radiotherapy in all institutions. The preferred radiation doses typically range from 45 to 50 Gy in conventional fractionation. IMRT/VMAT was standard in most Institutions. Spain's radiotherapy practices among respondents generally align with international guidelines for GI tumors highlighting Spain's commitment to evidence-based medical practice.

The Buzz Surrounding Precision Medicine: The Imperative of Incorporating It into Evidence-Based Medical Practice.

Precision medicine (PM), through the integration of omics and environmental data, aims to provide a more precise prevention, diagnosis, and treatment of disease. Currently, PM is one of the emerging approaches in modern healthcare and public health, with wide implications for health care delivery, public health policy making formulation, and entrepreneurial endeavors. In spite of its growing popularity and the buzz surrounding it, PM is still in its nascent phase, facing considerable challenges that need to be addressed and resolved for it to attain the acclaim for which it strives. In this article, we discuss some of the current methodological pitfalls of PM, including the use of big data, and provide a perspective on how these challenges can be overcome by bringing PM closer to evidence-based medicine (EBM). Furthermore, to maximize the potential of PM, we present real-world illustrations of how EBM principles can be integrated into a PM approach.

Application of the MMPI-2 inventory in the differential diagnosis of psychotic disorders – based on profile analysis of a patient diagnosed with persistent delusional disorder and personality disorder

Aim: Paranoid states or traits can be present in various mental disorders; hence, their clarification is valuable for establishing a reliable nosological diagnosis. Clinical practice and literature on the subject highlight a range of defence mechanisms specific to the discussed nosological group. These mechanisms can impede the process of psychiatric and psychotherapeutic diagnosis and treatment. In contemporary evidence-based medical practice, the prevalent clinical approach is based on qualitative methods (e.g. free interviews and observations) complemented by standardised diagnostic tools. This approach assists the clinician in supplementing, organising, and objectifying clinical data related to the patient’s mental state. It is particularly beneficial for handling data that may be uncertain or unavailable in an observational study for various reasons. The article presents insightful and pragmatic theoretical, empirical, and case-related information on the potential application of the Minnesota Multiphasic Personality Inventory (MMPI-2) in the psychological diagnosis of patients with persistent delusional disorders. Methods: The paper explores theoretical issues and analyses a case study involving a female patient with a suspected diagnosis of delusional disorder and co-occurring personality disorder. In the case study, the authors employed qualitative methods, including observation and free psychological interview, and supplemented clinical data with insights gained through the use of a standardised psychometric method: the MMPI-2. Reflections and practical recommendations are divided into two groups. One group comprises the potential applications of the MMPI-2 in clinical psychological diagnosis. The other focuses on the importance of the diagnostic alliance and its roles in the process of planning the psychological diagnosis in patients with delusional disorders.

Collaborative governance in integrated healthcare networks: insights from the cancer program in Québec (Canada)

Context: The challenge of modernizing health services delivery for cancer patients and their loved ones involves moving towards integrated network-based practices. While initiatives at different levels of healthcare systems contribute to this movement, further efforts are needed to maintain and extend gains to adapt to the complex and fast-changing cancer environment. A collaborative governance regime, understood as a form of capacity building for joint action across boundaries, represents a promising way to improve and sustain integrated care.&#x0D; Objective: This presentation reports insights from providers and users of health services gained from the experience in operationalizing an integrated network-of-networks in the context of a national cancer program in Quebec (Canada). &#x0D; Methods: Methods: Insights are drawn from a larger multiple case study that took place from 2018 to 2021. Participants (n=39) are knowledgeable informants on how “mandated” integration structures and processes support collaboration among the various components of the network. Documents (n=45) related to network governance and integrated practices are also included. The data collection guide and analysis based on qualitative interpretive description are framed on the Collaborative Governance framework to capture critical dimensions in the integration process. These include clear mission, common and shared definition of complex problems and potential solutions, and identification of common values to support motivation, engagement and capacity for joint action.&#x0D; Results: We report on three main tensions related to integration in the cancer network that suggest strategies for enhancing collaborative governance: &#x0D; The first tension emerges as some participants perceive “mandated integration” within a “prescribed collaborative work” as a constraint that undermines previous collaborative work at local level. This tension leads to unresolved controversies within and between actor groups, weakening the mechanisms of collaborative governance. &#x0D; The second tension is a principle-to-practice divide around engaging people affected by cancer in network governance. Despite widespread motivation, participation at the local level varies according to managers' willingness and skill in creating open and inclusive processes where evidence-based medical practice and lived patient experience can be assembled. This tension is seen to contribute to a poor consideration of patient perspectives during the highly volatile period of decision-making during the COVID-19 pandemic.&#x0D; The third tension involves the hierarchy of cancer services promoted in the national cancer program and the standardization of practices. Organizing the network-of- networks by cancer specialization involves creating trajectories by type of cancer and their navigation according to established standards of practice and quality considerations. The consequent redistribution of human and financial resources, and revised ownership of care process creates perceived asymmetries between cancer network professionals and centers and controversies that hinder integrated practices. &#x0D; Conclusion: Despite favorable starting conditions from the national cancer program and its central leadership promoting collaborative governance, tensions that emerge through the pursuit of network integration limit the transition to a more collaborative regime. Taking the time to work out these tensions as integration proceeds appears essential to arrive at a governance model that is appropriate and acceptable for all network members.

Shared decision-making in pediatric palliative care

Shared decision-making (SDM) with parents and adolescents is normative in pediatric practice in North America. In this article we discuss how it is applicable to the practice of pediatric palliative care (PPC). As PPC itself is exemplary of patient-and-family-centered care, it often uses a SDM approach in clarifying patient and family preferences, goals, and values. This often occurs in an iterative process and across care environments, wherein the patient and family narrative is elaborated. Decisions are then made incorporating both evidence-based medical practice and the unique attributes and considerations of the patient and family.