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Complex systems and unintended consequences
Published in Frances Rapport, Robyn Clay-Williams, Jeffrey Braithwaite, Implementation Science, 2022
Cane toads (Figure 55.1) were introduced into Australia from South America in 1935, to control a beetle that ate the sugarcane crops (Sutherst, Floyd, and Maywald 1996). The intervention not only failed to control the beetle but the cane toads were also large and poisonous and had no natural predators in Australia. The toad population spread invasively and now inhabits most of the Australian tropics and sub-tropics, reducing biodiversity and causing severe environmental impact (Shanmuganathan et al. 2010). What happened here? Those who introduced the cane toads did not consider interactions with other parts of the ecosystem or how that ecosystem would change over time (Urban et al. 2008). Unintended consequences, as in this example, are the outcomes of a purposeful action that are not foreseen.
Opportunities and Challenges for Digital Health Advancement
Published in Connie White Delaney, Charlotte A. Weaver, Joyce Sensmeier, Lisiane Pruinelli, Patrick Weber, Deborah Trautman, Kedar Mate, Howard Catton, Nursing and Informatics for the 21st Century – Embracing a Digital World, 3rd Edition, Book 1, 2022
Gillian Strudwick, Sanaz Riahi, Nicholas R. Hardiker
The response to the COVID-19 pandemic has required an accelerated adoption of digital health solutions to ensure ongoing access to clinical care and enable adherence to public health measures in mitigating the transmission and spread of the virus. However, these recent events have further exacerbated the long-existing inequities of access to and implementation of digital health, as well as the quality of care afforded by digital health (Crawford & Serhal, 2020). In the development of digital health solutions, generally, there has been a lack of attention to health equity (Sinha & Schryer-Roy, 2018). With the proliferation of digital solutions in response to the pandemic, there have been unintended consequences of furthering health inequities. Having limited or lack of access to technology due to such factors as poverty, under-resourcing of health systems and neighborhoods, and homelessness contribute to the current digital health inequities. Other factors that need to be considered for digital health technologies are the social, cultural and economic realities, as well as social determinants of health, which all directly and or indirectly impact health equity (Were et al., 2019; Crawford & Serhal, 2020).
What Promotes Joy
Published in Eve Shapiro, Joy in Medicine?, 2020
How did we ever become obsessed with RVUs? We don’t live in a relative value unit world. By definition, an RVU is an assignment of work effort for a healthcare activity a provider is performing. It has become accepted as a measure of productivity for physicians and mid-level providers—and the foundation for provider performance compensation models for employed providers. But there are unintended consequences that may not be aligned with the patient’s best interests. Who defines “relative value”? RVUs are part of the resource-based relative value scale. Historically, the American Medical Association’s Specialty Society Relative Value Scale Update Committee, with input from a number of specialty societies, has largely determined Medicare’s RVU physician work values. In practice, real value may be unmeasurable and unaccountable. For example, if a provider spends an hour communicating with a non-English-speaking individual who needs a minor surgical procedure but doesn’t understand the language and therefore requires substantial additional time (time largely uncompensated by RVUs), the procedure will not be as financially rewarding as the same procedure performed on an English-speaking patient. Yet, for the non-English-speaking patient, unquestionable value has been delivered.
Role and Function of the Clinical Tutor in Mental Health Nursing in Ireland
Published in Issues in Mental Health Nursing, 2022
C. Flanagan, M. Lonergan, J. Durning, T. Frawley
This study employs a qualitative descriptive design to examine the role of the CT in mental health nursing. This approach is important and appropriate for investigating poorly understood phenomena and permits the exploration of topics for which there is little research (Kim et al., 2017). More importantly this methodology seeks to provide a clear description of specific phenomena from the perspectives of those who experience the event allowing potential innovative perspectives to emerge from the viewpoint of participants (Sandelowski, 2010). In this way, it is a useful approach for refining and defining roles and interventions and may help identify unintended consequences. Data were collected using focus group discussions where possible and one-to-one semi structured interviews to describe the experiences of participants. This was undertaken by a researcher who was not working as a clinical tutor to minimise potential bias.
Understanding impacts of accreditation on medical teachers and students: A systematic review and meta-ethnography
Published in Medical Teacher, 2022
George Choa, Zakia Arfeen, See Chai Carol Chan, Mohammed Ahmed Rashid
This study systematically examined qualitative research about medical teachers’ and students’ perspectives on medical school accreditation. It demonstrates that the impact of medical education accreditation is complex and includes many unintended consequences. Power differentials between stakeholders, the credibility of the accreditation process, the influence of accreditation on medical education programmes, and the culture and behaviour of stakeholders engaging in the process are all important aspects of how medical teachers and students experience accreditation. Although medical teachers and students recognise many positive impacts of accreditation, they also perceive many negative impacts, which policymakers and regulators can seek to address as they work to improve current accreditation policies and practices.
Evaluation of spin in the abstracts of systematic reviews and meta-analyses focused on treatments of alcohol use disorder
Published in The American Journal of Drug and Alcohol Abuse, 2021
Cole Verble, Marysa Cloeter, Ryan Ottwell, Wade Arthur, Micah Hartwell, Branden Carr, Kelly Dunn, Jana Baker, Drew N. Wright, Meghan Sealey, Lan Zhu, Matt Vassar
Subjectivity within a study is often referred to as “spin,” which has been defined as “a specific way of reporting, intentional or not, to highlight that the beneficial effect of the experimental treatment in terms of efficacy or safety is greater than that shown by the results” (13). The unintended consequences may be misunderstanding the significance of research findings and providing suboptimal patient care. Therefore, our primary objective was to investigate the presence of spin within the abstracts of systematic reviews of alcohol use disorder therapies. Our secondary objective was to determine whether any associations existed between characteristics of the systematic reviews – including funding source, quality of systematic reviews, and the impact factors of the journals they are published in – and the presence of spin.