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Rationale: Defensive caesarean section (CS) has become one of the most common medical procedure worldwide. Additionally, performing CS in accordance with the patient's choice is an appropriate professional practice. Aims and Objective: This paper reports a prospective, observational, multicenter study to quantify the use of this type of practice that is performed by obstetricians to avoid medico‐legal complaints and decrease the frequency of malpractice litigations. Methods: We interviewed 73 obstetricians from three distinct units of obstetrics and gynaecology, to assess their opinion regarding defensive caesarean delivery and caesarean delivery performed upon maternal request. We conducted an opinion‐based survey using questionnaires based on nine, close‐ended questions. Results: Out of 73 respondents, 51 (69.9%) stated that they perform defensive CS; 63 (86.3%) declared that their choice of birth delivery is influenced by the risk of being accused of malpractice; 60 (82.2%) indicated that it is normal for the patient to be able to decide on the type of delivery; and 63 (86.3%) declared that they consult their patients regarding their delivery preferences. We found statistically significant differences between the respondents who declare that they perform defensive CS (69.9%) and those who said that they are influenced by the risk of malpractice when they choose the method of delivery for their patients (86.3%) (P < .001; McNemar Test). Conclusions: The results of our study indicate that defensive caesarean section is a widespread practice among obstetrics practitioners in Romania. [ABSTRACT FROM AUTHOR]

To investigate perceived factors relating to the reliable application of four clinical care practices targeting ventilator-associated pneumonias, in the context of a patient safety improvement initiative called the Safer Patients Initiative (SPI). Qualitative case study. Seventeen semi-structured individual interviews with clinical operational leads, programme coordinators and executive managers who were involved in the implementation of the programme's critical care work stream during its pilot phase. The interviews had a focus on perceived aspects pertaining to the reliable implementation of the four clinical practices, promoted by the Institute for Healthcare Improvement as the 'ventilator care bundle'. Thematic analysis of the verbatim transcripts revealed three overarching themes experienced by the participants during the implementation of the clinical practices included in the SPI ventilator care bundle: the power of measurement, feedback to peers and experts and improvement tools specific to SPI. Consistent measurement of compliance with the four elements of the bundle and outcomes made the staff realize that their engagement in previous improvement work for ventilated patients was inadequate and motivated them to apply the introduced clinical practices more reliably. Feedback to experts and peers of staff compliance with the four clinical practices and outcome improvement was perceived as a very influential aspect of SPI. Small tests of change (Plan-Do-Study-Act cycles), teaching sessions and daily goal sheets were quoted as particularly useful tools throughout the implementation of the four clinical care practices. Future initiatives that aim to improve the adherence of clinical staff with clinical practice guidelines in intensive care units could benefit from integrating in their methodology consistent measurement and feedback practices of both process compliance and outcome data. [ABSTRACT FROM AUTHOR]

Goal attainment scaling was an individualized assessment technique developed to evaluate the provision of complex public services. However, this produced a measure which was driven more by the need to demonstrate clinical efficacy rather than reflecting a patient's own aspirations. People with low back pain have problems ranging from functional daily activities to areas which impinge upon their wider role in society and quality of life. Commonly used scales to measure back pain-related disability may not capture domains of relevance to patients. The aim of this project was to develop a goal-based individualized assessment tool capable of defining meaningful change in condition from the patient perspective for use in longitudinal clinical studies. We developed a semi-structured interview to elicit patient important goals. We refined our initial framework by conducting consecutive rounds of interviews with patients and reviewing the feedback. Within this approach, we included a point identified as the minimum level of change needed within each goal that would be considered a meaningful improvement in condition by the patient. Fifteen patients with low back pain took part in the study. Three rounds of interviews were held to refine the questions used to develop the goal scales. Overall, the participants identified a total of 59 problem areas, reducing these to the 45 most important goals (three for each patient). The minimal significant improvement was identified on 31 (69%) of these, with all except one patient able to identify this marker on two or more of their goal scales. The formation of individualized goal scales was successful in all of the participants in this study. Patients were able to understand the concept of 'minimal important change', and identify a specific target to reflect this for two-thirds of their chosen goals. [ABSTRACT FROM AUTHOR]