Codes of medical practice forbid a doctor to have sex with a patient. Still, practice and attitudes turn out to be unruly, so there is a need for (public) discussion and education. Moreover, other professional limitations in the doctor-patient relationship (e.g., 'non-medical' physical contact, dating a patient, accepting gifts from a patient, and treating partners, family-members and friends) ...

Every child reaches a point somewhere between infancy and young adulthood when he or she takes a step toward independence by caring for himself or herself for a period of time when no adult is present. Family decisions to allow their children to care for themselves vary widely, depending among other things on the family’s view of the risks associated with self-care, the child’s readiness for se...

“Complex interventions” are health service interventions that are not drugs or surgical procedures, but have many potential “active ingredients.” A complex intervention combines different components in a whole that is more than the sum of its parts. Randomised controlled trials (RCTs) are the most rigorous way to evaluate the effectiveness of interventions, regardless of their complexity. Becau...

According to a review by Campbell and Roland,1 a patient’s decision to consult a doctor is dependent on a multitude of physical, psychological and social reasons, with or without prior self-care. The patient’s journey of seeking medical care is influenced by socio-economic and demographic status, perception of susceptibility and severity, benefits/costs of seeking the interaction, as well as th...

BACKGROUND 'Continuity of personal care by anaesthetist', as defined by a single anaesthetist providing preoperative evaluation, performing anaesthesia, and delivering a postoperative visit to the patient, has been shown to be a major factor for patient satisfaction with anaesthesia care. This prospective randomized study investigated whether a single postoperative visit increased the patient's...

The randomised controlled trial (RCT) is at the heart of the evidence-based medicine movement and by implication should also be central to evidence-based nursing. One objection to RCTs in nursing science is that nursing is too complex an activity to be subjected to a carefully controlled experimental paradigm. We suggest that this argument is false and use examples from complex interventions re...

1 the bmj | BMJ 2015;350:h1258 | doi: 10.1136/bmj.h1258 1DECIPHer UKCRC Public Health Research Centre of Excellence, School of Social Sciences, Cardiff University, Cardiff, UK 2DECIPHer UKCRC Public Health Research Centre of Excellence, School of Social and Community Medicine, University of Bristol, Bristol, UK 3MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK 4Centr...

Manymedical interventions—particularly non-pharmacological ones—are complex, consisting of multiple interacting components targeted at different organisational levels. 2 Published descriptions of complex interventions often do not contain enough detail to enable their replication. Reports of behaviour change interventions should include descriptions of setting, mode, intensity, and duration, an...

BACKGROUND Including qualitative evidence on patients' perspectives in systematic reviews of complex interventions may reveal reasons for variation in trial findings. This is particularly the case when the intervention is for a long-term disease, as management may rely heavily on the efforts of the patient. Inclusion though seldom happens, possibly because of methodological challenges, and when...

Background Defining ‘usual care’ in studies of health services is challenging as it comprises a large variety of locally variable services. Building Blocks is trialling the Family Nurse Partnership Programme (FNP) in England. FNP is a complex intervention provided to first-time teenage mothers in the community setting. It was developed and previously trialled in the USA where support services a...