Other studies may wish to quantitatively test the relationship between dual practice and retention by drawing on this conceptual framework, and to investigate whether the framework applies beyond the context of specialists and to other cadres of health workers.
We demonstrated that, among ICU patients, a strategy of de-escalation in a context of global management with microbiologists, infectious disease specialists, and clinical pharmacists was possible in most cases, including septic shock, and did not influence short- and long-term prognosis or acquisition of MDR bacteria.
In a context of finite budgets, it is important that the prescription of these drugs is done by trained specialists that are proficient in treatment selection.
In summary, from our review of the literature, while family meetings are promoted as a common and valuable tool within the context of specialist palliative care there is limited evidence related to how they should be conducted and indeed whether they are valuable, most evidence being extrapolated from other settings.
While there is consensus in the literature that family meetings are necessary and valuable, our study identified an absence of empirical evidence, within the context of specialist palliative care settings, to guide when they are required, who should attend, how they should be conducted and whether or not they are beneficial.
Women at high risk can be offered preventive therapy in the context of specialist clinics, but on a population basis it may be optimal to implement risk assessment and treatment in general practitioner practices as is the case for the prevention of CVD in clinical practice.
Our interviews were limited to the context of specialist units, and it is certainly possible that some of the clients' fears might be justifiable in lower-tier institutions.
Therefore, in terms of service delivery, the eye health system staff did not work outside the context of specialist eye units (either in the secondary hospitals or the specialist clinics).
Having established the diagnosis, management of advanced BCC should take place in the context of a specialist multidisciplinary team, involving dermatologists, plastic surgeons, oncologists, pathologists, radiologists and nurse specialists in order to determine appropriate treatment options.
It has been estimated that <20% of all patients with cancer in England were managed in the context of a specialist team 15 years ago, 10 years later that number had increased to 80% (Griffith and Turner, 2004; Fleissig et al, 2006).
We set out to develop practice guidelines for conducting family meetings within the context of the specialist palliative care setting, based on the best available evidence and complemented by consensus based expert opinion.
