The existence of multiple instruments, including multiple AQoL instruments, raises three questions.
The existence of appropriate instruments to measure a caring culture in hospitals is unknown.
Indeed, the main limitation of this work concerns the lack of systematicity, which is explained, at least partly, by the non-existence of valid instruments and methodology to assess adverse events and also by the lack of previous reviews on this topic.
In this case the apple establishes the existence of the epistemic instrument by which it is known.
For this initial stage of CRUs' and CROs' existence, the instrument of Memorandums of Understanding signed directly between the Regional Councils and UNICEF have been used.
The hypothesis of this study was the existence of correlation between the instruments.
This technique relies on the existence of one variable or "instrument" that is supposed to achieve similar observations with a different treatment for "arbitrary" reasons, thus inducing substantial variation in the treatment decision with no direct effect on the outcome.
Whilst the existence of a public sector instrument for performance appraisal is undoubtedly positive, its implementation appears to be challenging and it likely that it will take time for its use to become established [ 20].
Instrumental variable (IV) analysis attempts to mimic the process of randomisation in an RCT by exploiting the existence of another variable (the instrument) which can be measured in the available data, which is highly correlated with the probability of exposure but unrelated to the outcome of interest except through its association with treatment [ 16].
However, despite the existence of data on such factors, instruments, and models, the process of knowledge translation remains laggard, rendering physician utilization low.
The existence of so many different 'satisfaction' instruments and the lack of data on their reliability and validity does not only cast doubt on the soundness of the instruments, but also makes comparisons of studies impossible and conclusions drawn from studies implausible.
