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Nüssler EK, Nüssler E, Eskildsen JK, Håkonsson DD, Löfgren M, Mitkidis P. The influence of geographical and clinical factors on decisions to use surgical mesh in operations for pelvic organ prolapse. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2018. [DOI: 10.1080/14783363.2018.1452610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Emil K. Nüssler
- Department of Clinical Science, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Emil Nüssler
- Department of Clinical Science, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Jacob Kjær Eskildsen
- Department of Management, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Dorthe D. Håkonsson
- Department of Management, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
- Department of Business Development and Technology, School of Business and Social Sciences, Aarhus University, Herning, Denmark
| | - Mats Löfgren
- Department of Clinical Science, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Panagiotis Mitkidis
- Department of Management, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
- Center for Advanced Hindsight, Social Science Research Institute, Duke University, Durham, NC, USA
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Neumann I, Alonso-Coello P, Vandvik PO, Agoritsas T, Mas G, Akl EA, Brignardello-Petersen R, Emparanza J, McCullagh L, De Sitio C, McGinn T, Almodaimegh H, Almodaimegh K, Rivera S, Rojas L, Stirnemann J, Irani J, Hlais S, Mustafa R, Bdair F, Aly A, Kristiansen A, Izcovich A, Ramirez A, Brozek J, Guyatt G, Schünemann HJ. Do clinicians want recommendations? A multicenter study comparing evidence summaries with and without GRADE recommendations. J Clin Epidemiol 2018. [PMID: 29530644 DOI: 10.1016/j.jclinepi.2018.02.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Evidence-based clinical practice guidelines provide recommendations to assist clinicians in decision-making and to reduce the gap between best current research evidence and clinical practice. However, some argue that providing preappraised evidence summaries alone, rather than recommendations, is more appropriate. The objective of the study is to evaluate clinicians' preferences, and understanding of the evidence and intended course of action in response to evidence summaries with and without recommendations. STUDY DESIGN SETTING We included practicing clinicians attending educational sessions across 10 countries. Clinicians were randomized to receive relevant clinical scenarios supported by research evidence of low or very low certainty and accompanied by either strong or weak recommendations developed with the GRADE system. Within each group, participants were further randomized to receive the recommendation plus the corresponding evidence summary or the evidence summary alone. We evaluated participants' preferences and understanding for the presentation strategy, as well as their intended course of action. RESULTS One hundred eighty-nine of 219 (86%) and 201 of 248 (81%) participants preferred having recommendations accompanying evidence summaries for both strong and weak recommendations, respectively. Across all scenarios, less than half of participants correctly interpreted information provided in the evidences summaries (e.g., estimates of effect, certainty in the research evidence). The presence of a recommendation resulted in a more appropriate intended course of action for two scenarios involving strong recommendations. CONCLUSION Evidence summaries alone are not enough to impact clinicians' course of action. Clinicians clearly prefer having recommendations accompanying evidence summaries in the context of low or very low certainty of evidence (Trial registration NCT02006017).
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Affiliation(s)
- Ignacio Neumann
- Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Alameda 340, Santiago 8331150, Chile.
| | - Pablo Alonso-Coello
- Centro Cochrane Iberoamericano, Instituto de Investigación Biomédica (CIBERESP-IIB Sant Pau), C/ Sant Antoni Maria Claret 167, Barcelona 08025, Spain
| | - Per Olav Vandvik
- Department of Medicine, Innlandet Hospital Trust-division Gjøvik, Kyrre Greppsgt.11, Gjøvik 2819, Norway
| | - Thomas Agoritsas
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Gabrielle-Perret-Gentil 4 Geneva 14 1211, Switzerland
| | - Gemma Mas
- Centro Cochrane Iberoamericano, Instituto de Investigación Biomédica (CIBERESP-IIB Sant Pau), C/ Sant Antoni Maria Claret 167, Barcelona 08025, Spain
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut 1107 2020, Lebanon
| | - Romina Brignardello-Petersen
- Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Av Libertador Bernardo O'Higgins 1058, Santiago, Región Metropolitana 8330111, Chile
| | - Jose Emparanza
- Clinical Epidemiology Unit, (CASPe-CIBER-ESP), Donostia University Hospital, Paseo Doctor Beriguistain 109, San Sebastian 20014, Spain
| | - Lauren McCullagh
- Department of Medicine, North Shore-LIJ Health System, 600 Community Drive, Suite 300, Manhasset 11030, NY, USA
| | - Catherine De Sitio
- Department of Medicine, North Shore-LIJ Health System, 600 Community Drive, Suite 300, Manhasset 11030, NY, USA
| | - Thomas McGinn
- Medicine Service Line Northwell Health, 300 Community Drive, Manhasset 11030, NY, USA
| | - Hind Almodaimegh
- College of Pharmacy-Female Branch, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, PO BOX 22490, Riyadh 11426, Saudi Arabia
| | - Khalid Almodaimegh
- Family Medicine and Diabetology, Al-Iman Hospital, Riyadh 11544, Saudi Arabia
| | - Solange Rivera
- Department of Family Medicine, Pontificia Universidad Catolica de Chile, Alameda 340, Santiago 8331150, Chile
| | - Luis Rojas
- Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Alameda 340, Santiago 8331150, Chile
| | - Jérôme Stirnemann
- Department of General Internal Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1211, Switzerland
| | - Jihad Irani
- University of Balamand, Faculty of Medicine & Medical Sciences, Beirut, Lebanon
| | - Sani Hlais
- Family Medicine Departments, American University of Beirut and Saint Joseph University, Beirut, Lebanon
| | - Reem Mustafa
- University of Missouri-Kansas City School of Medicine, M4-303 2411 Holmes St., Kansas City 64108-2792, MO, USA
| | - Fadi Bdair
- Mosaic Life Care, 011 E St Maartens Dr, St Joseph 64506, MO, USA
| | - Abdelrahman Aly
- University of Missouri-Kansas City School of Medicine, M4-303 2411 Holmes St., Kansas City 64108-2792, MO, USA
| | - Annette Kristiansen
- Department of Internal Medicine, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ariel Izcovich
- Department of Internal Medicine, Hospital Alemán, Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Anggie Ramirez
- International Health Central American Institute Foundation & Cochrane Central America & Spanish Caribbean Branch of the Iberoamerican Cochrane Centre, San Jose, Costa Rica Costa Rica, San José, Santa Ana, Condominio Santa Ana Hills #43, San Jose Zip Code: 10-901, Costa Rica
| | - Jan Brozek
- Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Main Street West 1200, Hamilton L8S4L8, Ontario, Canada
| | - Gordon Guyatt
- Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Main Street West 1200, Hamilton L8S4L8, Ontario, Canada
| | - Holger J Schünemann
- Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Main Street West 1200, Hamilton L8S4L8, Ontario, Canada
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Barni S, Venturini M, Molino A, Donadio M, Rizzoli S, Maiello E, Gori S. Importance of adherence to guidelines in breast cancer clinical practice. The Italian experience (AIOM). TUMORI JOURNAL 2018; 97:559-63. [DOI: 10.1177/030089161109700503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Project RIGHT (Research for the Identification of the most effective and hIGHly accepted clinical guidelines for cancer Treatment) is promoted by the Italian Association of Medical Oncology (AIOM) to evaluate the concordance between AIOM breast cancer guidelines and clinical practice in Italy. In RIGHT-1, feasibility and the appropriateness of indicators were assessed in patients with early breast cancer. RIGHT-2 evaluated the compliance with guidelines in a nationwide program. Methods Thirty-five Italian centers participated in the RIGHT-2 survey. Ten indicators were evaluated to verify an agreement between 2005 AIOM breast cancer guidelines and practice. Patients with clinical stage I-II invasive breast cancer, age ≤70 years, who had their first visit at the oncology center between October 2005 and November 2006 were included. Results In RIGHT-2, ≥90% adherence for the diagnosis indicator and three therapy indicators were observed. The lowest degree of compliance (0%) was observed for the follow-up indicator in asymptomatic patients. Conclusions In RIGHT-2, compliance to the 2005 AIOM breast cancer guidelines was 64%. When the follow-up indicator was eliminated, overall adherence to AIOM guidelines was 71%. The results highlight the need to continue improving the already good standards of breast cancer care.
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Affiliation(s)
- Sandro Barni
- Oncologia Medica, Azienda Ospedaliera
Treviglio-Caravaggio, Treviglio, Bergamo
| | | | | | | | | | | | - Stefania Gori
- Oncologia Medica, Azienda Ospedaliera,
Perugia, Italy
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Sokol RG, Shaughnessy AF. Making the Most of Continuing Medical Education: Evidence of Transformative Learning During a Course in Evidence-Based Medicine and Decision Making. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2018; 38:102-109. [PMID: 29851715 DOI: 10.1097/ceh.0000000000000199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Continuing medical information courses have been criticized for not promoting behavior change among their participants. For behavior change to occur, participants often need to consciously reject previous ideas and transform their way of thinking. Transformational learning is a process that cultivates deep emotional responses and can lead to cognitive and behavioral change in learners, potentially facilitating rich learning experiences and expediting knowledge translation. We explored participants' experiences at a 2-day conference designed to support transformative learning as they encounter new concepts within Information Mastery, which challenge their previous frameworks around the topic of medical decision making. Using the lens of transformative learning theory, we asked: how does Information Mastery qualitatively promote perspective transformation and hence behavior change? METHODS We used a hermeneutic phenomenologic approach to capture the lived experience of 12 current and nine previous attendees of the "Information Mastery" course through individual interviews, focus groups, and observation. Data were thematically analyzed. RESULTS Both prevoius and current conference attendees described how the delivery of new concepts about medical decision making evoked strong emotional responses, facilitated personal transformation, and propelled expedited behavior change around epistemological, moral, and information management themes, resulting in a newfound sense of self-efficacy, confidence, and ownership in their ability to make medical decisions. DISCUSSION When the topic area holds the potential to foster a qualitative reframing of learners' guiding paradigms and worldviews, attention should be paid to supporting learners' personalized meaning-making process through transformative learning opportunities to promote translation into practice.
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Affiliation(s)
- Randi G Sokol
- Dr. Sokol: Assistant Professor of Family Medicine, Tufts Family Medicine Residency Program at Cambridge Health Alliance, Malden, MA. Dr. Shaughnessy: Professor of Family Medicine, Professor of Public Health and Community Medicine, Tufts University School of Medicine, Malden, MA
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Sarkies MN, Bowles KA, Skinner EH, Haas R, Lane H, Haines TP. The effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare: a systematic review. Implement Sci 2017; 12:132. [PMID: 29137659 PMCID: PMC5686806 DOI: 10.1186/s13012-017-0662-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 11/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is widely acknowledged that health policy and management decisions rarely reflect research evidence. Therefore, it is important to determine how to improve evidence-informed decision-making. The primary aim of this systematic review was to evaluate the effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The secondary aim of the review was to describe factors perceived to be associated with effective strategies and the inter-relationship between these factors. METHODS An electronic search was developed to identify studies published between January 01, 2000, and February 02, 2016. This was supplemented by checking the reference list of included articles, systematic reviews, and hand-searching publication lists from prominent authors. Two reviewers independently screened studies for inclusion, assessed methodological quality, and extracted data. RESULTS After duplicate removal, the search strategy identified 3830 titles. Following title and abstract screening, 96 full-text articles were reviewed, of which 19 studies (21 articles) met all inclusion criteria. Three studies were included in the narrative synthesis, finding policy briefs including expert opinion might affect intended actions, and intentions persisting to actions for public health policy in developing nations. Workshops, ongoing technical assistance, and distribution of instructional digital materials may improve knowledge and skills around evidence-informed decision-making in US public health departments. Tailored, targeted messages were more effective in increasing public health policies and programs in Canadian public health departments compared to messages and a knowledge broker. Sixteen studies (18 articles) were included in the thematic synthesis, leading to a conceptualisation of inter-relating factors perceived to be associated with effective research implementation strategies. A unidirectional, hierarchal flow was described from (1) establishing an imperative for practice change, (2) building trust between implementation stakeholders and (3) developing a shared vision, to (4) actioning change mechanisms. This was underpinned by the (5) employment of effective communication strategies and (6) provision of resources to support change. CONCLUSIONS Evidence is developing to support the use of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The design of future implementation strategies should be based on the inter-relating factors perceived to be associated with effective strategies. TRIAL REGISTRATION This systematic review was registered with Prospero (record number: 42016032947).
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Affiliation(s)
- Mitchell N. Sarkies
- Kingston Centre, Monash University and Monash Health Allied Health Research Unit, 400 Warrigal Road, Heatherton, VIC 3202 Australia
| | - Kelly-Ann Bowles
- Monash University Department of Community Emergency Health and Paramedic Practice, Building H McMahons Road, Frankston, VIC 3199 Australia
| | - Elizabeth H. Skinner
- Kingston Centre, Monash University and Monash Health Allied Health Research Unit, 400 Warrigal Road, Heatherton, VIC 3202 Australia
| | - Romi Haas
- Kingston Centre, Monash University and Monash Health Allied Health Research Unit, 400 Warrigal Road, Heatherton, VIC 3202 Australia
| | - Haylee Lane
- Kingston Centre, Monash University and Monash Health Allied Health Research Unit, 400 Warrigal Road, Heatherton, VIC 3202 Australia
| | - Terry P. Haines
- Kingston Centre, Monash University and Monash Health Allied Health Research Unit, 400 Warrigal Road, Heatherton, VIC 3202 Australia
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Schippke J, Provvidenza C, Kingsnorth S. Peer support for families of children with complex needs: Development and dissemination of a best practice toolkit. Child Care Health Dev 2017; 43:823-830. [PMID: 28718963 DOI: 10.1111/cch.12494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/22/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Benefits of peer support interventions for families of children with disabilities and complex medical needs have been described in the literature. An opportunity to create an evidence-informed resource to synthesize best practices in peer support for program providers was identified. The objective of this paper is to describe the key activities used to develop and disseminate the Peer Support Best Practice Toolkit. METHODS This project was led by a team of knowledge translation experts at a large pediatric rehabilitation hospital using a knowledge exchange framework. An integrated knowledge translation approach was used to engage stakeholders in the development process through focus groups and a working group. To capture best practices in peer support, a rapid evidence review and review of related resources were completed. Case studies were also included to showcase practice-based evidence. RESULTS The toolkit is freely available online for download and is structured into four sections: (a) background and models of peer support, (b) case studies of programs, (c) resources, and (d) rapid evidence review. A communications plan was developed to disseminate the resource and generate awareness through presentations, social media, and champion engagement. Eight months postlaunch, the peer support website received more than 2,400 webpage hits. Early indicators suggest high relevance of this resource among stakeholders. CONCLUSIONS The toolkit format was valuable to synthesize and share best practices in peer support. Strengths of the work include the integrated approach used to develop the toolkit and the inclusion of both the published research literature and experiential evidence.
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Affiliation(s)
- J Schippke
- Evidence to Care, Teaching and Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - C Provvidenza
- Evidence to Care, Teaching and Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - S Kingsnorth
- Evidence to Care, Teaching and Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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57
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Sharma S, Pandit A, Tabassum F. Potential facilitators and barriers to adopting standard treatment guidelines in clinical practice. Int J Health Care Qual Assur 2017; 30:285-298. [PMID: 28350223 DOI: 10.1108/ijhcqa-10-2016-0148] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to assess medicines information sources accessed by clinicians, if sources differed in theory and practice and to find out the barriers and facilitators to effective guideline adoption. Design/methodology/approach In all, 183 doctors were surveyed. Barriers and facilitators were classified as: communication; potential adopters; innovation; organization characteristics and environmental/social/economic context. Findings Most of the clinicians accessed multiple information sources including standard treatment guidelines, but also consulted seniors/colleagues in practice. The top three factors influencing clinical practice guideline adoption were innovation characteristics, environmental context and individual characteristics. The respondents differed in the following areas: concerns about flexibility offered by the guideline; denying patients' individuality; professional autonomy; insights into gaps in current practice and evidence-based practice; changing practices with little or no benefit. Barriers included negative staff attitudes/beliefs, guideline integration into organizational structures/processes, time/resource constraints. Fearing third parties (government and insurance companies) restricting medicines reimbursement and poor liability protection offered by the guidelines emerged as the barriers. Facilitators include aligning organizational structures/processes with the innovation; providing leadership support to guide diffusion; increasing awareness and enabling early innovation during pre/in-service training, with regular feedback on outcomes and use. Practical implications Guideline adoption in clinical practice is partly within doctors' control. There are other key prevailing factors in the local context such as environmental, social context, professional and organizational culture affecting its adoption. Organizational policy and accreditation standards necessitating adherence can serve as a driver. Originality/value This survey among clinicians, despite limitations, gives helpful insights. While favourable attitudes may be helpful, clinical adoption could be improved more effectively by targeting barriers.
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Affiliation(s)
- Sangeeta Sharma
- Department of Neuropsychopharmacology, Institute of Human Behaviour and Allied Sciences, Delhi, India
| | - Ajay Pandit
- Faculty of Management Studies, University of Delhi , Delhi, India
| | - Fauzia Tabassum
- Department of Pharmacology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
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Management of Pediatric Nonalcoholic Fatty Liver Disease by Academic Hepatologists in Canada: A Nationwide Survey. J Pediatr Gastroenterol Nutr 2017; 65:380-383. [PMID: 28333768 DOI: 10.1097/mpg.0000000000001581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The literature on the optimal clinical management of pediatric patients with nonalcoholic fatty liver disease (NAFLD) is limited. The objective of this study was to identify discrepancies in the care provided to patients with NAFLD by hepatologists practicing in academic centers across Canada. METHODS A nationwide survey was distributed electronically to all pediatric hepatologists practicing in university-affiliated hospitals using the infrastructure of the Canadian Pediatric Hepatology Research Group. The responses were anonymous. RESULTS The response rate to the survey was 79%. Everyone reported diagnosing NAFLD based on a combination of elevated transaminases and imaging suggestive of steatosis in the context of an otherwise negative workup for other liver diseases. Only 14% use liver biopsy to confirm the diagnosis. There are significant discrepancies in the frequency of screening for other comorbidities (eg, hypertension, sleep apnea, etc) and in the frequency of laboratory investigations (eg, lipid profile, transaminases, international normalized ratio, etc). Frequency of outpatient clinic follow-up varies significantly. Treatment is consistently based on lifestyle modifications; however, reported patient outcomes in terms of body mass index improvements are poor. CONCLUSIONS There are significant discrepancies in the care provided to children with NAFLD by hepatologists practicing in academic centers across Canada.
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Tan J, Linos E, Sendelweck MA, van Zuuren EJ, Ersser S, Dellavalle RP, Williams H. Shared decision making and patient decision aids in dermatology. Br J Dermatol 2017; 175:1045-1048. [PMID: 27790692 DOI: 10.1111/bjd.14803] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2016] [Indexed: 11/30/2022]
Abstract
Shared decision making combines individual patient interests and values with clinical best evidence under the guiding principle of patient autonomy. Patient decision aids can support shared decision making and facilitate decisions that have multiple options with varying outcomes for which patients may attribute different values. Given the variable psychosocial impact of skin disease on individuals and relative uncertainty regarding best treatments and their adherence in many dermatological conditions, informed shared decision making, supported by patient decision aids, should constitute a central component of dermatological care.
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Affiliation(s)
- J Tan
- Western University, London, ON, Canada.
| | - E Linos
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, CA, U.S.A
| | | | - E J van Zuuren
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - S Ersser
- School of Healthcare, University of Leeds, Leeds, U.K
| | - R P Dellavalle
- Denver Veterans Affairs Medical Center, Denver, CO, U.S.A
| | - H Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
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Uneke CJ, Sombie I, Keita N, Lokossou V, Johnson E, Ongolo-Zogo P, Uro-Chukwu HC. Assessment of policy makers' individual and organizational capacity to acquire, assess, adapt and apply research evidence for maternal and child health policy making in Nigeria: a cross-sectional quantitative survey. Afr Health Sci 2017; 17:700-711. [PMID: 29085397 PMCID: PMC5656188 DOI: 10.4314/ahs.v17i3.12] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Throughout the world, there is increasing awareness and acknowledgement of the value of research evidence in the development of effective health policy and in quality health care practice and administration. Among the major challenges associated with the lack of uptake of research evidence into policy and practice in Nigeria is the capacity constraints of policymakers to use research evidence in policy making. Objective To assess the capacity of maternal and child health policy makers to acquire, access, adapt and apply available research evidence. Methods This cross-sectional quantitative survey was conducted at a national maternal, newborn and child health (MNCH) stakeholders' engagement event. An evidence to policy self-assessment questionnaire was used to assess the capacity of forty MNCH policy makers to acquire, assess, adapt and apply research evidence for policy making. Results Low mean ratings were observed ranging from 2.68–3.53 on a scale of 5 for knowledge about initiating/conducting research and capacity to assess authenticity, validity, reliability, relevance and applicability of research evidence and for organizational capacity for promoting and using of research for policy making. Conclusion There is need to institute policy makers' capacity development programmes to improve evidence-informed policymaking.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy & Health Systems, Ebonyi State University, PMB 053 Abakaliki Nigeria
| | - Issiaka Sombie
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Namoudou Keita
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Virgil Lokossou
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Ermel Johnson
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Pierre Ongolo-Zogo
- Hopital Central Yaounde, CDBPH Lawrence VERGNE Building 2nd Floor, Avenue Henry Dunant Messa Yaoundé, Cameroon
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Diagnostic uncertainty and epistemologic humility. Clin Rheumatol 2017; 36:1211-1214. [DOI: 10.1007/s10067-017-3631-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
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Curtis K, Van C, Lam M, Asha S, Unsworth A, Clements A, Atkins L. Implementation evaluation and refinement of an intervention to improve blunt chest injury management-A mixed-methods study. J Clin Nurs 2017; 26:4506-4518. [PMID: 28252839 PMCID: PMC6686633 DOI: 10.1111/jocn.13782] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 01/10/2023]
Abstract
Aims and objectives To investigate uptake of a Chest Injury Protocol (ChIP), examine factors influencing its implementation and identify interventions for promoting its use. Background Failure to treat blunt chest injuries in a timely manner with sufficient analgesia, physiotherapy and respiratory support, can lead to complications such as pneumonia and respiratory failure and/or death. Design This is a mixed‐methods implementation evaluation study. Methods Two methods were used: (i) identification and review of the characteristics of all patients eligible for the ChIP protocol, and (ii) survey of hospital staff opinions mapped to the Theoretical Domains Framework (TDF) to identify barriers and facilitators to implementation. The characteristics and treatment received between the groups were compared using the chi‐square test or Fischer's exact test for proportions, and the Mann–Whitney U‐test for continuous data. Quantitative survey data were analysed using descriptive statistics. Qualitative data were coded in NVivo 10 using a coding guide based on the TDF and Behaviour Change Wheel (BCW). Identification of interventions to change target behaviours was sourced from the Behaviour Change Technique Taxonomy Version 1 in consultation with stakeholders. Results Only 68.4% of eligible patients received ChIP. Fifteen facilitators and 10 barriers were identified to influence the implementation of ChIP in the clinical setting. These themes were mapped to 10 of the 14 TDF domains and corresponded with all nine intervention functions in the BCW. Seven of these intervention functions were selected to address the target behaviours and a multi‐faceted relaunch of the revised protocol developed. Following re‐launch, uptake increased to 91%. Conclusions This study demonstrated how the BCW may be used to revise and improve a clinical protocol in the ED context. Relevance to clinical practice Newly implemented clinical protocols should incorporate clinician behaviour change assessment, strategy and interventions. Enhancing the self‐efficacy of emergency nurses when performing assessments has the potential to improve patient outcomes and should be included in implementation strategy.
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Affiliation(s)
- Kate Curtis
- Sydney Nursing School, The University of Sydney, Camperdown, NSW, Australia.,Trauma Service, St George Hospital, Kogarah, NSW, Australia.,The George Institute for Global Health, Sydney, NSW, Australia
| | - Connie Van
- Sydney Nursing School, The University of Sydney, Camperdown, NSW, Australia
| | - Mary Lam
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Stephen Asha
- St George Clinical School, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia.,Department of Emergency Medicine, St George Hospital, Kogarah, NSW, Australia
| | - Annalise Unsworth
- St George Clinical School, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Alana Clements
- Department of Emergency Medicine, St George Hospital, Kogarah, NSW, Australia
| | - Louise Atkins
- Centre for Behaviour Change, University College London, London, UK
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Abstract
Objectivity has been traditionally established as an aim of science; however, its feasibility and desirability have been repeatedly called into question. In this article, I provide a brief overview of the historical context surrounding the concept of objectivity in science. I then examine Helen Longino's theory of transformative criticism as an example of an attempt to secure scientific objectivity through the social nature of the scientific process. Possible objections to this critique are discussed, and ultimately, I argue that her account falls short in securing scientific objectivity. I briefly discuss objectivity and its relationship to human sciences such as nursing. I conclude by arguing that achieving complete objectivity in science is neither possible nor desirable.
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Affiliation(s)
- Aimee Milliken
- Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
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Curtis K, Fry M, Shaban RZ, Considine J. Translating research findings to clinical nursing practice. J Clin Nurs 2017; 26:862-872. [PMID: 27649522 PMCID: PMC5396371 DOI: 10.1111/jocn.13586] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2016] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To describe the importance of, and methods for, successfully conducting and translating research into clinical practice. BACKGROUND There is universal acknowledgement that the clinical care provided to individuals should be informed on the best available evidence. Knowledge and evidence derived from robust scholarly methods should drive our clinical practice, decisions and change to improve the way we deliver care. Translating research evidence to clinical practice is essential to safe, transparent, effective and efficient healthcare provision and meeting the expectations of patients, families and society. Despite its importance, translating research into clinical practice is challenging. There are more nurses in the frontline of health care than any other healthcare profession. As such, nurse-led research is increasingly recognised as a critical pathway to practical and effective ways of improving patient outcomes. However, there are well-established barriers to the conduct and translation of research evidence into practice. DESIGN This clinical practice discussion paper interprets the knowledge translation literature for clinicians interested in translating research into practice. METHODS This paper is informed by the scientific literature around knowledge translation, implementation science and clinician behaviour change, and presented from the nurse clinician perspective. We provide practical, evidence-informed suggestions to overcome the barriers and facilitate enablers of knowledge translation. Examples of nurse-led research incorporating the principles of knowledge translation in their study design that have resulted in improvements in patient outcomes are presented in conjunction with supporting evidence. CONCLUSIONS Translation should be considered in research design, including the end users and an evaluation of the research implementation. The success of research implementation in health care is dependent on clinician/consumer behaviour change and it is critical that implementation strategy includes this. RELEVANCE TO PRACTICE Translating best research evidence can make for a more transparent and sustainable healthcare service, to which nurses are central.
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Affiliation(s)
- Kate Curtis
- Sydney Nursing SchoolUniversity of SydneyCamperdownNSWAustralia
- Trauma ServiceSt George HospitalKogarahNSWAustralia
- St George and Sutherland Clinical SchoolUniversity of New South WalesSt George HospitalKogarahNSWAustralia
| | - Margaret Fry
- Northern Sydney Local Health DistrictRoyal North Shore Hospital CampusSt LeonardsNSWAustralia
- Faculty of HealthUniversity of Technology SydneyUltimoNSWAustralia
| | - Ramon Z Shaban
- School of Nursing and MidwiferyMenzies Health Institute QueenslandGriffith UniversityNathanQldAustralia
- Department of Infection Control and Infectious DiseasesGold Coast University HospitalGold Coast Hospital and Health ServiceSouthportQldAustralia
| | - Julie Considine
- Centre for Quality and Patient Safety ResearchSchool of Nursing and MidwiferyDeakin UniversityBurwoodVicAustralia
- Midwifery Research CentreEastern HealthDeakin University NursingBox HillVicAustralia
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Chamberlain C, O'Mara‐Eves A, Porter J, Coleman T, Perlen SM, Thomas J, McKenzie JE. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 2017; 2:CD001055. [PMID: 28196405 PMCID: PMC6472671 DOI: 10.1002/14651858.cd001055.pub5] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tobacco smoking remains one of the few preventable factors associated with complications in pregnancy, and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and is increasing in low- to middle-income countries. OBJECTIVES To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. SEARCH METHODS In this sixth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2015), checked reference lists of retrieved studies and contacted trial authors. SELECTION CRITERIA Randomised controlled trials, cluster-randomised trials, and quasi-randomised controlled trials of psychosocial smoking cessation interventions during pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, with meta-regression conducted in STATA 14. MAIN RESULTS The overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.In separate comparisons, there is high-quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small.Evidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention.There was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20).High-quality evidence suggests incentive-based interventions are effective when compared with an alternative (non-contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I2 = 93%).High-quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health.The effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32).Importantly, high-quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions.The intensity of support women received in both the intervention and comparison groups has increased over time, with higher-intensity interventions more likely to have higher-intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta-regression analyses. Among meta-regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio-economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self-reported abstinence. It was unclear whether incorporating use of self-help manuals or telephone support increased the effectiveness of interventions. AUTHORS' CONCLUSIONS Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight. Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered. The effect of health education and social support is less clear. New trials have been published during the preparation of this review and will be included in the next update.
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Affiliation(s)
- Catherine Chamberlain
- La Trobe UniversityJudith Lumley Centre251 Faraday StreetMelbourneVicAustralia3000
- University of MelbourneMelbourne School of Population and Global HealthMelbourneAustralia
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneAustralia
- Murdoch Childrens Research InstituteHealthy Mothers Healthy Families Research GroupMelbourneVictoriaAustralia3052
| | - Alison O'Mara‐Eves
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Jessie Porter
- University of MelbourneMelbourne School of Population and Global HealthMelbourneAustralia
| | - Tim Coleman
- University of NottinghamDivision of Primary CareD1411, Medical SchoolQueen's Medical CentreNottinghamUKNG7 2UH
| | - Susan M Perlen
- Murdoch Childrens Research InstituteHealthy Mothers Healthy Families Research GroupMelbourneVictoriaAustralia3052
| | - James Thomas
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Joanne E McKenzie
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneAustralia
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Löhler J, Akcicek B, Müller F, Dreier G, Meerpohl JJ, Vach W, Werner JA. Evidence gaps in ENT surgery - a qualitative survey. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 15:Doc10. [PMID: 28025610 PMCID: PMC5169083 DOI: 10.3205/cto000137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: As in other disciplines, the burgeoning knowledge in ENT medicine long ago surpassed our ability to adequately absorb it and maintain a proper overview. This can give rise to actual or assumed evidence gaps that can impede the progress of the discipline and evidence-based treatment of patients. Clinics and medical practices also hold to traditional doctrines that shape day-to-day medicine, without these schools being challenged based on evidence. Methods: Between February and June 2015, 160 ENT clinics, including 34 university hospitals, and 2,670 ENT practices took part in a two-arm online survey on existing or perceived evidentiary gaps in ENT medicine using a previously developed questionnaire. The survey used for half of the participants was open in form; the other half were given a closed survey with systematics of the field for orientation. The survey was augmented with additional data such as the number of publications and focus areas in the clinics and the age and type of practice of the established physicians. Results: The return rate from the clinics was 39.7%; the return rate of the closed surveys was 29.3%. Of the physicians in medical practice, 14.6% responded to the closed and 18.6% to the open survey. There were no major differences between the two forms of survey. Otological and oncological issues comprised approximately 30% of the list of answers from clinics. Corresponding questions were formulated regarding the current diagnostic and therapeutic problems, such as with stage-related tumor treatment or implantable hearing aids. Diagnostic procedures, e.g., special new procedures in audiology and vestibulogy, dominated the surveys from the practices. However clinics and practices alike cited marginal areas of the discipline that are of daily relevance. Discussion: The cited evidence gaps then needed to be verified or refuted and clarified based on research of the literature as to whether the existing evidence actually reached healthcare providers in the form of guidelines, publications, conferences, or continuing training for application in daily practice. Other steps would include prioritizing future research, evidence mapping, deciding on further systematic reviews, and targeted studies in conjunction with procuring third-party funding and in cooperation with patient associations. The knowledge thus gained should ultimately be transferred in improved form for application in daily clinical practice. Ten questions of key importance each needed to be formulated for the hospitals and practices.
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Affiliation(s)
- Jan Löhler
- German Study Center of Oto-Rhino-Laryngology, Head and Neck Surgery, Bonn, Germany; Scientific Institute for Applied Otolaryngology, Bad Bramstedt, Germany
| | - B Akcicek
- Scientific Institute for Applied Otolaryngology, Bad Bramstedt, Germany
| | - F Müller
- University Department of Otolaryngology, Philipps University of Marburg, Germany
| | - G Dreier
- German Study Center of Oto-Rhino-Laryngology, Head and Neck Surgery, Bonn, Germany; Study Center of the University Hospital of Freiburg, Germany
| | - J J Meerpohl
- Cochrane Germany, University Hospital of Freiburg, Germany
| | - W Vach
- Department of Medical Biometry and Medical Informatics, University Hospital of Freiburg, Germany
| | - J A Werner
- German Study Center of Oto-Rhino-Laryngology, Head and Neck Surgery, Bonn, Germany; University Department of Otolaryngology, Philipps University of Marburg, Germany
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Haggard M. The relationship between evidence and guidelines. Otolaryngol Head Neck Surg 2016; 137:S72-7. [PMID: 17894952 DOI: 10.1016/j.otohns.2007.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 08/01/2007] [Indexed: 10/22/2022]
Abstract
This reflection aims to soothe some frustrations, to cool current debates, and to encourage an understanding whereby the relationship between evidence and guidelines can be more productive in future. The relationship of evidence to guidelines, an important link between research and application, is not as simple and unidirectional as is often imagined. The recent emphasis on evidence of high quality and aggregation of evidence is appropriate but can be modified and extended. There are other important elements in guidelines besides the available evidence (which is centered on efficacy and effectiveness). Available evidence may be poor, or not be the most relevant to the decision at hand. To offset the limitations to which this predicament leads, effort is also appropriate to develop more rigorous principles for interpretation and evaluation of evidence, so as to make better use of what is available. The processes for generating guidelines from evidence emphasize reliability, generalizability of a limited kind, and freedom from bias to be achieved via systematic review. If the inclusion criterion for studies is too stringent, there may be little to say from evidence alone, or the evidence that remains may suffer limitations of relevance due to context, or it may be misapplied, simply because it has been endorsed as to quality. Knowledge-based medicine (KBM) would acknowledge a greater role for the scientific principles underlying particular pieces of evidence and deploy a fuller understanding of the health-care context. It should thus make guidelines more professionally accepted and useful in the future.
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Affiliation(s)
- Mark Haggard
- MRC Multi-Centre Otitis Media Study Group, Cambridge, UK.
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Adamou M, Graham K, MacKeith J, Burns S, Emerson LM. Advancing services for adult ADHD: the development of the ADHD Star as a framework for multidisciplinary interventions. BMC Health Serv Res 2016; 16:632. [PMID: 27821125 PMCID: PMC5100092 DOI: 10.1186/s12913-016-1894-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder is prevalent in adulthood, resulting in serious impairment across multiple domains of living. Despite clinical guidance recommendations, the relative infancy of research on service provision for adults with ADHD, along with the evidence transfer gap, means that there is a lack of specific frameworks for service delivery. Igniting research and developing service delivery frameworks within adult ADHD is an essential step in the provision of effective services for adults with ADHD. METHOD Following the methodology used in previous related research that utilises a Participatory Action Research approach, we gathered data from clinicians and service users on the domains of living in which they wish to create change, and the steps and end point of the change process. This data was utilised, alongside data gathered from previous research and policies, to develop the domains of assessment for the ADHD Star, and the scale on which change is assessed. RESULTS The resulting tool, the ADHD Star, consists of eight domains: understanding your ADHD, focus and attention, organising yourself, friends and social life, thinking and reacting, physical health, how you feel and meaningful use of time. Each domain is rated on a five-point scale, the 'ladder of change', ranging from 'stuck' to 'choice'. CONCLUSIONS The ADHD Star offers a guiding framework for the development of care pathways and subsequent service provision for adults with ADHD, based on multi-disciplinary, holistic and person-centred care.
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Affiliation(s)
- Marios Adamou
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, Wakefield, Portobello Road, WF1 5PN, UK.
- University of Huddersfield, School of Human Health Sciences, Queensgate, HD13DH, UK.
| | - Katharine Graham
- Triangle Consulting Social Enterprise, The Dock Hub, Wilbury Villas, Hove, BN3 6AH, UK
| | - Joy MacKeith
- Triangle Consulting Social Enterprise, The Dock Hub, Wilbury Villas, Hove, BN3 6AH, UK
| | - Sara Burns
- Triangle Consulting Social Enterprise, The Dock Hub, Wilbury Villas, Hove, BN3 6AH, UK
| | - Lisa-Marie Emerson
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, Wakefield, Portobello Road, WF1 5PN, UK
- Department of Psychology, University of Sheffield, Sheffield, UK
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Authors’ Reply to Alain Braillon’s Comment on “Safety and Tolerability of Pharmacological Treatment of Alcohol Dependence: Comprehensive Review of Evidence”. Drug Saf 2016; 39:1153-1154. [DOI: 10.1007/s40264-016-0448-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Delivering an infection control link nurse programme: an exploration of the experiences of the link nurses. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/14690446050060010501] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This is the third in a series of articles describing a research study that examined the efficacy of an infection control link nurse programme, which had an educational programme based upon adult learning theory, delivered using an action research approach. This article describes the results of a qualitative study that explored the experiences of the link nurses who participated in the programme. Implications for practice are discussed.
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Cooper T. Delivering an infection control link nurse programme: implementation and evaluation of a flexible teaching approach. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/14690446040050050701] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infection control nurses work to ensure practice is evidence-based, thereby minimising infection risks. There is, however, a gap between theory and practice in infection control at clinical level. Link nurse groups have been used in an attempt to ensure practice is evidence-based. This article describes a research study that examined the efficacy of an infection control link nurse programme, which had an educational programme based upon adult learning theory, delivered using an action-research approach. Results of the study are described in subsequent articles.
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O'Rourke HM, Fraser KD. How Quality Improvement Practice Evidence Can Advance the Knowledge Base. J Healthc Qual 2016; 38:264-74. [DOI: 10.1097/jhq.0000000000000067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Adams ES, Longhurst CA. Clinical Decision Support for Pediatric Blood Product Prescriptions. J Pediatr Intensive Care 2016; 5:108-112. [PMID: 31110894 DOI: 10.1055/s-0035-1569996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/07/2015] [Indexed: 10/22/2022] Open
Abstract
Since the beginning of the 20th century, blood products have been used to effectively treat life-threatening conditions. Over time, we have come to appreciate the many benefits along with significant risks inherent to blood product transfusions. As such, recommendations for the safe and effective use of blood products have evolved over time. Current evidence supports the use of restrictive transfusion strategies that can avoid the risks of unnecessary transfusions. In spite of good evidence, there is a considerable amount of variability in transfusion practices across providers. Clinical decision support (CDS) is an effective tool capable of increasing adherence to evidence-based practices. CDS has been used successfully to improve adherence to transfusion guidelines. Pediatric literature demonstrates strong evidence for the use of CDS to improve appropriateness of red blood cell and plasma transfusion utilization. Further studies in more diverse settings with more standardized reporting are needed to provide more clarity around the effectiveness of CDS in blood product prescriptions.
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Affiliation(s)
- Eloa S Adams
- Department of Pediatric Intensive Care Medicine, Kaiser Permanente, Oakland Medical Center, Oakland, California, United States
| | - Christopher A Longhurst
- Department of Pediatrics, Stanford University School of Medicine, Lucille Packard Children's Hospital, Palo Alto, California, United States
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Haddaway NR, Bernes C, Jonsson BG, Hedlund K. The benefits of systematic mapping to evidence-based environmental management. AMBIO 2016; 45:613-20. [PMID: 26984257 PMCID: PMC4980318 DOI: 10.1007/s13280-016-0773-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/29/2015] [Accepted: 03/01/2016] [Indexed: 05/04/2023]
Abstract
Reviews of evidence are a vital means of summarising growing bodies of research. Systematic reviews (SRs) aim to reduce bias and increase reliability when summarising high priority and controversial topics. Similar to SRs, systematic maps (SMs) were developed in social sciences to reliably catalogue evidence on a specific subject. Rather than providing answers to specific questions of impacts, SMs aim to produce searchable databases of studies, along with detailed descriptive information. These maps (consisting of a report, a database, and sometimes a geographical information system) can prove highly useful for research, policy and practice communities, by providing assessments of knowledge gaps (subjects requiring additional research), knowledge gluts (subjects where full SR is possible), and patterns across the research literature that promote best practice and direct research resources towards the highest quality research. Here, we introduce SMs in detail using three recent case studies that demonstrate their utility for research and decision-making.
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Affiliation(s)
- Neal R. Haddaway
- Mistra Council for Evidence-Based Environmental Management, Stockholm Environment Institute, Box 24218, 104 51 Stockholm, Sweden
| | - Claes Bernes
- Mistra Council for Evidence-Based Environmental Management, Stockholm Environment Institute, Box 24218, 104 51 Stockholm, Sweden
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Abstract
The BARRIERS scale was developed in the US as a method of identifying the main barriers to research utilisation reported by nurses. However, its appropriateness for assessing such barriers in the UK is not clear. The current drive for evidence-based practice makes it desirable to assess the availability of an instrument to measure the progress of nurses who have implemented research. Information about the appropriateness of the BARRIERS scale for use in the UK would allow its potential as a monitoring instrument to be assessed. This paper is a section of a wider study aimed at producing a general picture of the underlying types of barrier to the implementation of research findings. Objectives included exploring those factors which acted as barriers to research implementation; assessing the construct validity and the internal consistency of the BARRIERS scale in the UK; and identifying barriers which might be excluded or added in future studies. A census survey of practice nurses and nurses from two hospital and two community trusts within one health authority, and one community trust from another health authority, was undertaken. The BARRIERS questionnaire was sent by mail to 4,501 nurses, with a 44.6% response rate. Exploratory factor analysis was used to identify key factors underlying the 29 items of the BARRIERS scale which acted as barriers to the utilisation of research findings. Four factors were identified, which were conceptualised as: the benefits, quality and accessibility of research, and resources for implementation. These were similar, but not identical, to factors identified in the original US study. One factor appeared mainly to be concerned with critical appraisal, which could be considered to be a facilitator rather than a barrier. More than one-fifth of the original items were not included in the UK model. Under-reported (mainly research issues) and additional barriers (mainly organisational issues) were identified. The four-factor solution was roughly comparable with that derived in the US, although fewer items were retained (22 instead of 28), and some of the factors were conceptually a little different. It was concluded that the internal reliability of the four-factor solution was fair. The scale may not be suitable for use in the UK without further development: a scale which includes positive as well as negative aspects of research culture, with a greater emphasis on organizational issues, may be more useful.
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Kirigia JM, Pannenborg CO, Amore LGC, Ghannem H, IJsselmuiden C, Nabyonga-Orem J. Global Forum 2015 dialogue on "From evidence to policy - thinking outside the box": perspectives to improve evidence uptake and good practices in the African Region. BMC Health Serv Res 2016; 16 Suppl 4:215. [PMID: 27453984 PMCID: PMC4959371 DOI: 10.1186/s12913-016-1453-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Global Forum 2015 panel session dialogue entitled "From evidence to policy - thinking outside the box" was held on 26 August 2015 in the Philippines to debate why evidence was not fully translated into policy and practice and what could be done to increase its uptake. This paper reports the reasons and possible actions for increasing the uptake of evidence, and highlights the actions partners could take to increase the use of evidence in the African Region. DISCUSSION The Global Forum 2015 debate attributed African Region's low uptake of evidence to the big gap in incentives and interests between research for health researchers and public health policy-makers; limited appreciation on the side of researchers that public health decisions are based on multiple and complex considerations; perception among users that research evidence is not relevant to local contexts; absence of knowledge translation platforms; sub-optimal collaboration and engagement between industry and research institutions; lack of involvement of civil society organizations; lack of engagement of communities in the research process; failure to engage the media; limited awareness and debate in national and local parliaments on the importance of investing in research and innovation; and dearth of research and innovation parks in the African Region. CONCLUSION The actions needed in the Region to increase the uptake of evidence in policy and practice include strengthening NHRS governance; bridging the motivation gap between researchers and health policy-makers; restoring trust between researchers and decision-makers; ensuring close and continuous intellectual intercourse among researchers, ministry of health policy-makers and technocrats during the life course of research projects or programmes; proactive collaboration between academia and industry; regular briefings of civil society, media, relevant parliamentary committees and development partners; development of vibrant knowledge translation platforms; development of action plans for implementing research recommendations, preferably in the context of the Sustainable Development Goals; and encouragement of competition on NHRS strengthening and research output and uptake among the countries using a barometer or scorecard to review their performance at various regional ministerial forums and taking into account the lessons learned from the MDG period.
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Affiliation(s)
- Joses Muthuri Kirigia
- Health Systems and Services Cluster, World Health Organization, Regional Office for Africa, B. P. 06, Brazzaville, Congo
| | | | - Luis Gabriel Cuervo Amore
- Research Promotion and Development, Pan American Health Organization/World Health Organization (PAHO/WHO), Washington, D.C, USA
| | - Hassen Ghannem
- Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunis Tunisia
| | - Carel IJsselmuiden
- Council on Health Research for Development (COHRED), Geneva, Switzerland
| | - Juliet Nabyonga-Orem
- Health Systems and Services Cluster, World Health Organization, Regional Office for Africa, B. P. 06, Brazzaville, Congo
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Bussières AE, Al Zoubi F, Stuber K, French SD, Boruff J, Corrigan J, Thomas A. Evidence-based practice, research utilization, and knowledge translation in chiropractic: a scoping review. Altern Ther Health Med 2016; 16:216. [PMID: 27412625 PMCID: PMC4944433 DOI: 10.1186/s12906-016-1175-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 06/16/2016] [Indexed: 12/18/2022]
Abstract
Background Evidence-based practice (EBP) gaps are widespread across health disciplines. Understanding factors supporting the uptake of evidence can inform the design of strategies to narrow these EBP gaps. Although research utilization (RU) and the factors associated with EBP have been reported in several health disciplines, to date this area has not been reviewed comprehensively in the chiropractic profession. The purpose of this review was to report on the current state of knowledge on EBP, RU, and knowledge translation (KT) in chiropractic. Methods A scoping review using the Arksey and O’Malley framework was used to systematically select and summarize existing literature. Searches were conducted using a combination of keywords and MeSH terms from the earliest date available in each database to May 2015. Quantitative and thematic analyses of the selected literature were conducted. Results Nearly 85 % (56/67) of the included studies were conducted in Canada, USA, UK or Australia. Thematic analysis for the three categories (EBP, RU, KT) revealed two themes related to EBP (attitudes and beliefs of chiropractors; implementation of EBP), three related to RU (guideline adherence; frequency and sources of information accessed; and perceived value of websites and search engines), and three related to KT (knowledge practice gaps; barriers and facilitators to knowledge use; and selection, tailoring, and implementation of interventions). EBP gaps were noted in the areas of assessment of activity limitation, determination of psychosocial factors influencing pain, general health indicators, establishing a prognosis, and exercise prescription. While most practitioners believed EBP and research to be important and a few studies suggested that traditional and online educational strategies could improve patient care, use of EBP and guideline adherence varied widely. Conclusion Findings suggest that the majority of chiropractors hold favourable attitudes and beliefs toward EBP. However, much remains to be done for chiropractors to routinely apply evidence into clinical practice. Educational strategies aimed at practicing chiropractors can lead to more EBP and improved patient care. The chiropractic profession requires more robust dissemination and implementation research to improve guideline adherence and patient health outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12906-016-1175-0) contains supplementary material, which is available to authorized users.
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Abstract
More than nine treatment options are available in Canada for moderate to severe psoriasis vulgaris. The process of deciding on optimal systemic antipsoriatic therapy for individual patients is dependent on multiple factors, including medical contraindications, the risks and benefits of treatment, and patient values and preferences. This article addresses current challenges faced by both dermatologists and their patients in the process of selecting systemic antipsoriatic therapy. Informed shared decision making is a useful relational model to describe the interaction between dermatologists and psoriasis patients in the selection of best systemic antipsoriatic treatment. There are no systematic reviews inclusive of the spectrum of treatment options for moderate to severe psoriasis, including biologics. Current guidelines of care are of varying quality and provide disparate and conflicting recommendations. Shortcomings in facilitating informed choice include inadequate training, skills, and resources. There is an urgent need for a high-quality systematic review of systemic antipsoriatic agents that includes the biologics. The evidence from such a document can form the basis for rational clinical guidelines and policy and can provide the foundation for educational and counseling tools. Furthermore, to facilitate dialogue and values-based informed choice, the use of decision aids for patients may be useful in selection of the most appropriate therapy.
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Affiliation(s)
- Jerry K.L. Tan
- From the Department of Medicine, University of Western Ontario and Windsor Clinical Research Inc., Windsor, ON
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Trembath D, Hawtree R, Arciuli J, Caithness T. What do speech-language pathologists think parents expect when treating their children with autism spectrum disorder? INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 18:250-258. [PMID: 27063700 DOI: 10.3109/17549507.2016.1139625] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 12/04/2015] [Accepted: 12/14/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Despite the importance of Speech-Language Pathologists (SLPs) collaborating with parents in the treatment of children with Autism Spectrum Disorder (ASD), few studies have examined the nature of this working relationship and how best to facilitate collaboration. To explore what SLPs think parents of children with ASD expect of them when it comes to the delivery of evidence-based interventions. METHOD The participants were 22 SLPs from Australia who specialised in ASD and who each participated in a semi-structured interview. Recordings were transcribed and analysed according to the procedures outlined by Braun and Clarke. RESULT The SLPs expressed strong support for evidence-based practice (EBP) and indicated that they thought parents expected their children would be provided with evidence-based interventions. However, SLPs identified factors that influenced the way and the extent to which they were able to share information as part of a collaborative decision-making process, including the parents' education level and the amount of time since their children's diagnoses. CONCLUSION The results highlight the challenges that SLPs face when engaging with parents in the delivery of EBP. Strategies that the SLPs had developed to cater to the individual needs of each parent are discussed, along with implications for clinical practice.
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Affiliation(s)
- David Trembath
- a Griffith University, Menzies Health Institute Queensland , Southport , Australia
| | - Ruth Hawtree
- b Griffith University, School of Allied Health Sciences , Southport , Australia
| | - Joanne Arciuli
- c University of Sydney, Faculty of Health Sciences , Lidcombe , Australia , and
| | - Teena Caithness
- d La Trobe University, Olga Tennison Autism Research Centre , Bundoora , Australia
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Curtis K, Foster K, Mitchell R, Van C. Models of Care Delivery for Families of Critically Ill Children: An Integrative Review of International Literature. J Pediatr Nurs 2016; 31:330-41. [PMID: 26699441 DOI: 10.1016/j.pedn.2015.11.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 11/06/2015] [Accepted: 11/07/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED Critical illness in children is a life changing event for the child, their parents, caregivers and wider family. There is a need to design and evaluate models of care that aim to implement family-centred care to support more positive outcomes for critically ill children and their families. Due to a gap in knowledge on the impact of such models, the present review was conducted. ELIGIBILITY CRITERIA Primary research articles written in English that focused on children hospitalised for an acute, unexpected, sudden critical illness, such as that requiring an intensive care admission; and addressed the implementation of a model of care in a paediatric acute care hospital setting. SAMPLE Thirteen studies met the inclusion criteria. RESULTS The models of care implemented were associated with positive changes such as reduced parental anxiety and improved communication between parents/caregivers and health professionals. However, no model provided intervention throughout each phase of care to (or post) hospital discharge. CONCLUSIONS Models of care applying family-centred care principles targeting critically ill children and their families can create positive changes in care delivery for the family. However a model which provides continuity across the span of care is required. IMPLICATIONS There is need to describe how best to design, implement and sustain models of care for critically ill children and their families. The success of any intervention implementation will be dependent on the comprehensiveness of the strategy for implementation, the relevance to the context and setting, and engagement with key stakeholders.
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Affiliation(s)
- Kate Curtis
- Sydney Nursing School, The University of Sydney, Sydney, Australia; St George Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kim Foster
- Sydney Nursing School, The University of Sydney, Sydney, Australia; Faculty of Health, University of Canberra, Canberra, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Connie Van
- Sydney Nursing School, The University of Sydney, Sydney, Australia.
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Reach G. Simplistic and complex thought in medicine: the rationale for a person-centered care model as a medical revolution. Patient Prefer Adherence 2016; 10:449-57. [PMID: 27103790 PMCID: PMC4829191 DOI: 10.2147/ppa.s103007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
According to the concept developed by Thomas Kuhn, a scientific revolution occurs when scientists encounter a crisis due to the observation of anomalies that cannot be explained by the generally accepted paradigm within which scientific progress has thereto been made: a scientific revolution can therefore be described as a change in paradigm aimed at solving a crisis. Described herein is an application of this concept to the medical realm, starting from the reflection that during the past decades, the medical community has encountered two anomalies that, by their frequency and consequences, represent a crisis in the system, as they deeply jeopardize the efficiency of care: nonadherence of patients who do not follow the prescriptions of their doctors, and clinical inertia of doctors who do not comply with good practice guidelines. It is proposed that these phenomena are caused by a contrast between, on the one hand, the complex thought of patients and doctors that sometimes escapes rationalization, and on the other hand, the simplification imposed by the current paradigm of medicine dominated by the technical rationality of evidence-based medicine. It is suggested therefore that this crisis must provoke a change in paradigm, inventing a new model of care defined by an ability to take again into account, on an individual basis, the complex thought of patients and doctors. If this overall analysis is correct, such a person-centered care model should represent a solution to the two problems of patients' nonadherence and doctors' clinical inertia, as it tackles their cause. These considerations may have important implications for the teaching and the practice of medicine.
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Affiliation(s)
- Gérard Reach
- Department of Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital AP-HP, Sorbonne Paris Cité, Bobigny, France
- EA 3412, Centre de Recherche en Nutrition Humaine Ile-de-France (CRNH-IDF), Paris 13 University, Sorbonne Paris Cité, Bobigny, France
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Luk LJ, Mosen D, MacArthur CJ, Grosz AH. Implementation of a Pediatric Posttonsillectomy Pain Protocol in a Large Group Practice. Otolaryngol Head Neck Surg 2016; 154:720-4. [DOI: 10.1177/0194599815627810] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/30/2015] [Indexed: 12/31/2022]
Abstract
Objective In response to the increased risk of respiratory failure and death after tonsillectomy related to codeine use, Kaiser Permanente Northwest restricted use of opioids in patients <7 years old via electronic health record (EHR). However, opioids could be prescribed at physician discretion by overriding the EHR. This study aims to examine protocol compliance in a large group practice using EHR order sets and complication rates as compared with historical data. Study Design Case series with chart review. Setting Ambulatory care within a health maintenance organization. Subjects and Methods Procedural codes were used to identify children <7 years old who underwent tonsillectomy or adenotonsillectomy approximately 1.5 years before and after implementation of EHR protocol (n = 437). Primary outcome was opioid pain prescriptions received by patients. Secondary outcomes were emergency or urgent care utilization, postoperative bleeding, nausea, vomiting, dehydration, death, and reasons for prescribing opioid pain medication after EHR protocol implementation. Chi-square analysis and Fischer’s exact testing were used to compare differences in event rates. Results Implementation of an age-based narcotic protocol significantly decreased physician narcotic prescribing from 82.2% to 15.4% ( P < .0001). The most common reason for narcotic prescription after the intervention was the report of inadequate pain control by phone call (35%). There was no significant difference in rate of emergency or urgent care utilization between pre- and postimplementation groups (4% vs 6%, P = .29). Conclusions Implementation of an age-based narcotic restriction for posttonsillectomy patients using an EHR order set is an effective and safe way to influence physician prescription practices.
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Affiliation(s)
- Lauren J. Luk
- Division of Pediatric Otolaryngology, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - David Mosen
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Carol J. MacArthur
- Division of Pediatric Otolaryngology, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Anna H. Grosz
- Department of Otolaryngology–Head and Neck Surgery, Kaiser Permanente Northwest, Clackamas, Oregon, USA
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Safaei J. Deliberative democracy in health care: current challenges and future prospects. J Healthc Leadersh 2015; 7:123-136. [PMID: 29355181 PMCID: PMC5740990 DOI: 10.2147/jhl.s70021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a vast body of literature on deliberative, participative, or engaged democracy. In the area of health care there is a rapidly expanding literature on deliberative democracy as embodied in various notions of public engagement, shared decision-making (SDM), patient-centered care, and patient/care provider autonomy over the past few decades. It is useful to review such literature to get a sense of the challenges and prospects of introducing deliberative democracy in health care. OBJECTIVE This paper reviews the key literature on deliberative democracy and SDM in health care settings with a focus on identifying the main challenges of promoting this approach in health care, and recognizing its progress so far for mapping out its future prospects in the context of advanced countries. METHOD Several databases were searched to identify the literature pertinent to the subject of this study. A total of 56 key studies in English were identified and reviewed carefully for indications and evidence of challenges and/or promising avenues of promoting deliberative democracy in health care. RESULTS Time pressure, lack of financial motivation, entrenched professional interests, informational imbalance, practical feasibility, cost, diversity of decisions, and contextual factors are noted as the main challenges. As for the prospects, greater clarity on conception of public engagement and policy objectives, real commitment of the authorities to public input, documenting evidence of the effectiveness of public involvement, development of patient decision supports, training of health professionals in SDM, and use of multiple and flexible methods of engagement leadership suited to specific contexts are the main findings in the reviewed literature. CONCLUSION Seeking deliberative democracy in health care is both challenging and rewarding. The challenges have been more or less identified. However, its prospects are potentially significant. Such prospects are more likely to materialize if deliberative democracy is pursued more systematically in the broader sociopolitical domains.
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Affiliation(s)
- Jalil Safaei
- Department of Economics, University of Northern British Columbia, Prince George, BC, Canada
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Dragan IF, Newman M, Stark P, Steffensen B, Karimbux N. Using a Simulated Infobutton Linked to an Evidence-Based Resource to Research Drug-Drug Interactions: A Pilot Study with Third-Year Dental Students. J Dent Educ 2015. [DOI: 10.1002/j.0022-0337.2015.79.11.tb06032.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Irina F. Dragan
- Department of Periodontology; Tufts University School of Dental Medicine
| | - Michael Newman
- University of California; Los Angeles School of Dentistry
| | - Paul Stark
- Tufts University School of Dental Medicine
| | - Bjorn Steffensen
- Department of Periodontology; Tufts University School of Dental Medicine
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Silva TM, Costa LCM, Costa LOP. Evidence-Based Practice: a survey regarding behavior, knowledge, skills, resources, opinions and perceived barriers of Brazilian physical therapists from São Paulo state. Braz J Phys Ther 2015; 19:294-303. [PMID: 26443977 PMCID: PMC4620978 DOI: 10.1590/bjpt-rbf.2014.0102] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: Evidence-Based Practice (EBP) has been widely used by health professionals.
However, no study in Brazil has investigated the data regarding the knowledge and
difficulties related to EBP from a representative sample of physical therapists.
OBJECTIVE: To identify behavior, knowledge, skills, resources, opinions and perceived
barriers of Brazilian physical therapists from the state of São Paulo regarding
EBP. METHOD: A customized questionnaire about behavior, knowledge, skills, resources, opinions
and perceived barriers regarding EBP was sent by email to a sample of 490 physical
therapists registered by the Registration Board of São Paulo, Brazil. Physical
therapists who did not respond to the questionnaire were contacted by telephone
and/or letter. The data were analyzed descriptively. RESULTS: The final response rate was 64.4% (316/490). Because 60 physical therapists were
no longer practicing, 256 answers were analyzed. The physical therapists reported
that they routinely read scientific papers (89.5%) as a resource for professional
development, followed by continuing education courses (88.3%) and books (86.3%).
Approximately 35% of the respondents reported a clear understanding of the
implementation of research findings in their practice; approximately 37% reported
no difficulties in critically appraising scientific papers; and 67.2% strongly
agreed that EBP is important for their practice. The most commonly reported
barriers were related to difficulties in obtaining full-text papers (80.1%), using
EBP may represent higher cost (80.1%) and the language of publication of the
papers (70.3%). CONCLUSION: Physical therapists from São Paulo state believe that they have knowledge and
skills to use EBP. Although they have favorable opinions regarding its
implementation, they still encounter difficulties in implementing EBP
successfully.
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Mota da Silva T, da Cunha Menezes Costa L, Garcia AN, Costa LOP. What do physical therapists think about evidence-based practice? A systematic review. ACTA ACUST UNITED AC 2015; 20:388-401. [DOI: 10.1016/j.math.2014.10.009] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/01/2014] [Accepted: 10/16/2014] [Indexed: 11/30/2022]
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Ashrafi-Rizi H, Fateme Z, Khorasgani ZG, Kazempour Z, Imani ST. Barriers to Research Activities from the Perspective of the Students of Isfahan University of Medical Sciences. Acta Inform Med 2015; 23:155-9. [PMID: 26236082 PMCID: PMC4499306 DOI: 10.5455/aim.2015.23.155-159] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 05/18/2015] [Indexed: 11/09/2022] Open
Abstract
Introduction: Necessity to establish a coherent and targeted research context in order to development of any country is increasingly important. But the basic step in creating an effective research context would be enrichment motivation of researchers especially students and resolve barriers of research. Therefore, the purpose of this study was to determine barriers of research activities from the perspective of students of Isfahan University of Medical Sciences. Methods: This is research. Data was collected with author made questionnaire. The study sample consisted of students from Isfahan medical university and sample size based on Krejcie and Morgan table was 357. Sampling was Stratified Random. The validity of questionnaire confirmed by Library and information professionals and reliability based on Cronbach’s Alpha was 0.933, respectively. The type of descriptive statistics was (percentage, frequency and mean) and inferential statistics (T-test, ANOVA, one-Sample Statistics) and SPSS software was used. Findings: Results showed that the mean of barriers to research activities among students of Isfahan University of Medical Sciences was 3.89 ± 0. 483. The highest mean was related to density of students’ curriculum (4.22± 0.968) and lowest mean related to lack of access to appropriate library resources. Also, the mean of research activities ’s barriers, according to aspects showed that the mean in individual barriers level (4.06±0.635) was more than other aspects: social and cultural aspects (4.01± 0.661), economical aspect (4.04± 0.787) and organizational barriers (3.78±0.503). The lowest mean was related to organizational barriers. Also there is no difference between mean of research activities’ barriers of student of Isfahan University of Medical Sciences with regarded of gender, level of education and college. Conclusion: According to results of this research, although, the main barriers between students was individual barriers such as: lack of sufficient familiarity with research methods, insufficient experience in research and lack of familiarity with the terms of the articles in publication, but other aspects like economic, cultural, social and organizational was in bad condition too. Therefore it is suggested that workshops related to research methodologies is executed, like proposal writing, writing articles in university especially for students and administrators support student’s research activities, effectively.
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Affiliation(s)
- Hasan Ashrafi-Rizi
- Medical Library and Information Science Department, Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zarmehr Fateme
- Library and Information Science Department, Faculty of Media, Payame Noor, University, Tehran, Iran
| | - Zahra Ghazavi Khorasgani
- Medical Library and Information Science Department, Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Kazempour
- Library and Information Science Department, Faculty of Media, Payame Noor, University, Tehran, Iran
| | - Sona Taebi Imani
- Medical Library and Information Science Department, Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Kana MA, Doctor HV, Peleteiro B, Lunet N, Barros H. Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014. BMC Public Health 2015; 15:334. [PMID: 25881020 PMCID: PMC4429684 DOI: 10.1186/s12889-015-1688-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence.
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Affiliation(s)
- Musa Abubakar Kana
- Department of Community Medicine, Faculty of Medicine, Kaduna State University, Kaduna, Nigeria. .,EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal.
| | - Henry Victor Doctor
- Integrated Programme and Oversight Branch, Division for Operations, United Nations Office on Drugs and Crime, Abuja, Nigeria.
| | - Bárbara Peleteiro
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal. .,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal. .,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal. .,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
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Castellani A, Girlanda F, Barbui C. Rigour of development of clinical practice guidelines for the pharmacological treatment of bipolar disorder: systematic review. J Affect Disord 2015; 174:45-50. [PMID: 25484176 DOI: 10.1016/j.jad.2014.11.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/17/2014] [Accepted: 11/17/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is an increasing concern about the quality of clinical practice guidelines. Because no information is available on the rigour of development of clinical practice guidelines for bipolar disorder, we carried out a systematic review of those focusing on its pharmacological treatment. METHODS We searched the National Guideline Clearinghouse, MEDLINE, EMBASE, PsychINFO and CINHAL for guidelines published from 2003 to 2014. The quality of each guideline was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). RESULTS Fourteen guidelines were appraised. The overall quality of included guidelines varied considerably, both within and across AGREE II domains. Overall, six guidelines were rated as "recommended", two "recommended with modifications", and six were not recommended according to AGREE II ratings. The mean score for rigour of development was 46.8% of the maximum possible score, with no guidelines scoring the maximum score in this domain. Guidelines with lower editorial independence scores also had lower rigour of development scores, whereas those with higher-quality domain scores scored high in both domains. LIMITATIONS As current appraisal focused on guidelines for the pharmacological treatment of bipolar disorder, it will be important to critically assess the rigour of development of other guidelines for bipolar and other psychiatric disorders. CONCLUSIONS Health care providers, policy makers, physicians and patients alike need to be aware of the variability in guideline quality and identify the high-quality guidelines that meet their needs.
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Affiliation(s)
- Arianna Castellani
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Francesca Girlanda
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
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Becker SJ. Direct-to-Consumer Marketing: A Complementary Approach to Traditional Dissemination and implementation Efforts for Mental Health and Substance Abuse Interventions. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2015; 22:85-100. [PMID: 25937710 PMCID: PMC4415980 DOI: 10.1111/cpsp.12086] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The overall chasm between those who need treatment for mental health and substance abuse (M/SU) and those who receive effective treatment consists of two, interrelated gaps: the research-to-practice gap and the treatment gap. Prior efforts to disseminate evidence-based practice (EBP) for M/SU have predominantly targeted the research-to-practice gap, by focusing efforts toward treatment providers. This article introduces direct-to-consumer (DTC) marketing that targets patients and caregivers as a complementary approach to existing dissemination efforts. Specific issues discussed include: rationale for DTC marketing based on the concept of push versus pull marketing; overview of key stakeholders involved in DTC marketing; and description of the Marketing Mix planning framework. The applicability of these issues to the dissemination of EBP for M/SU is discussed.
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Affiliation(s)
- Sara J Becker
- Department of Behavioral and Social Sciences, Brown University
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Becker SJ. Evaluating whether direct-to-consumer marketing can increase demand for evidence-based practice among parents of adolescents with substance use disorders: rationale and protocol. Addict Sci Clin Pract 2015; 10:4. [PMID: 25928298 PMCID: PMC4422145 DOI: 10.1186/s13722-015-0028-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 01/30/2015] [Indexed: 11/28/2022] Open
Abstract
Background Fewer than one in 10 adolescents with substance use disorders (ASUDs) will receive specialty treatment, and even fewer will receive treatment designated as evidence-based practice (EBP). Traditional efforts to increase the utilization of EBP by ASUDs typically focus on practitioners—either in substance use clinics or allied health settings. Direct-to-consumer (DTC) marketing that directly targets parents of ASUDs represents a potentially complementary paradigm that has yet to be evaluated. The current study is the first to evaluate the relevance of a well-established marketing framework (the Marketing Mix) and measurement approach (measurement of perceived service quality [PSQ]) with parents of ASUDs in need of treatment. Methods/design A mixed-methods design is employed across three study phases, consistent with well-established methods used in the field of marketing science. Phase 1 consists of formative qualitative research with parents (and a supplementary sample of adolescents) in order to evaluate and potentially adapt a conceptual framework (Marketing Mix) and measure of PSQ. Phase 2 is a targeted survey of ASUD parents to elucidate their marketing preferences, using the adapted Marketing Mix framework, and to establish the psychometric properties of the PSQ measure. The survey will also gather data on parents’ preferences for different targeted marketing messages. Phase 3 is a two-group randomized controlled trial comparing the effectiveness of targeted marketing messages versus standard clinical information. Key outcomes will include parents’ ratings of PSQ (using the new measure), behavioral intentions to seek out information about EBP, and actual information-seeking behavior. Discussion The current study will inform the field whether a well-established marketing framework and measurement approach can be used to increase demand for EBP among parents of ASUDs. Results of this study will have the potential to immediately inform DTC marketing efforts by professional organizations, federal agencies, clinicians, and clinical researchers.
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Affiliation(s)
- Sara J Becker
- Department of Behavioral and Social Sciences, Center for Alcohol and Addictions Studies, Brown University, 121 South Main Street, Providence, RI, 02903, USA. .,Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, 222 Richmond Street, Providence, RI, 02903, USA.
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93
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Imms C, Novak I, Kerr C, Shields N, Randall M, Harvey A, Graham HK, Reddihough D. Improving allied health professionals' research implementation behaviours for children with cerebral palsy: protocol for a before-after study. Implement Sci 2015; 10:16. [PMID: 25889110 PMCID: PMC4328993 DOI: 10.1186/s13012-014-0202-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 12/23/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cerebral palsy is a permanent disorder of posture and movement caused by disturbances in the developing brain. It affects approximately 1 in every 500 children in developed countries and is the most common form of childhood physical disability. People with cerebral palsy may also have problems with speech, vision and hearing, intellectual difficulties and epilepsy. Health and therapy services are frequently required throughout life, and this care should be effective and evidence informed; however, accessing and adopting new research findings into day-to-day clinical practice is often delayed. METHODS/DESIGN This 3-year study employs a before and after design to evaluate if a multi-strategy intervention can improve research implementation among allied health professionals (AHPs) who work with children and young people with cerebral palsy and to establish if children's health outcomes can be improved by routine clinical assessment. The intervention comprises (1) knowledge brokering with AHPs, (2) access to an online research evidence library, (3) provision of negotiated evidence-based training and education, and (4) routine use of evidence-based measures with children and young people aged 3-18 years with cerebral palsy. The study is being implemented in four organisations, with a fifth organisation acting as a comparison site, across four Australian states. Effectiveness will be assessed using questionnaires completed by AHPs at baseline, 6, 12 and 24 months, and by monitoring the extent of use of evidence-based measures. Children's health outcomes will be evaluated by longitudinal analyses. DISCUSSION Government, policy makers and service providers all seek evidence-based information to support decision-making about how to distribute scarce resources, and families are seeking information to support intervention choices. This study will provide knowledge about what constitutes an efficient, evidence-informed service and which allied health interventions are implemented for children with cerebral palsy. TRIAL REGISTRATION Trial is not a controlled healthcare intervention and is not registered.
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Affiliation(s)
- Christine Imms
- Australian Catholic University, 17 Young Street, Fitzroy, Melbourne, 3065, Australia.
- Murdoch Children's Research Institute, Parkville, 3052, Australia.
| | - Iona Novak
- Cerebral Palsy Alliance, Frenchs Forest, PO Box 6427, NSW, 2086, Sydney, Australia.
- School of Medicine, University of Notre Dame Australia, Broadway, PO Box 944, 2007, Sydney, Australia.
| | - Claire Kerr
- Australian Catholic University, 17 Young Street, Fitzroy, Melbourne, 3065, Australia.
| | - Nora Shields
- La Trobe University, Kingsbury Drive, Bundoora, 3086, Victoria, Australia.
- Northern Health, 1231 Plenty Road, Bundoora, 3083, Victoria, Australia.
| | - Melinda Randall
- Australian Catholic University, 17 Young Street, Fitzroy, Melbourne, 3065, Australia.
- Murdoch Children's Research Institute, Parkville, 3052, Australia.
| | - Adrienne Harvey
- Victorian Paediatric Rehabilitation Service, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, 3052, Australia.
- Murdoch Children's Research Institute, Parkville, 3052, Australia.
| | - H Kerr Graham
- Hugh Williamson Gait Laboratory, Royal Children's Hospital, Parkville, Australia.
- University of Melbourne, Parkville, Australia.
- Murdoch Children's Research Institute, Parkville, 3052, Australia.
| | - Dinah Reddihough
- University of Melbourne, Parkville, Australia.
- Murdoch Children's Research Institute, Parkville, 3052, Australia.
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Shah NH, Anspacher M, Davis A, Bhansali P. Development of a Curriculum on the Child With Medical Complexity: Filling a Gap When Few Practice Guidelines Exist. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2015; 35:278-283. [PMID: 26953859 DOI: 10.1097/ceh.0000000000000001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Pediatric hospitalists are increasingly involved in the clinical management of children with medical complexity (CMC), specifically those with neurologic impairment and technology dependence. Clinical care guidelines and educational resources on management of the diseases and devices prevalent in CMC are scarce. The objective of this study was to develop and evaluate a web-based curriculum on care of CMC for hospitalists at our institution using a novel approach to validate educational content. METHODS Junior faculty collaborated with senior hospitalist peer mentors to create multimedia learning modules on highly-desired topics as determined by needs assessment. Module authors were encouraged to work with subspecialty experts from within the institution and to submit their modules for external peer review. Pilot study participants were asked to complete all modules, associated knowledge tests, and evaluations over a 4-month period. RESULTS Sixteen of 33 eligible hospitalists completed the curriculum and associated assessments. High scores with respect to satisfaction were seen across all modules. There was a significant increase in posttest knowledge scores (P < 0.001) with sustained retention at 6 months posttest (P < 0.013). Participants were most likely to make changes to their teaching and clinical practice based on participation in this curriculum. CONCLUSIONS We used a novel approach for content development in this curriculum that incorporated consultation with experts and external peer review, resulting in improved knowledge, high satisfaction, and behavior change. Our approach may be a useful method to improve content validity for educational resources on topics that do not have established clinical care guidelines.
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Affiliation(s)
- Neha H Shah
- Drs. Shah, Anspacher, Davis, and Bhansali: Assistant Professors of Pediatrics, Division of Hospitalist Medicine, Children's National Medical Center and The George Washington University School of Medicine, Washington DC
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95
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Ashrafi-Rizi H, Zarmehr F, Bahrami S, Ghazavi-Khorasgani Z, Kazempour Z, Shahrzadi L. Study on research anxiety among faculty members of isfahan university of medical sciences. Mater Sociomed 2014; 26:356-9. [PMID: 25685076 PMCID: PMC4314177 DOI: 10.5455/msm.2014.26.356-359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/25/2014] [Indexed: 12/01/2022] Open
Abstract
Introduction: One of the most common anxieties in higher education is research anxiety. The purpose of this study was to determine the research anxiety level among the faculty members of Isfahan University of Medical Sciences (IUMS). Methods: this was survey- analytical study. The stratified random sampling method was used and a sample of 212 people was selected. For data collection was used a questionnaire. Data were analyzed with descriptive and analytical (T Test, ANOVA and LSD) statistics. Findings: The average anxiety research in IUMS was about 3.27 ±0.536. Among factors, highest scores in descending order are related to lack of timely payment of fees (3.97±0.961), the long approval process of proposals and research project reporting (3.86.±0.99) and lack of research efficiency on the part of faculty (3.70±1.00). The lowest scores were related to having insufficient funds to conduct research (2.67±1.08), another’s understanding of inability for researching (2.84±1.192), and unfriendly behavior from journals and research center staffs (2.89±0.802). Conclusion: The mean level of research anxiety among faculty members of IUMS was found higher than average. So it’s essential that authorities pay greater attention to the factors that cause research anxiety.
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Affiliation(s)
- Hasan Ashrafi-Rizi
- Medical Library and Information Science Department, Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fateme Zarmehr
- Library and Information Science Department, Isfahan University, Isfahan, Iran
| | - Susan Bahrami
- Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Ghazavi-Khorasgani
- Medical Library and Information Science Department, Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Kazempour
- Library and Information Science Department, Faculty of Media, Payame Noor University, Tehran, Iran
| | - Leila Shahrzadi
- Medical Library and Information Science Department, Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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96
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Brown L, Carne A, Bywood P, McIntyre E, Damarell R, Lawrence M, Tieman J. Facilitating access to evidence: Primary Health Care Search Filter. Health Info Libr J 2014; 31:293-302. [DOI: 10.1111/hir.12087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 10/21/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Lynsey Brown
- Primary Health Care Research & Information Service (PHCRIS); Discipline of General Practice; Flinders University of South Australia; Adelaide SA Australia
| | - Amanda Carne
- Primary Health Care Research & Information Service (PHCRIS); Discipline of General Practice; Flinders University of South Australia; Adelaide SA Australia
| | - Petra Bywood
- Primary Health Care Research & Information Service (PHCRIS); Discipline of General Practice; Flinders University of South Australia; Adelaide SA Australia
| | - Ellen McIntyre
- Primary Health Care Research & Information Service (PHCRIS); Discipline of General Practice; Flinders University of South Australia; Adelaide SA Australia
| | - Raechel Damarell
- Flinders Filters; Flinders University of South Australia; Adelaide SA Australia
| | - Mikaela Lawrence
- Flinders Filters; Flinders University of South Australia; Adelaide SA Australia
| | - Jennifer Tieman
- Flinders Filters; Flinders University of South Australia; Adelaide SA Australia
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97
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Lowrie R, Lloyd SM, McConnachie A, Morrison J. A cluster randomised controlled trial of a pharmacist-led collaborative intervention to improve statin prescribing and attainment of cholesterol targets in primary care. PLoS One 2014; 9:e113370. [PMID: 25405478 PMCID: PMC4236200 DOI: 10.1371/journal.pone.0113370] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 10/21/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Small trials with short term follow up suggest pharmacists' interventions targeted at healthcare professionals can improve prescribing. In comparison with clinical guidance, contemporary statin prescribing is sub-optimal and achievement of cholesterol targets falls short of accepted standards, for patients with atherosclerotic vascular disease who are at highest absolute risk and who stand to obtain greatest benefit. We hypothesised that a pharmacist-led complex intervention delivered to doctors and nurses in primary care, would improve statin prescribing and achievement of cholesterol targets for incident and prevalent patients with vascular disease, beyond one year. METHODS We allocated general practices to a 12-month Statin Outreach Support (SOS) intervention or usual care. SOS was delivered by one of 11 pharmacists who had received additional training. SOS comprised academic detailing and practical support to identify patients with vascular disease who were not prescribed a statin at optimal dose or did not have cholesterol at target, followed by individualised recommendations for changes to management. The primary outcome was the proportion of patients achieving cholesterol targets. Secondary outcomes were: the proportion of patients prescribed simvastatin 40 mg with target cholesterol achieved; cholesterol levels; prescribing of simvastatin 40 mg; prescribing of any statin and the proportion of patients with cholesterol tested. Outcomes were assessed after an average of 1.7 years (range 1.4-2.2 years), and practice level simvastatin 40 mg prescribing was assessed after 10 years. FINDINGS We randomised 31 practices (72 General Practitioners (GPs), 40 nurses). Prior to randomisation a subset of eligible patients were identified to characterise practices; 40% had cholesterol levels below the target threshold. Improvements in data collection procedures allowed identification of all eligible patients (n = 7586) at follow up. Patients in practices allocated to SOS were significantly more likely to have cholesterol at target (69.5% vs 63.5%; OR 1.11, CI 1.00-1.23; p = 0.043) as a result of improved simvastatin prescribing. Subgroup analysis showed the primary outcome was achieved by prevalent but not incident patients. Statistically significant improvements occurred in all secondary outcomes for prevalent patients and all but one secondary outcome (the proportion of patients with cholesterol tested) for incident patients. SOS practices prescribed more simvastatin 40 mg than usual care practices, up to 10 years later. INTERPRETATION Through a combination of educational and organisational support, a general practice based pharmacist led collaborative intervention can improve statin prescribing and achievement of cholesterol targets in a high-risk primary care based population. TRIAL REGISTRATION International Standard Randomised Controlled Trials Register ISRCTN61233866.
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Affiliation(s)
- Richard Lowrie
- Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, Glasgow, Scotland, United Kingdom
| | - Suzanne M. Lloyd
- Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Jill Morrison
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom
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98
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Anderson CS, Qureshi AI. Implications of INTERACT2 and other clinical trials: blood pressure management in acute intracerebral hemorrhage. Stroke 2014; 46:291-5. [PMID: 25395408 DOI: 10.1161/strokeaha.114.006321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Craig S Anderson
- From the Neurological and Mental Health Division, The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Camperdown, NSW, Australia (C.S.A.); and Zeenat Qureshi Stroke Institute, St Cloud Hospital Stroke Center, St Cloud, MN (A.I.Q.).
| | - Adnan I Qureshi
- From the Neurological and Mental Health Division, The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Camperdown, NSW, Australia (C.S.A.); and Zeenat Qureshi Stroke Institute, St Cloud Hospital Stroke Center, St Cloud, MN (A.I.Q.)
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99
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Wood FM. Skin regeneration: the complexities of translation into clinical practise. Int J Biochem Cell Biol 2014; 56:133-40. [PMID: 25448410 DOI: 10.1016/j.biocel.2014.10.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/22/2014] [Accepted: 10/22/2014] [Indexed: 12/01/2022]
Abstract
The integration of engineering into biological science has resulted in the capacity to provide tissue engineered solutions for tissue damage. Skin regeneration remains the goal of skin repair to reduce the long term consequences of scarring to the individual. A scar is abnormal in its architecture, chemistry and cell phenotype, tissue engineering of scaffolds and cells opens up the potential of tissue regeneration into the future. Tissue engineering solutions have been applied to skin many decades despite technical success the clinical application has been modest. To realise the potential of the developing technologies needs alignment of not only the science and engineering but also the commercial upscaling of production in a safe and regulated framework for clinical use. In addition the education and training for the introduction of new technology within the health system is essential, bringing together the technology and systems for utilisation to optimise the patient outcome. This article is part of a Directed Issue entitled: Regenerative Medicine: The challenge of translation.
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Affiliation(s)
- Fiona M Wood
- Burns Service of Western Australia, Burn Injury Research Unit, University of Western Australia, Australia.
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Brubaker SG, Friedman AM, Cleary KL, Prendergast E, D'Alton ME, Ananth CV, Wright JD. Patterns of use and predictors of receipt of antibiotics in women undergoing cesarean delivery. Obstet Gynecol 2014; 124:338-344. [PMID: 25004352 DOI: 10.1097/aog.0000000000000392] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Perioperative antibiotics are recommended during cesarean delivery to reduce the risk of postoperative infections and resulting maternal morbidity. We examined the patterns of use and predictors of receipt of antibiotics in women undergoing cesarean delivery. METHODS We identified a national cohort of women who underwent a cesarean delivery between 2003 and 2010 using a commercial hospitalization database. Women who received antibiotics on the day of cesarean delivery were classified as having received perioperative antibiotics. Multivariable regression models were developed to account for patient, obstetric, physician, and hospital factors on receipt of antibiotics. Between-hospital variation was calculated using generalized linear mixed models. RESULTS Among 1,137,804 women who underwent cesarean delivery, 59.5% received perioperative antibiotics. The proportion of patients receiving antibiotics increased over time from 52.5% in 2003 to 63.1% in 2010 (P<.001) and varied significantly by geographic region. Women who did not labor were more likely to receive antibiotics than those who had a cesarean delivery after labor (66% compared with 44%, P<.001). Age, race, and insurance status were not major determinants of the use of perioperative antibiotics. CONCLUSION Among women undergoing cesarean delivery, compliance with the recommendation for universal perioperative antibiotic prophylaxis is poor. Coordinated efforts are needed to enhance use of guideline-based perioperative antibiotic prophylaxis for women undergoing cesarean delivery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sara G Brubaker
- Divisions of Maternal-Fetal Medicine and Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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