Evidence-based medicine among hospital doctors in Jordan: awareness, attitude and practice

Online Searching as a Practice for Evidence-Based Medicine in the Neonatal Intensive Care Unit, University of Malaya Medical Center, Malaysia: Cross-sectional Study

Background

The use of the internet for research is essential in the practice of evidence-based medicine. The online search habits of medical practitioners in clinical settings, particularly from direct observation, have received little attention.

Objective

The goal of the research is to explore online searching for information as an evidence-based practice among medical practitioners.

Methods

A cross-sectional study was conducted to evaluate the clinical teams’ use of evidence-based practice when making clinical decisions for their patients' care. Data were collected through online searches from 2015 to 2018. Participants were medical practitioners and medical students in a Malaysian public teaching hospital’s neonatal intensive care unit who performed online searches to find answers to clinical questions that arose during ward rounds.

Results

In search sessions conducted by the participants, 311 queries were observed from 2015 to 2018. Most participants (34/47, 72%) were house officers and medical students. Most of the searches were conducted by house officers (51/99, 52%) and medical students (32/99, 32%). Most searches (70/99, 71%) were directed rather than self-initiated, and 90% (89/99) were completed individually rather than collaboratively. Participants entered an average of 4 terms in each query; three-quarters of the queries yielded relevant evidence, with two-thirds yielding more than one relevant source of evidence.

Conclusions

Our findings suggest that junior doctors and medical students need more training in evidence-based medicine skills such as clinical question formulation and online search techniques for performing independent online searches effectively. However, because the findings were based on intermittent opportunistic observations in a specific clinical setting, they may not be generalizable.

Jordanian Radiologists' Perspectives and Application of Evidence-Based Radiology in Clinical Practice

PURPOSE

To evaluate radiologists' education, knowledge and skills of research, attitude toward evidence-based radiology (EBR), understanding of terms and use of related published work in clinical practice and the association between these variables and sociodemographic characteristics. We also aim to assess the availability of resources and to identify sources and the main barriers to implementing EBR.

MATERIALS AND METHODS

A total of 87 radiologists completed a questionnaire, which consisted of eight sections related to radiologists' demographic characteristics, and EBR-related questions. Descriptive statistics were used, and the association between EBR-related parts and sociodemographic characteristics was performed.

RESULTS

Ninety-three percent of the radiologists believed that EBR is necessary in practice. Only 40% received formal training in search strategies and 29.9% in critical appraisal of research literature during academic preparation. Moreover, 21-62% of the respondents completely understand specific terms related to EBR. Sixty-three percent stated that they can access relevant databases and the Internet at workplace. Research articles were only used by 24% to make a clinical decision. Almost 50% reported that they read or reviewed ≤1 article per month. The primary barrier to implementing EBR was the lack of colleagues' support. Understanding terms and the number of articles used in clinical decision were significantly related to education (P-value=0.001, 0.007) and hospital section (P-value=0.002, 0.027) respectively.

CONCLUSION

Radiologists showed positive attitude toward EBR. However, there is a lack in information resources, colleagues' support, use of published literature, understanding of research terms and the ability of radiologists to access relevant databases at workplaces.

From hopelessness to some hope: A qualitative interpretive research project to improve birthing experiences in Jordan

BACKGROUND

Many women living in Middle Eastern countries report negative, dehumanising experiences of childbirth. Finding effective ways of changing maternity care to improve women's experience is needed but is challenging.

AIM

This paper explores the potential strategies to improve birthing experiences of women in Jordan and identifies the facilitators and obstacles to change.

METHOD

A qualitative interpretive research design underpinned by a feminist approach was used. Seventeen community women, 14 midwives and midwifery leaders were engaged in workshops and face-to-face semi-structured interviews. Data were transcribed verbatim and thematic analysis undertaken.

RESULTS

An overarching theme "From hopelessness to some hope" emerged from data analysis and comprised of two themes: 'It's hopeless-there are so many obstacles'; and 'Finding some hope for the way forward'. The community women were unhappy with the current maternity services but accepted the situation. Midwives offered explanations for the way women are treated, including that women have no voice. For these participants, the obstacles seemed almost insurmountable; however, there was some hope expressed about potential for small changes to occur.

CONCLUSIONS

This study highlights the value of women and midwives sharing experiences and listening to the stories of women. Listening to women's birth stories may also be an important element of undergraduate and continuing education in Jordan. Small changes, such as promoting women's dignity by ensuring they are covered during birth are possible, but real change needs to be generated at a professional and societal level.

Daily versus weekly evidence reports for orthopaedic surgeons in India: A mixed-methods study

BACKGROUND

There is a dearth of research regarding the impact of evidence-based medicine (EBM) tools, such as evidence summaries, in developing countries. The goals of this study were to: investigate accessibility, use, and impact of an online EBM knowledge dissemination portal in orthopaedic surgery in India; explore whether receiving daily targeted evidence summaries results in more frequent use of an EBM tool compared with receiving general weekly reports; and identify and explain the barriers and benefits of an online EBM resource in the Indian context.

METHODS

Forty-four orthopaedic surgeons in Pune, India, were provided free access to OrthoEvidence (OE), a for-profit, online EBM knowledge dissemination portal. Participants were subsequently randomized into 2 groups-1 group received daily targeted evidence summaries while the other received general weekly summaries. This study employed an explanatory sequential mixed methods design that incorporated 2 questionnaires, OE usage data, and semi-structured interviews to gain insight into the surgeons' usage, perceptions, and impact of OE.

RESULTS

There were no observable differences in OE usage between groups. OE was deemed to be comprehensive, practical, useful, and applicable to clinical practice by the majority of surgeons. The exit survey data revealed no differences between groups' perceptions of the OE tool. semi-structured interviews revealed barriers to keeping up with evidence that included limited access to relevant medical literature and limited incentive to keep up with current evidence.

CONCLUSIONS

Neither frequency of delivery (daily versus weekly) nor targeted versus general content affected the use of evidence summaries. Facilitating uptake of current evidence into clinical practice among Indian orthopedic surgeons may require additional components beyond dissemination of evidence summaries.

Cross-cultural Comparison of Pharmacy Students' Attitudes, Knowledge, Practice, and Barriers Regarding Evidence-based Medicine

Objective. To explore cultural influences on US and Japanese pharmacy students' evidence-based medicine (EBM) attitudes, knowledge, and behavior. Methods. A cross-sectional study was conducted using a self-administered survey. Senior students in one pharmacy school in the United States and two pharmacy schools in Japan were invited to complete a 33-item survey instrument. Results. Students in both countries reported having positive attitudes and understanding of EBM concepts. In their self-evaluation, American students rated their current EBM practice, EBM skills, and access to EBM resources higher than Japanese students rated themselves in these areas. The most common barriers to EBM for American students were lack of time (84.5%), lack of statistical knowledge (63.9%), and lack of critical appraisal skills (53.1%). The most common barriers to EBM for Japanese students were lack of training (92.6%), lack of clinical knowledge (90.4%), and lack of opportunity (88.8%). Conclusion. Although barriers to implementing EBM and confidence levels in using EBM differed between US and Japanese pharmacy students, both cohorts recognized EBM as an important skillset for the pharmacy profession. Culturally specific approaches to teaching EBM to pharmacy students are needed to improve EBM use in practice.

Integrating the Principles of Evidence Based Medicine and Evidence Based Public Health: Impact on the Quality of Patient Care and Hospital Readmission Rates in Jordan

INTRODUCTION

Hospital readmissions impose not only an extra burden on health care systems but impact patient health outcomes. Identifying modifiable behavioural risk factors that are possible causes of potentially avoidable readmissions can lower readmission rates and healthcare costs.

METHODS

Using the core principles of evidence based medicine and public health, the purpose of this study was to develop a heuristic guide that could identify what behavioural risk factors influence hospital readmissions through adopting various methods of analysis including regression models, t-tests, data mining, and logistic regression. This study was a retrospective cohort review of internal medicine patients admitted between December 1, 2012 and December 31, 2013 at King Abdullah University Hospital, in Jordan.

RESULTS

29% of all hospitalized patients were readmitted during the study period. Among all readmissions, 44% were identified as potentially avoidable. Behavioural factors including smoking, unclear follow-up and discharge planning, and being non-compliant with treatment regimen as well as discharge against medical advice were all associated with increased risk of avoidable readmissions.

CONCLUSION

Implementing evidence based health programs that focus on modifiable behavioural risk factors for both patients and clinicians would yield a higher response in terms of reducing potentially avoidable readmissions, and could reduce direct medical costs.

Patient enrollment and logistical problems top the list of difficulties in clinical research: a cross-sectional survey

Background

Many medical research projects encounter difficulties. The objective of this study was to assess the self-reported frequency of difficulties encountered by medical researchers while conducting research and to identify factors associated with their occurrence.

Methods

The authors conducted a cross-sectional survey in 2010 among principal investigators of 996 study protocols approved by the Research Ethics Committee in Geneva, Switzerland, between 2001 and 2005. The authors asked principal investigators to rate the level of difficulty (1: none, to 5: very great) encountered across the research process.

Results

588 questionnaires were sent back (participation rate 59.0 %). 391 (66.5 %) studies were completed at the time of the survey. Investigators reported that the most frequent difficulties were related to patient enrollment (44.3 %), data collection (26.7 %), data analysis and interpretation (21.5 %), collaboration with caregivers (21.0 %), study design (20.4 %), publication in peer-reviewed journal (20.2 %), hiring of competent study personnel (20.2 %), and getting funding (19.2 %). On average, investigators reported 2.8 difficulties per project (SD 2.8, range 0 to 12). In multivariable analysis, the number of difficulties was higher for studies initiated by public sponsors (vs. private), single center studies (vs. multicenter), and studies about treatment, diagnosis or prognosis (i.e., clinical vs. other studies).

Conclusions

Medical researchers reported substantial logistical difficulties in conducting clinical research.

Electronic supplementary material

The online version of this article (doi:10.1186/s12874-016-0151-1) contains supplementary material, which is available to authorized users.

Awareness, knowledge, use, and attitudes toward evidence based medicine in a developing country: survey of physicians in a canton in Bosnia and Herzegovina

Aim

To assess awareness, knowledge, use, and attitudes toward evidence-based medicine (EBM) and The Cochrane Library (CL) among physicians from Zenica-Doboj Canton (ZDC), Bosnia and Herzegovina.

Methods

In this cross-sectional study, a self-administered anonymous questionnaire was sent by post to all state owned health institutions (2 hospitals and 11 Primary Health Care Institutions) in ZDC. The main outcome measures were physicians’ awareness of the Cochrane, awareness and use of CL, access to EBM databases, and access to internet at work. 358 of 559 physicians responded (63.69%).

Results

23.18% of respondents stated they had access to EBM databases, but only 3.91% named the actual EBM databases they used. The question on the highest level of evidence in EBM was correctly answered by 35.7% respondents, 34.64% heard about Cochrane and 32.68% heard about CL. They obtained information about CL mostly on the internet and from colleagues, whereas the information about EBM was obtained mainly during continuous medical education.

Conclusion

Although the attitudes toward EBM are positive, there is a low awareness of EBM among physicians in ZDC. Open access to the CL should be used more. Educational interventions in popularizing EBM and Cochrane are needed to raise awareness both among students and practicing physicians, and finally among lay audience.

Familiarity of physicians, translational researchers, nurses, and other health professionals with evidence-based medicine terms and resources

Evidence-based medicine (EBM) is a central theme in health practice and training. The understanding of EBM technical terms and the familiarity with EBM resources were surveyed in four different health professional categories. A self-administered questionnaire on the familiarity with EBM terminology and resources was proposed to 218 health professionals (physicians, translational researchers, nurses, and others) working in the oncology field. Relationships between variable and familiarity were examined: Pearson χ(2) or exact Fisher test was used for the categorical variables and one-way ANOVA for the continuous ones. The odds of familiarity for subjects, who had followed or not at least one EBM course, were estimated fitting a multiple logistic regression model adjusted for age, gender, and profession. All subjects completed the questionnaire. The majority of health personnel seemed to lack a sound knowledge of key EBM terms and sources. Physicians showed the highest knowledge of terms, nurses the lowest. Physicians also declared the largest familiarity with the widest variety of resources, followed by others and the researchers. The most popular resource was PLNG, the Italian Guideline System. People who attended at least one EBM course showed consistently higher percentages of knowledge, but the association was irrelevant for nurses. The main perceived barrier to implement EBM in practice was a lack of personal time. Familiarity of health professionals with EBM terminology and resources is still limited to the medical field and needs to be improved. Increasing education may be pivotal, even if different approaches should be developed for different professional categories.

Knowledge, skills and attitude of evidence-based medicine among obstetrics and gynaecology trainees: a questionnaire survey

Objectives

To determine current evidence-based medicine skills and practice among trainees.

Design

Questionnaire study.

Setting

Electronic survey was sent to all obstetrics and gynaecology trainees in East Midlands South Deanery, and responses collected were anonymous.

Participants

All obstetrics and gynaecology trainees in East Midland South Deanery.

Main outcome measures

Self-reported attitude, skills and knowledge in various components of evidence-based medicine.

Results

69 trainees were included in the study of which 35 responded. Among all respondents, almost 72% of trainees use non-evidence-based methods to find answers for their clinical questions, whereas only 18% use appropriate evidence-based medicine practice for such queries. Just 35% of trainees have minimum skills of literature searching. Most of the trainees struggle to understand various components of evidence-based medicine. Nearly 80% of trainees do not have formal education or training with regard to evidence-based medicine.

Conclusions

This study highlights the inadequacy of evidence-based medicine skills among trainees and urges that evidence-based medicine be incorporated in formal training along with specialty study modules.

Attitude, knowledge and behaviour towards evidence-based medicine of physical therapists, students, teachers and supervisors in the Netherlands: a survey

RATIONALE, AIMS AND OBJECTIVES

Evidence-based medicine (EBM) has gained widespread acceptance in physical therapy. However, because little is known about the attitudes, knowledge and behaviour of physical therapists towards EBM, and their participation in research to generate EBM, we explored these aspects among physical therapy students, teachers, supervisors and practising physical therapists.

METHODS

This is a cross-sectional survey in which participants completed a web-based questionnaire to determine their attitudes, knowledge and behaviour regarding EBM, and their participation in research.

RESULTS

Questionnaires were sent to 814 participants of which 165 were returned. The overall mean score for attitude was 4.3 [standard deviation (SD) 1.0; range 1-7], which indicates a weak positive attitude. Teachers scored the highest (4.9, SD 1.2) and students the lowest (4.1, SD 0.8). Although most participants had some understanding of the technical terms used in EBM, only teachers felt able to explain these terms to others. Of the students, 45% rated their perceived EBM knowledge as bad and 45% as average, whereas 78% of the teachers considered that they had good knowledge. To answer clinical questions, most students generally use textbooks (96%) and the opinion of their supervisors (87.7%).

CONCLUSIONS

There is a weak positive attitude of physical therapists, teachers, supervisors and students towards participating in research in general practice, but there is a lack of knowledge and active behaviour regarding EBM, especially among physical therapy students.

Evaluating factors affecting the implementation of evidence based medicine in primary healthcare centers in Dubai

OBJECTIVES

To assess the current evidence based medicine (EBM) knowledge, attitude and perceptions of physicians at Dubai Primary Health Care Sector (PHCS). Further to evaluate barrier and facilitator factors toward implementing the EBM practice.

METHODOLOGY

A cross-sectional study, at Dubai PHCS, UAE between June and August 2010. The survey was composed of two phases. The first phase was a self administrated questionnaire employed for data collection and the second phase was qualitative method, which was in the form of individual interviews. Statistical Package for Social Sciences (SPSS) was used for data analysis.

RESULTS

In total 48 participants responded to the survey questionnaire and 13 responded to individual interviews. The response rate was 70.0%. Mean age was 42.18 (SD 10.46). The majority were females (64.6%). The physicians who attended EBM courses reported 70.30% using EBM and showed statistical significance (p = 0.002) from those who did not attend the EBM courses. 65.0% believe that 50-75% of the patients are capable of participating in clinical decision while 71.8% disagreed that the concept of EBM is not applicable to their culture. In addition they showed significance (p = 0.03) between physician beliefs with regard to patient capacity to take decision. About 67.0% of the family physicians were knowledgeable and followed systematic review as the strongest evidence. They had no access to the EBM resources (37.0%) and had no time to practice the EBM (38.0%). Nearly 40.0% interviewees reported lack of encouragement to attend EBM courses. EBM activities (22.0%) and active audit (18.0%) were top rated facilitating factors.

CONCLUSIONS

EBM is not fully utilized by indefinite physicians in the Dubai PHC sector. Factors associated with non-utilization of EBM in the PHCS are lack of encouragement to attend EBM courses, senior physicians resist adoption of EBM, lack of time and insufficient dissemination process for implementing the clinical guideline.

Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review

OBJECTIVES

Evidence-based practice (EBP) may help improve healthcare quality. However, not all healthcare professionals and managers use EBP in their daily practice. We systematically reviewed the literature to summarise self-reported appreciation of EBP and organisational infrastructure solutions proposed to promote EBP.

DESIGN

Systematic review. Two investigators independently performed the systematic reviewing process.

INFORMATION SOURCES

MEDLINE, EMBASE and Cochrane Library were searched for publications between 2000 and 2011.

ELIGIBILITY CRITERIA FOR INCLUDED STUDIES

Reviews and surveys of EBP attitude, knowledge, awareness, skills, barriers and facilitators among managers, doctors and nurses in clinical settings.

RESULTS

We found 31 surveys of fairly good quality. General attitude towards EBP was welcoming. Respondents perceived several barriers, but also many facilitators for EBP implementation. Solutions were proposed at various organisational levels, including (inter)national associations and hospital management promoting EBP, pregraduate and postgraduate education, as well as individual support by EBP mentors on the wards to move EBP from the classroom to the bedside.

CONCLUSIONS

More than 20 years after its introduction, the EBP paradigm has been embraced by healthcare professionals as an important means to improve quality of patient care, but its implementation is still deficient. Policy exerted at microlevel , middlelevel and macrolevel, and supported by professional, educational and managerial role models, may further facilitate EBP.

Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review

OBJECTIVES

Evidence-based practice (EBP) may help improve healthcare quality. However, not all healthcare professionals and managers use EBP in their daily practice. We systematically reviewed the literature to summarise self-reported appreciation of EBP and organisational infrastructure solutions proposed to promote EBP.

DESIGN

Systematic review. Two investigators independently performed the systematic reviewing process.

INFORMATION SOURCES

MEDLINE, EMBASE and Cochrane Library were searched for publications between 2000 and 2011.

ELIGIBILITY CRITERIA FOR INCLUDED STUDIES

Reviews and surveys of EBP attitude, knowledge, awareness, skills, barriers and facilitators among managers, doctors and nurses in clinical settings.

RESULTS

We found 31 surveys of fairly good quality. General attitude towards EBP was welcoming. Respondents perceived several barriers, but also many facilitators for EBP implementation. Solutions were proposed at various organisational levels, including (inter)national associations and hospital management promoting EBP, pregraduate and postgraduate education, as well as individual support by EBP mentors on the wards to move EBP from the classroom to the bedside.

CONCLUSIONS

More than 20 years after its introduction, the EBP paradigm has been embraced by healthcare professionals as an important means to improve quality of patient care, but its implementation is still deficient. Policy exerted at microlevel , middlelevel and macrolevel, and supported by professional, educational and managerial role models, may further facilitate EBP.

Integration of evidence based medicine into the clinical years of a medical curriculum

Teaching Evidence Based Medicine (EBM) helps medical students to develop their decision making skills based on current best evidence, especially when it is taught in a clinical context. Few medical schools integrate Evidence Based Medicine into undergraduate curriculum, and those who do so, do it at the academic years only as a standalone (classroom) teaching but not at the clinical years. The College of Medicine at King Saud bin Abdulaziz University for Health Sciences was established in January 2004. The college adopted a four-year Problem Based Learning web-based curriculum. The objective of this paper is to present our experience in the integration of the EBM in the clinical phase of the medical curriculum. We teach EBM in 3 steps: first step is teaching EBM concepts and principles, second is teaching the appraisal and search skills, and the last step is teaching it in clinical rotations. Teaching EBM at clinical years consists of 4 student-centered tutorials. In conclusion, EBM may be taught in a systematic, patient centered approach at clinical rounds. This paper could serve as a model of Evidence Based Medicine integration into the clinical phase of a medical curriculum.

Evidence-based medicine training in a resource-poor country, the importance of leveraging personal and institutional relationships

RATIONALE, AIMS AND OBJECTIVES

Efforts to implement evidence-based medicine (EBM) training in developing countries are limited. We describe the results of an international effort to improve research capacity in a developing country; we conducted a course aimed at improving basic EBM attitudes and identified challenges.

METHOD

Between 2005 and 2009, we conducted an annual 3-day course in Perú consisting of interactive lectures and case-based workshops. We assessed self-reported competence and importance in EBM using a Likert scale (1 = low, 5 = high).

RESULTS

Totally 220 clinicians participated. For phase I (2005-2007), self-reported EBM competence increased from a median of 2 to 3 (P < 0.001) and the perceived importance of EBM did not change (median = 5). For phase II (2008-2009), before the course, 8-72% graded their competence very low (score of 1-2). After the course, 67-92% of subjects graded their increase in knowledge very high (score of 4-5). The challenges included limited availability of studies relevant to the local reality written in Spanish, participants' limited time and lack of long-term follow-up on practice change. Informal discussion and written evaluation from participants were universally in agreement that more training in EBM is needed.

CONCLUSIONS

In an EBM course in a resource-poor country, the baseline self-reported competence and experience on EBM were low, and the course had measurable improvements of self-reported competence, perceived utility and readiness to incorporate EBM into their practices. Similar to developed countries, translational research and building the research capacity in developing countries is critical for translating best available evidence into practice.