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Papaefthimiou M, Kontou PI, Bagos PG, Braliou GG. Integration of Antioxidant Activity Assays Data of Stevia Leaf Extracts: A Systematic Review and Meta-Analysis. Antioxidants (Basel) 2024; 13:692. [PMID: 38929131 PMCID: PMC11201069 DOI: 10.3390/antiox13060692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Stevia rebaudiana Bertoni, a no-calorie natural sweetener, contains a plethora of polyphenols that exert antioxidant properties with potential medicinal significance. Due to the variety of functional groups, polyphenols exhibit varying solubility depending on the nature of the extraction solvents (water, organic, or their mixtures, defined further on as hydroalcoholic extracts). In the present study, we performed a systematic review, following PRISMA guidelines, and meta-analysis, synthesizing all available data from 45 articles encompassing 250 different studies. Our results showed that the total phenolic content (TPC) of hydroalcoholic and aqueous extracts presents higher values (64.77 and 63.73 mg GAE/g) compared to organic extracts (33.39). Total flavonoid content (TFC) was also higher in aqueous and hydroalcoholic extracts; meta-regression analysis revealed that outcomes in different measuring units (mg QE/g, mg CE/g, and mg RUE/g) do not present statistically significant differences and can be synthesized in meta-analysis. Using meta-regression analysis, we showed that outcomes from the chemical-based ABTS, FRAP, and ORAC antioxidant assays for the same extract type can be combined in meta-analysis because they do not differ statistically significantly. Meta-analysis of ABTS, FRAP, and ORAC assays outcomes revealed that the antioxidant activity profile of various extract types follows that of their phenolic and flavonoid content. Using regression meta-analysis, we also presented that outcomes from SOD, CAT, and POX enzymatic antioxidant assays are independent of the assay type (p-value = 0.905) and can be combined. Our study constitutes the first effort to quantitatively and statistically synthesize the research results of individual studies using all methods measuring the antioxidant activity of stevia leaf extracts. Our results, in light of evidence-based practice, uncover the need for a broadly accepted, unified, methodological strategy to perform antioxidant tests, and offer documentation that the use of ethanol:water 1:1 mixtures or pure water can more efficiently extract stevia antioxidant compounds.
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Affiliation(s)
- Maria Papaefthimiou
- Department of Computer Science and Biomedical Informatics, University of Thessaly, 35131 Lamia, Greece; (M.P.); (P.G.B.)
| | | | - Pantelis G. Bagos
- Department of Computer Science and Biomedical Informatics, University of Thessaly, 35131 Lamia, Greece; (M.P.); (P.G.B.)
| | - Georgia G. Braliou
- Department of Computer Science and Biomedical Informatics, University of Thessaly, 35131 Lamia, Greece; (M.P.); (P.G.B.)
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Chlabicz M, Nabożny A, Koszelew J, Łaguna W, Szpakowicz A, Sowa P, Budny W, Guziejko K, Róg-Makal M, Pancewicz S, Kondrusik M, Czupryna P, Cudowska B, Lebensztejn D, Moniuszko-Malinowska A, Wierzbicki A, Kamiński KA. Medical Misinformation in Polish on the World Wide Web During the COVID-19 Pandemic Period: Infodemiology Study. J Med Internet Res 2024; 26:e48130. [PMID: 38551638 PMCID: PMC10984342 DOI: 10.2196/48130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/26/2023] [Accepted: 11/29/2023] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Although researchers extensively study the rapid generation and spread of misinformation about the novel coronavirus during the pandemic, numerous other health-related topics are contaminating the internet with misinformation that have not received as much attention. OBJECTIVE This study aims to gauge the reach of the most popular medical content on the World Wide Web, extending beyond the confines of the pandemic. We conducted evaluations of subject matter and credibility for the years 2021 and 2022, following the principles of evidence-based medicine with assessments performed by experienced clinicians. METHODS We used 274 keywords to conduct web page searches through the BuzzSumo Enterprise Application. These keywords were chosen based on medical topics derived from surveys administered to medical practitioners. The search parameters were confined to 2 distinct date ranges: (1) January 1, 2021, to December 31, 2021; (2) January 1, 2022, to December 31, 2022. Our searches were specifically limited to web pages in the Polish language and filtered by the specified date ranges. The analysis encompassed 161 web pages retrieved in 2021 and 105 retrieved in 2022. Each web page underwent scrutiny by a seasoned doctor to assess its credibility, aligning with evidence-based medicine standards. Furthermore, we gathered data on social media engagements associated with the web pages, considering platforms such as Facebook, Pinterest, Reddit, and Twitter. RESULTS In 2022, the prevalence of unreliable information related to COVID-19 saw a noteworthy decline compared to 2021. Specifically, the percentage of noncredible web pages discussing COVID-19 and general vaccinations decreased from 57% (43/76) to 24% (6/25) and 42% (10/25) to 30% (3/10), respectively. However, during the same period, there was a considerable uptick in the dissemination of untrustworthy content on social media pertaining to other medical topics. The percentage of noncredible web pages covering cholesterol, statins, and cardiology rose from 11% (3/28) to 26% (9/35) and from 18% (5/28) to 26% (6/23), respectively. CONCLUSIONS Efforts undertaken during the COVID-19 pandemic to curb the dissemination of misinformation seem to have yielded positive results. Nevertheless, our analysis suggests that these interventions need to be consistently implemented across both established and emerging medical subjects. It appears that as interest in the pandemic waned, other topics gained prominence, essentially "filling the vacuum" and necessitating ongoing measures to address misinformation across a broader spectrum of health-related subjects.
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Affiliation(s)
- Małgorzata Chlabicz
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Białystok, Poland
- Department of Invasive Cardiology, Medical University of Białystok, Białystok, Poland
| | - Aleksandra Nabożny
- Department of Software Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Jolanta Koszelew
- R&D Department, Science4People Limited Liability Company, Szczecin, Poland
| | - Wojciech Łaguna
- Faculty of Computer Science, Bialystok University of Technology, Białystok, Poland
| | - Anna Szpakowicz
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Paweł Sowa
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Białystok, Poland
| | - Wojciech Budny
- Department of Allergology and Internal Medicine, Medical University of Białystok, Białystok, Poland
| | - Katarzyna Guziejko
- 2nd Department of Lung Diseases and Tuberculosis, Medical University of Białystok, Białystok, Poland
| | - Magdalena Róg-Makal
- Department of Invasive Cardiology, Medical University of Białystok, Białystok, Poland
| | - Sławomir Pancewicz
- Department of Infectious Diseases and Neuroinfection, Medical University of Białystok, Białystok, Poland
| | - Maciej Kondrusik
- Department of Infectious Diseases and Neuroinfection, Medical University of Białystok, Białystok, Poland
| | - Piotr Czupryna
- Department of Infectious Diseases and Neuroinfection, Medical University of Białystok, Białystok, Poland
| | - Beata Cudowska
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition, Allergology and Pulmonology, Medical University of Bialystok, Białystok, Poland
| | - Dariusz Lebensztejn
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition, Allergology and Pulmonology, Medical University of Bialystok, Białystok, Poland
| | - Anna Moniuszko-Malinowska
- Department of Infectious Diseases and Neuroinfection, Medical University of Białystok, Białystok, Poland
| | - Adam Wierzbicki
- Department of Computer Science, Polish-Japaneese Academy of Information Technology, Warsaw, Poland
| | - Karol A Kamiński
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Białystok, Poland
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Kunisch S, Denyer D, Bartunek JM, Menz M, Cardinal LB. Review Research as Scientific Inquiry. ORGANIZATIONAL RESEARCH METHODS 2023. [DOI: 10.1177/10944281221127292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article and the related Feature Topic at Organizational Research Methods upcoming were motivated by the concern that despite the bourgeoning number and diversity of review articles, there was a lack of guidance on how to produce rigorous and impactful literature reviews. In this article, we introduce review research as a class of research inquiries that uses prior research as data sources to develop knowledge contributions for academia, practice and policy. We first trace the evolution of review research both outside of and within management including the articles published in this Feature Topic, and provide a holistic definition of review research. Then, we argue that in the plurality of forms of review research, the alignment of purpose and methods is crucial for high-quality review research. To accomplish this, we discuss several review purposes and criteria for assessing review research's rigor and impact, and discuss how these and the review methods need to be aligned with its purpose. Our paper provides guidance for conducting or evaluating review research and helps establish review research as a credible and legitimate scientific endeavor.
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Magwood O, Riddle A, Petkovic J, Lytvyn L, Khabsa J, Atwere P, Akl EA, Campbell P, Welch V, Smith M, Mustafa RA, Limburg H, Dans LF, Skoetz N, Grant S, Concannon T, Tugwell P. PROTOCOL: Barriers and facilitators to stakeholder engagement in health guideline development: A qualitative evidence synthesis. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1237. [PMID: 36911345 PMCID: PMC9038083 DOI: 10.1002/cl2.1237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND There is a need for the development of comprehensive, global, evidence-based guidance for stakeholder engagement in guideline development. Stakeholders are any individual or group who is responsible for or affected by health- and healthcare-related decisions. This includes patients, the public, providers of health care and policymakers for example. As part of the guidance development process, Multi-Stakeholder Engagement (MuSE) Consortium set out to conduct four concurrent systematic reviews to summarise the evidence on: (1) existing guidance for stakeholder engagement in guideline development, (2) barriers and facilitators to stakeholder engagement in guideline development, (3) managing conflicts of interest in stakeholder engagement in guideline development and (4) measuring the impact of stakeholder engagement in guideline development. This protocol addresses the second systematic review in the series. OBJECTIVES The objective of this review is to identify and synthesise the existing evidence on barriers and facilitators to stakeholder engagement in health guideline development. We will address this objective through two research questions: (1) What are the barriers to multi-stakeholder engagement in health guideline development across any of the 18 steps of the GIN-McMaster checklist? (2) What are the facilitators to multi-stakeholder engagement in health guideline development across any of the 18 steps of the GIN-McMaster checklist? SEARCH METHODS A comprehensive search strategy will be developed and peer-reviewed in consultation with a medical librarian. We will search the following databases: MEDLINE, Cumulative Index to Nursing & Allied Health Literature (CINAHL), EMBASE, PsycInfo, Scopus, and Sociological Abstracts. To identify grey literature, we will search the websites of agencies who actively engage stakeholder groups such as the AHRQ, Canadian Institutes of Health Research (CIHR) Strategy for Patient-Oriented Research (SPOR), INVOLVE, the National Institute for Health and Care Excellence (NICE) and the PCORI. We will also search the websites of guideline-producing agencies, such as the American Academy of Pediatrics, Australia's National Health Medical Research Council (NHMRC) and the WHO. We will invite members of the team to suggest grey literature sources and we plan to broaden the search by soliciting suggestions via social media, such as Twitter. SELECTION CRITERIA We will include empirical qualitative and mixed-method primary research studies which qualitatively report on the barriers or facilitators to stakeholder engagement in health guideline development. The population of interest is stakeholders in health guideline development. Building on previous work, we have identified 13 types of stakeholders whose input can enhance the relevance and uptake of guidelines: Patients, caregivers and patient advocates; Public; Providers of health care; Payers of health services; Payers of research; Policy makers; Program managers; Product makers; Purchasers; Principal investigators and their research teams; and Peer-review editors/publishers. Eligible studies must describe stakeholder engagement at any of the following steps of the GIN-McMaster Checklist for Guideline Development. DATA COLLECTION AND ANALYSIS All identified citations from electronic databases will be imported into Covidence software for screening and selection. Documents identified through our grey literature search will be managed and screened using an Excel spreadsheet. A two-part study selection process will be used for all identified citations: (1) a title and abstract review and (2) full-text review. At each stage, teams of two review authors will independently assess all potential studies in duplicate using a priori inclusion and exclusion criteria. Data will be extracted by two review authors independently and in duplicate according to a standardised data extraction form. MAIN RESULTS The results of this review will be used to inform the development of guidance for multi-stakeholder engagement in guideline development and implementation. This guidance will be official GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group guidance. The GRADE system is internationally recognised as a standard for guideline development. The findings of this review will assist organisations who develop healthcare, public health and health policy guidelines, such as the World Health Organization, to involve multiple stakeholders in the guideline development process to ensure the development of relevant, high quality and transparent guidelines.
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Affiliation(s)
- Olivia Magwood
- C.T. Lamont Primary Health Care Research CentreBruyere Research InstituteOttawaCanada
| | - Alison Riddle
- School of Epidemiology and Public Health, Faculty of MedicineUniversity of OttawaOttawaCanada
| | | | - Lyubov Lytvyn
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
| | - Joanne Khabsa
- Clinical Research InstituteAmerican University of Beirut Medical CenterBeirutLebanon
| | - Pearl Atwere
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
| | - Elie A. Akl
- Department of Internal MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research UnitGlasgow Caledonian UniversityGlasgowUK
| | - Vivian Welch
- Methods CentreBruyère Research InstituteOttawaCanada
| | - Maureen Smith
- Cochrane Consumer Network ExecutiveCochraneOttawaCanada
| | - Reem A. Mustafa
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
| | - Heather Limburg
- Global Health and Guidelines DivisionPublic Health Agency of CanadaOttawaCanada
| | - Leonila F. Dans
- Department of Clinical EpidemiologyUniversity of the Philippines College of MedicineManillaPhilippines
| | - Nicole Skoetz
- Cochrane Cancer, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital CologneUniversity of CologneCologneGermany
| | - Sean Grant
- Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public HealthIndiana UniversityIndianapolisIndianaUSA
| | | | - Peter Tugwell
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
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Milosavljevic M, Hewitt L, Fish J, Cuenca J, Ashford B. How to streamline the low and negligible research ethics and governance review process from 80 to 10 days: submission to decision. Intern Med J 2022; 52:853-858. [PMID: 35538005 DOI: 10.1111/imj.15773] [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: 12/09/2021] [Revised: 01/28/2022] [Accepted: 02/19/2022] [Indexed: 11/28/2022]
Abstract
Most clinicians find research ethics and governance difficult and time consuming. This study aimed to develop a better local review process for low-risk research. We used real-time processing, leveraged local expertise and streamlined paperwork. As a result, turnaround times decreased from more than 80 days to 10 days, creating an efficient review process for low-risk projects.
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Affiliation(s)
- Marianna Milosavljevic
- Research Office, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia.,Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lyndel Hewitt
- Research Office, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia.,Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Janaye Fish
- Research Office, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Jose Cuenca
- Research Office, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Bruce Ashford
- Research Office, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia.,Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
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Brownson RC, Shelton RC, Geng EH, Glasgow RE. Revisiting concepts of evidence in implementation science. Implement Sci 2022; 17:26. [PMID: 35413917 PMCID: PMC9004065 DOI: 10.1186/s13012-022-01201-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/04/2022] [Indexed: 11/20/2022] Open
Abstract
Background Evidence, in multiple forms, is a foundation of implementation science. For public health and clinical practice, evidence includes the following: type 1 evidence on etiology and burden; type 2 evidence on effectiveness of interventions; and type 3: evidence on dissemination and implementation (D&I) within context. To support a vision for development and use of evidence in D&I science that is more comprehensive and equitable (particularly for type 3 evidence), this article aims to clarify concepts of evidence, summarize ongoing debates about evidence, and provide a set of recommendations and tools/resources for addressing the “how-to” in filling evidence gaps most critical to advancing implementation science. Main text Because current conceptualizations of evidence have been relatively narrow and insufficiently characterized in our opinion, we identify and discuss challenges and debates about the uses, usefulness, and gaps in evidence for implementation science. A set of questions is proposed to assist in determining when evidence is sufficient for dissemination and implementation. Intersecting gaps include the need to (1) reconsider how the evidence base is determined, (2) improve understanding of contextual effects on implementation, (3) sharpen the focus on health equity in how we approach and build the evidence-base, (4) conduct more policy implementation research and evaluation, and (5) learn from audience and stakeholder perspectives. We offer 15 recommendations to assist in filling these gaps and describe a set of tools for enhancing the evidence most needed in implementation science. Conclusions To address our recommendations, we see capacity as a necessary ingredient to shift the field’s approach to evidence. Capacity includes the “push” for implementation science where researchers are trained to develop and evaluate evidence which should be useful and feasible for implementers and reflect community or stakeholder priorities. Equally important, there has been inadequate training and too little emphasis on the “pull” for implementation science (e.g., training implementers, practice-based research). We suggest that funders and reviewers of research should adopt and support a more robust definition of evidence. By critically examining the evolving nature of evidence, implementation science can better fulfill its vision of facilitating widespread and equitable adoption, delivery, and sustainment of scientific advances.
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Kumbhare D, Frontera WR. Integration of Research Knowledge to Enhance the Evidence Informed Practice of the Busy Physiatrist: Introduction of the New "Special Research" Section. Am J Phys Med Rehabil 2022; 101:1. [PMID: 34915540 DOI: 10.1097/phm.0000000000001909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Dinesh Kumbhare
- From the Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada (DK); and Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF)
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Rosenblum S, Isett KR, Melkers J, Funkhouser E, Hicks D, Gilbert GH, Melkers MJ, McEdward D, Buchberg-Trejo M. The association between professional stratification and use of online sources: Evidence from the National Dental Practice-Based Research Network. J Inf Sci 2021; 47:373-386. [PMID: 34177010 PMCID: PMC8221114 DOI: 10.1177/0165551519890519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of online information sources in most professions is widespread, and well researched. Less understood is how the use of these sources vary across the strata within a single profession, and how question context affects search behaviour. Using the dental profession as a case of a highly stratified discipline, we examine search preferences for sources by professional strata among dentists in a practice-based network. Results show that variation exists in information search behaviour across professional strata of dental clinicians. This study highlights the importance of addressing information literacy across different levels of a profession. Findings also underscore that search behaviour and source preference vary with perceived question relevance.
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Affiliation(s)
- Simone Rosenblum
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Julia Melkers
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA
| | - Ellen Funkhouser
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Diana Hicks
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA
| | - Gregg H Gilbert
- School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Deborah McEdward
- South Atlantic Region, National Dental Practice-Based Research Network, Gainesville, FL, USA
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Abou Dargham N, Sultan Y, Mourad O, Baidoun M, Aboul Hosn O, Abou El Naga A, Bahmad HF, Azakir B. Perception of Biostatistics by Lebanese Medical Students: A Cross-Sectional Study. ALEXANDRIA JOURNAL OF MEDICINE 2021. [DOI: 10.1080/20905068.2021.1892306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
| | - Youssef Sultan
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Omar Mourad
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Mariam Baidoun
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Omar Aboul Hosn
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | | | - Hisham F Bahmad
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
- Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Bilal Azakir
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
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Salandra R, Criscuolo P, Salter A. Directing scientists away from potentially biased publications: the role of systematic reviews in health care. RESEARCH POLICY 2021. [DOI: 10.1016/j.respol.2020.104130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Morgott M, Heinmüller S, Hueber S, Schedlbauer A, Kühlein T. Do guidelines help us to deviate from their recommendations when appropriate for the individual patient? A systematic survey of clinical practice guidelines. J Eval Clin Pract 2020; 26:709-717. [PMID: 31206241 DOI: 10.1111/jep.13187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/03/2019] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Clinical practice guidelines (CPG) were introduced to summarize the best scientific evidence available. Thereby, CPG were meant to support evidence-based medicine (EBM). However, besides evidence, EBM also asks for patients' preferences and physicians' experiences to be considered when coming to therapeutic decisions. Thus, deviations from CPG recommendations are sometimes necessary when practicing EBM. We wanted to examine whether CPG support deviations from their recommendations when appropriate. For operationalization, we asked whether absolute effect sizes (AES) for benefit and/or harm of suggested therapies were provided along with the respective CPG recommendation. METHODS This systematic survey comprised the most common CPG on chronic coronary heart disease (CCHD) and type 2 diabetes mellitus (T2DM) from English- and German-speaking countries. Only CPG recommendations on pharmacotherapy were evaluated. If AES of a recommended therapy were reported, we rated how easily findable they were within the CPG. Moreover, we assessed whether the CPG provided patient information material and whether this material supplied AES allowing patients to determine the effects to be expected. RESULTS In the 13 CPG surveyed, 144 recommendations on pharmacotherapy were identified. For 108 recommendations (75%), no AES for benefit and/or harm were reported. Thirty-one recommendations (22%) were accompanied by one or more AES for either benefit or harm. Along with five recommendations (3%), one or more AES for both benefit and harm were given. AES were considered easy to find for three of these 36 recommendations (8%). Patient information material was provided in three of the 13 CPG (23%) accounting for AES in one occasion only. CONCLUSION Current CPG on T2DM and CCHD do not sufficiently offer AES for benefits and harms of recommended therapies. Thus, they lack satisfactory information to support deviations from CPG recommendations. Consequently, CPG in their present form do not adequately facilitate EBM.
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Affiliation(s)
- Marc Morgott
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Institute of General Practice, Erlangen, Germany
| | - Stefan Heinmüller
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Institute of General Practice, Erlangen, Germany
| | - Susann Hueber
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Institute of General Practice, Erlangen, Germany
| | - Angela Schedlbauer
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Institute of General Practice, Erlangen, Germany
| | - Thomas Kühlein
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Institute of General Practice, Erlangen, Germany
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Alhajji S, Mojiminiyi S. Adherence to Current Lipid Guidelines by Physicians in Kuwait. Med Princ Pract 2020; 29:436-443. [PMID: 31805555 PMCID: PMC7511683 DOI: 10.1159/000505244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/05/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Alarmingly high rates of dyslipidemia have been found in the Gulf region in patients presenting with acute coronary syndrome, with the highest being found in Kuwait (37%). Therefore, it is of utmost importance to treat dyslipidemia promptly and effectively. In an effort to understand the practices of local physicians, the use of evidence-based medicine, and adherence to lipid treatment guidelines, the objective of this study was to survey and assess the current standards of care. METHODS A survey questionnaire, designed to assess physicians' attitudes and practice towards lipid guidelines, was completed by 279 participants and returned between October 2015 and June 2016. Statistical analysis was done using SPSS. RESULTS Over 90% of physicians claimed to use lipid guidelines, with the majority rating themselves as knowledgeable. Younger physicians were found to be less knowledgeable and consequently used guidelines less frequently. The most important factor influencing clinical decision-making was the availability of clinical guidelines. The majority (72.4%) of physicians identified time limitation as a key barrier. The most commonly selected lipid guideline in daily practice was a guideline on the treatment of blood cholesterol published by the American College of Cardiology/American Heart Association in 2013. The most common risk assessment tool used was the Framingham risk score. CONCLUSIONS Multiple interventions to improve guideline adherence are proposed in this study. We have taken into account the barriers to adherence, i.e., attitude, behavior, and (most importantly) knowledge, all 3 of which were reaffirmed in our investigation in Kuwait.
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Affiliation(s)
- Salwa Alhajji
- Clinical Biochemistry, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait,
| | - Segun Mojiminiyi
- Clinical Biochemistry, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
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Yin C, Moszcyznski AJ, Blom JN, Johnson TPE, Jones DL. Advancing the understanding of research during medical education through collaborative learning: the Collaboration of Practitioners and Researchers Seminar Series. BMC MEDICAL EDUCATION 2019; 19:457. [PMID: 31823767 PMCID: PMC6905010 DOI: 10.1186/s12909-019-1890-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The Collaboration of Practitioners and Researchers Seminar Series is student-led program comprised of seminars delivered jointly by medical and graduate students on a topic in medicine of mutual interest to an audience of both medical and graduate students. METHODS Following its inaugural year in 2016-2017, we evaluated changes in attendees' perceived understanding of translational research through an electronic survey and semi-structured interviews with attendees. RESULTS Study participants rated their understanding of translational research and comfort with interacting with students from the other program higher following attending seminars. Participants believed that the seminars helped in breaking barriers between medical and graduate students. CONCLUSIONS We conclude that this seminar series positively impacted attendees' understanding of translational research and attitudes towards collaboration between medical and graduate students. We believe that similar initiatives may be of value in fostering new opportunities for collaboration between medical and graduate students at other institutions.
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Affiliation(s)
- Charles Yin
- Schulich School of Medicine and Dentistry, Western University, London, ON Canada
| | | | - Jessica N. Blom
- Schulich School of Medicine and Dentistry, Western University, London, ON Canada
| | | | - Douglas L. Jones
- Schulich School of Medicine and Dentistry, Western University, London, ON Canada
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Tal O, Booch M, Bar-Yehuda S. Hospital staff perspectives towards health technology assessment: data from a multidisciplinary survey. Health Res Policy Syst 2019; 17:72. [PMID: 31337398 PMCID: PMC6651984 DOI: 10.1186/s12961-019-0469-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 06/10/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Technology adoption in hospitals is usually based on cost-effectiveness analysis, feasibility and potential success. Different countries have embraced a range of principles to accomplish an effective comprehensive process of health technology assessment (HTA). The aim of the study was to analyse the viewpoints and relative weight of technology-oriented hospital staff members toward the clinical, social, technological and economic aspects of HTA. METHODS Using a structured questionnaire, a survey was conducted among different professionals in an 850-bed hospital. RESULTS We revealed a range of viewpoints among hospital staff members according to their personal characteristics and professional standpoints. The clinical aspects of HTA were considered 'highly important' (HI) by most participants, especially the 'lifesaving' parameter. Similarly, the 'lack of effective alternative technology' was ranked HI by a high percentage of participants, independent of their profession. Economic aspects were ranked HI only by half of the participants, while social and technological aspects were ranked HI only by a relatively low percentage. Nurses added 'improving quality of life', 'increasing teamwork efficiency' and 'improving medical standards'. Allied health professionals focused on 'lack of effective alternative technologies' as a main argument for adoption of HTA, alongside increasing efficiency, budget savings and contribution to hospital reputation. Engineers emphasised the requirement of significant investment in infrastructure and increasing efficiency. Administrators ranked patient experience as HI. Interestingly, the high ranking of social aspects correlated with older responders, while junior staff ranked safety significantly higher. CONCLUSIONS A multi-perspective multidisciplinary approach would be beneficial for policy-makers at hospitals and even on a national scale in Israel.
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Affiliation(s)
- Orna Tal
- Shamir Medical Center (Assaf Harofeh), 70300, Zerifin, Israel.
- ICET - Israeli Center for Emerging Technologies, Zerifin, Israel.
| | - Meirav Booch
- Shamir Medical Center (Assaf Harofeh), 70300, Zerifin, Israel
- ICET - Israeli Center for Emerging Technologies, Zerifin, Israel
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Horsley T. Tips for Improving the Writing and Reporting Quality of Systematic, Scoping, and Narrative Reviews. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2019; 39:54-57. [PMID: 30789378 DOI: 10.1097/ceh.0000000000000241] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The evidence base in health professions education continues to accumulate at an unprecedented rate. Summaries of evidence in the form of scoping, systematic and narrative reviews are also increasingly common. Unfortunately, many submissions go unpublished and for reasons that may be irreversible post-peer review. The goal of this commentary is to offer insights to review authors for improving the likelihood of publication success. These tips will not guarantee success; however, insights address common errors authors make along the continuum of review production that result in either requests for major revision or rejection.
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Affiliation(s)
- Tanya Horsley
- Dr. Horsley: Associate Director, Research Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada, and Adjunct Faculty, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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16
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van der Leeden M, Stuiver MM, Huijsmans R, Geleijn E, de Rooij M, Dekker J. Structured clinical reasoning for exercise prescription in patients with comorbidity. Disabil Rehabil 2018; 42:1474-1479. [DOI: 10.1080/09638288.2018.1527953] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Marike van der Leeden
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, The Netherlands
| | - Martijn M. Stuiver
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Faculty of Health, ACHIEVE, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Rosalie Huijsmans
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Edwin Geleijn
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Mariëtte de Rooij
- Reade, Amsterdam Rehabilitation Research Centre, Amsterdam, The Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Knowledge dissemination in clinical trials: Exploring influences of institutional support and type of innovation on selective reporting. RESEARCH POLICY 2018. [DOI: 10.1016/j.respol.2018.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Brownson RC, Fielding JE, Green LW. Building Capacity for Evidence-Based Public Health: Reconciling the Pulls of Practice and the Push of Research. Annu Rev Public Health 2018; 39:27-53. [PMID: 29166243 PMCID: PMC5972383 DOI: 10.1146/annurev-publhealth-040617-014746] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Timely implementation of principles of evidence-based public health (EBPH) is critical for bridging the gap between discovery of new knowledge and its application. Public health organizations need sufficient capacity (the availability of resources, structures, and workforce to plan, deliver, and evaluate the preventive dose of an evidence-based intervention) to move science to practice. We review principles of EBPH, the importance of capacity building to advance evidence-based approaches, promising approaches for capacity building, and future areas for research and practice. Although there is general agreement among practitioners and scientists on the importance of EBPH, there is less clarity on the definition of evidence, how to find it, and how, when, and where to use it. Capacity for EBPH is needed among both individuals and organizations. Capacity can be strengthened via training, use of tools, technical assistance, assessment and feedback, peer networking, and incentives. Modest investments in EBPH capacity building will foster more effective public health practice.
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Affiliation(s)
- Ross C Brownson
- Prevention Research Center in St. Louis, Brown School; Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri 63130, USA;
| | - Jonathan E Fielding
- Fielding School of Public Health and Geffen School of Medicine, University of California, Los Angeles, California 90095, USA;
| | - Lawrence W Green
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California 94127, USA;
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19
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Bianchi CF. Working toward an evidence-based cutoff recommendation for myocardial infarction detection after cardiac surgery. J Thorac Cardiovasc Surg 2018; 155:1055. [PMID: 29452458 DOI: 10.1016/j.jtcvs.2017.11.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/16/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Cesario F Bianchi
- Faculdade de Medicina, Núcleos de Pesquisa Tecnológica/Biotecnológica, Universidade de Mogi das Cruzes e Clinica Integracta, Mogi das Cruzes, São Paulo, Brazil
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20
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Gandjour A. Patient preferences: a Trojan horse for evidence-based medicine? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:167-172. [PMID: 28667449 DOI: 10.1007/s10198-017-0916-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The evidence-based medicine (EBM) movement has long acknowledged the relevance of patient preferences and values. According to EBM, clinicians first clarify the medical evidence about the benefits and burdens of the treatment in question and then, as a second step, elicit values and preferences from patients. Importantly, however, values are placed on patient-relevant outcomes. Surrogate endpoints are only used if their validity is proven. This article shows that some recent patient-preference studies attribute value to surrogate endpoints even when there is no improvement in patient-relevant outcomes. The article points out their foundation in neoclassical economics and discusses their clash with principles of EBM and medical ethics.
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Affiliation(s)
- Afschin Gandjour
- Frankfurt School of Finance and Management, Sonnemannstr. 9-11, 60314, Frankfurt am Main, Germany.
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Wang J, Wang D, Chen Y, Zhou Q, Xie H, Chen J, Li Y. The effect of an evidence-based medicine course on medical student critical thinking. J Evid Based Med 2017; 10:287-292. [PMID: 28452179 DOI: 10.1111/jebm.12254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 04/05/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Evidence-based medicine (EBM) was designed to foster student critical thinking (CT) while conveying knowledge to them. Chinese medical schools have adopted EBM to a varying degree but studies to examine its intended effect are few. This study evaluates the effect of an EBM course on Chinese medical student CT. METHODS A total of 158 medical students at a Chinese medical school took a seven-category Chinese version of the critical thinking disposition inventory (CTDI-CV) before and after taking an EBM course. Two-tailed, paired t-test measured the course effect. RESULTS Undergraduate (BS) students showed a significant mean difference (MD) in confidence (MD = 1.43, P = 0.025), inquisitiveness (MD = 1.23, P = 0.041), and overall score (MD = 3.45, P = 0.000). Graduate (MS) students showed a more significant mean difference in confidence (MD = 2.72, P = 0.006). Moreover, BS student course grade was correlated with truth-seeking (r = 0.214, P = 0.029) and open-mindedness (r = 0.246, P = 0.012) while that of MS student was correlated with systematicity (r = 0.295, P = 0.031) and overall score (r = 0.290, P = 0.033). CONCLUSIONS The results indicate some positive effect of an EBM course on student CT due to embedded CT elements in delivering the content. The discrepancy between a higher admission test score and weaker confidence shown by MS students reveals a drawback of the test centered Chinese education system.
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Affiliation(s)
- Jing Wang
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Danhua Wang
- Department of Developmental Studies, Indiana University of Pennsylvania, Indiana, United States
| | - Yanling Chen
- Department of Occupational Disease Department, Nuclear Industry 416 Hospital, Chengdu, China
| | - Qin Zhou
- Department of Nutrition, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hong Xie
- Department of West China School of Medicine, Sichuan University, Chengdu, China
| | - Jin Chen
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Youping Li
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
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Drisko J. Active Collaboration with Clients: An Underemphasized but Vital Part of Evidence-Based Practice. SOCIAL WORK 2017; 62:114-121. [PMID: 28339592 DOI: 10.1093/sw/swx003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/10/2016] [Indexed: 06/06/2023]
Abstract
Evidence-based practice (EBP) is a widely recognized concept in contemporary social work practice. However, recent studies have shown that social workers do not understand EBP correctly. Standardized administrative approaches to implementing EBP have led to confusion about its core practice decision-making process. This collaborative process is the heart of EBP in direct social work practice. This article explores the EBP process and addresses a vital but often underemphasized step of EBP: active collaboration with the client in decision making. Active collaboration with the client is shown to be important in that it (a) is consistent with social work's professional values and ethics, (b) is consistent with patient-centered health care in the Patient Protection and Affordable Care Act and contemporary health care approaches, (c) is consistent with culturally competent practice, and (d) has empirical support for its beneficial impact. Correctly and fully understanding EBP in direct practice is important to improving social work practice and improving client outcomes.
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Affiliation(s)
- James Drisko
- James Drisko, PhD, MSW, is professor, School for Social Work, Smith College, 23 West Street, Northampton, MA 01063; e-mail:
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23
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Abstract
Occupational therapists are under increasing pressure to incorporate standardised assessments into clinical practice, but little evidence of the actual uptake has been published to date. This paper begins to address this knowledge gap by reporting the results of a United Kingdom survey of the uptake of standardised hand assessments by occupational therapists in hospital-based rheumatology services. A purpose-designed postal questionnaire was mailed to ‘The Senior Occupational Therapist in Rheumatology’ at every hospital in the United Kingdom where a consultant rheumatologist was known to practise, seeking information on participants' knowledge about, use of and attitudes towards standardised hand assessments. The overall response rate was 80% (160/200). The 118 respondents who returned completed questionnaires reported a very low uptake of standardised hand assessments, with fewer than 10% using measures of observed task performance. The reasons for preferring non-standardised instruments clustered under six themes: advantages of non-standardised measures, access, delivery of care, training, barriers and exceptions. The barriers to increasing the uptake of standardised hand assessments by occupational therapists working in rheumatology need to be addressed. Initiatives are recommended to assist clinicians in selecting suitable standardised hand assessments, but occupational therapists must also accept their individual responsibility for implementing standardised assessments.
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24
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Hahlweg P, Hoffmann J, Härter M, Frosch DL, Elwyn G, Scholl I. In Absentia: An Exploratory Study of How Patients Are Considered in Multidisciplinary Cancer Team Meetings. PLoS One 2015; 10:e0139921. [PMID: 26441328 PMCID: PMC4595280 DOI: 10.1371/journal.pone.0139921] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/18/2015] [Indexed: 11/18/2022] Open
Abstract
Background Multidisciplinary team meetings and shared decision-making are potential means of delivering patient-centred care. Not much is known about how those two paradigms fit together in cancer care. This study aimed to investigate how decisions are made in multidisciplinary team meetings and whether patient perspectives are incorporated in these decisions. Materials and Methods A qualitative study was conducted using non-participant observation at multidisciplinary team meetings (also called tumor boards) at the University Cancer Center Hamburg-Eppendorf, Germany. Two researchers recorded structured field notes from a total of N = 15 multidisciplinary team meetings. Data were analyzed using content analysis and descriptive statistics. Results Physicians mainly exchanged medical information and based their decision-making on this information. Individual patient characteristics or their treatment preferences were rarely considered or discussed. In the few cases where patient preferences were raised as a topic, this information did not seem to be taken into account in decision-making processes about treatment recommendations. Conclusion The processes in multidisciplinary team meetings we observed did not exhibit shared decision-making. Patient perspectives were absent. If multidisciplinary team meetings wish to become more patient-centred they will have to modify their processes and find a way to include patient preferences into the decision-making process.
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Affiliation(s)
- Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Jana Hoffmann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominick L Frosch
- Gordon and Betty Moore Foundation, Palo Alto, California, United States of America
- Department of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, United States of America
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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25
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Salehi A, Marzban M, Imanieh MH. The Evaluation of Curative Effect of Acupuncture. J Evid Based Complementary Altern Med 2015; 21:202-14. [DOI: 10.1177/2156587215598422] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 07/04/2015] [Indexed: 02/05/2023] Open
Abstract
The present study attempts to critically evaluate previously published research articles on the efficiency of acupuncture in the treatment of diseases. First, 35 systematic reviews or meta-analysis were found in the Cochrane database. Second, 54 related articles were selected by searching important scientific databases. Based on the results obtained regarding the efficacy of acupuncture for the treatment of various diseases, the articles were divided into 3 groups. The first group of articles confirmed the efficacy of treatment by acupuncture. In the second group of articles, the therapeutic effect of acupuncture was shown; however, further research is required to verify the results. In the third group of articles there is no evidence regarding the therapeutic effect of acupuncture till now. There is an urgent need to design and conduct double-blinded randomized clinical trials with high-quality methodologies. This provides a more careful evaluation of acupuncture efficiency in relation to the treatment of a vast array of diseases, based on scientific evidence.
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26
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A novel approach to patients with acute odontoid fractures: atlantoaxial instability as a prognostic variable. Spine J 2015; 15:1161-3. [PMID: 25925623 DOI: 10.1016/j.spinee.2014.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 11/20/2014] [Indexed: 02/03/2023]
Abstract
Liu S, Liu L. Re: Evaniew N, Yarascavitch B, Madden K, Ghert M, Drew B, Bhandari M, et al. Atlantoaxial instability in acute odontoid fractures is associated with nonunion and mortality. Spine J 2015;15:1160 (in this issue).
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Sargeant JM, O'Connor AM. Introduction to systematic reviews in animal agriculture and veterinary medicine. Zoonoses Public Health 2015; 61 Suppl 1:3-9. [PMID: 24905991 DOI: 10.1111/zph.12128] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Indexed: 11/29/2022]
Abstract
This article is the first in a series of six articles related to systematic reviews in animal agriculture and veterinary medicine. In this article, we overview the methodology of systematic reviews and provide a discussion of their use. Systematic reviews differ qualitatively from traditional reviews by explicitly defining a specific review question, employing methods to reduce bias in the selection and inclusion of studies that address the review question (including a systematic and specified search strategy, and selection of studies based on explicit eligibility criteria), an assessment of the risk of bias for included studies and objectively summarizing the results qualitatively or quantitatively (i.e. via meta-analysis). Systematic reviews have been widely used to address human healthcare questions and are increasingly being used in veterinary medicine. Systematic reviews can provide veterinarians and other decision-makers with a scientifically defensible summary of the current state of knowledge on a topic without the need for the end-user to read the vast amount of primary research related to that topic.
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Affiliation(s)
- J M Sargeant
- Centre for Public Health and Zoonoses, University of Guelph, Guelph, ON, Canada; Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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The use of a knowledge translation program to increase use of standardized outcome measures in an outpatient pediatric physical therapy clinic: administrative case report. Phys Ther 2015; 95:613-29. [PMID: 25035269 DOI: 10.2522/ptj.20130434] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 07/13/2014] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Pediatric physical therapists face many challenges related to the application of research evidence to clinical practice. A multicomponent knowledge translation (KT) program may be an effective strategy to support practice change. The purpose of this case report is to describe the use of a KT program to improve the knowledge and frequency of use of standardized outcome measures by pediatric physical therapists practicing in an outpatient clinic. CASE DESCRIPTION This program occurred at a pediatric outpatient facility with 1 primary clinic and 3 additional satellite clinics, and a total of 17 physical therapists. The initial underlying problem was inconsistency across staff recommendations for frequency and duration of physical therapist services. Formal and informal discussion with the department administrator and staff identified a need for increased use of standardized outcome measures to inform these decisions. The KT program to address this need spanned 6 months and included identification of barriers, the use of a knowledge broker, multiple workshop and practice sessions, online and hard-copy resources, and ongoing evaluation of the KT program with dissemination of results to staff. Outcome measures included pre- and post-knowledge assessment and self-report surveys and chart review data on use of outcome measures. OUTCOMES Participants (N=17) gained knowledge and increased the frequency of use of standardized outcome measures based on data from self-report surveys, a knowledge assessment, and chart reviews. DISCUSSION Administrators and others interested in supporting practice change in physical therapy may consider implementing a systematic KT program that includes a knowledge broker, ongoing engagement with staff, and a variety of accessible resources.
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Kones R, Rumana U, Merino J. Exclusion of 'nonRCT evidence' in guidelines for chronic diseases - is it always appropriate? The Look AHEAD study. Curr Med Res Opin 2014; 30:2009-19. [PMID: 24841173 DOI: 10.1185/03007995.2014.925438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Evidence-based medicine (EBM) is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The introduction of EBM was a conceptual and practical milestone in the history of medicine, with far-reaching impact yet to be fully realized. EBM has limitations, including inapplicability to populations dissimilar to those in studies, and may not reflect duration of exposure to risk factors, details of lifestyle, incubation period, latency, or environmental changes during chronic diseases. Routine exclusion of evidence other than randomized controlled trials (RCTs) or meta-analyses from consideration in treatment may not always be wise. This review is not a result of a search, but rather a conceptual unification of (a) the increasing restrictions in guideline-writing favoring more RCTs, and rejecting observational studies when chronic diseases with a long incubation period may sometimes be best probed by the latter; (b) the possibility RCTs may be inconclusive, nonapplicable, or result in 'negative' results which may misdirect future therapy by physicians and undermine adherence by patients; (c) the potential improvement in patient care from having all available information evaluated (especially epidemiological studies of chronic diseases) and synthesized in guidelines. The example of the Look AHEAD study is chosen - a 'negative' RCT with significant information overlooked by reviewers, who initially declared that weight loss and physical activity were ineffective in treating diabetes, or in preventing cardiovascular complications. In this review, placing this study in perspective, among others, suggests the opposite - exercise and weight loss are effective if done early and sufficiently. Synthesizing worthy data from many sources, including prospective and pathophysiological studies, particularly when RCTs are unavailable, has the potential to add depth and expand the understanding of disease. In addition, integrated data may generate useful, rich material for use during shared decision making discussions with patients, and clarify future hypotheses.
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Affiliation(s)
- Richard Kones
- Cardiometabolic Research Institute , Houston, TX , USA
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Evidence-Based Self-care Guidelines for People Receiving Chemotherapy: Do They Reduce Symptom Burden and Psychological Distress? Cancer Nurs 2014; 38:E1-8. [PMID: 24945267 DOI: 10.1097/ncc.0000000000000154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite numerous evidence-based guidelines (EBGs) being developed to manage the symptom burden associated with cancer and chemotherapy, there is a paucity of research exploring their efficacy. OBJECTIVE The aim of this study was to explore the effect of implementing EBGs to reduce the symptom burden and psychological distress of cancer patients requiring outpatient chemotherapy at an acute, tertiary care public hospital in Western Australia. METHODS The study was conducted in 2 populations and stages, using action research to promote change. Stage 1 assessed prevalence; in stage 2, specific EBGs were implemented. Symptom prevalence, severity, and bother were determined at baseline and 1 week and 1 month after initial chemotherapy, to allow comparison between stages. RESULTS Stage 2 participants did better at managing feeling low (odds ratio, 2.33; 95% confidence interval, 1.47-3.70; P < .001) and vomiting (odds ratio, 2.37; 95% confidence interval, 1.13-4.97; P = .022). Bother was greater in stage 2 at baseline for vomiting (P = .040), pain (P = .017), feeling tired (P = .038), feeling anxious or worried (P = .001), and feeling low (P = .024). By 1 month, only feeling anxious or worried (P = .023) and feeling low (P = .006) differed. Severity was greater in stage 2 at baseline for pain (P = .025) and feeling anxious or worried (P = .008). By 1 month, only feeling anxious or worried (P = .010) differed. CONCLUSION Effective self-care strategies to manage the adverse effects of chemotherapy should be evidence based but individualized, as our findings suggest; for some, focusing on their symptoms may not always be beneficial. IMPLICATIONS FOR PRACTICE Providing patients with pathways to information as needed may be preferable to administering multiple EBGs.
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Labrecque M, Cauchon M. Is evidence-based medicine overrated in family medicine?: No. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2013; 59:1162-1163. [PMID: 24235186 PMCID: PMC3828089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Michel Labrecque
- Research Centre, Centre hospitalier universitaire de Québec, Hôpital Saint-François d'Assise, D6-728, 10 de l'Espinay St, Quebec city, QC G1L 3L5.
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de Leon J. Is psychiatry scientific? A letter to a 21st century psychiatry resident. Psychiatry Investig 2013; 10:205-17. [PMID: 24302942 PMCID: PMC3843011 DOI: 10.4306/pi.2013.10.3.205] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 06/14/2013] [Accepted: 06/14/2013] [Indexed: 11/30/2022] Open
Abstract
During the development of the DSM-5, even the lay press questioned psychiatr's scientific validity. This review provides 21st century psychiatry residents with ways of answering these attacks by defining the concepts and history of psychiatry (a branch of medicine), medicine and science. Psychiatric language has two levels: first, describing symptoms and signs (19th century descriptive psychopathology developed in France and Germany), and second, describing disorders (psychiatric nosology was developed in the early 20th century by Kraepelin and resuscitated by the US neo-Kraepelinian revolution leading to the DSM-III). Science is a complex trial-and-error historical process that can be threatened by those who believe too much in it and disregard its limitations. The most important psychiatric advances, electroconvulsive therapy and major psychopharmacological agents, were discovered by "chance", not by scientific planning. Jaspers's General Psychopathology is a complex 100-year-old book that describes: 1) psychiatric disorders as heterogeneous and 2) psychiatry as a hybrid scientific discipline requiring a combination of understanding (a social science method) and explanation (a natural science method). In the 21st century Berrios reminds us of psychiatry's unfortunate methodological issues due to hybrid symptoms and disorders, some of which are better understood as problems in communication between interacting human beings; in those situations neuroscience methods such as brain imaging make no sense. A new language is needed in psychiatry. East Asian psychiatry residents, who are not particularly attached to the antiquated language currently used, may be particularly equipped for the task of recreating psychiatric language using 21st century knowledge.
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Affiliation(s)
- Jose de Leon
- University of Kentucky Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
- Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain
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MANAVI S, OLYAEE MANESH A, YAZDANI S, SHAMS L, NASIRI T, SHIRVANI A, EMAMI RAZAVI H. Model for implementing evidence based health care system in iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2013; 42:758-66. [PMID: 24427754 PMCID: PMC3881621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 06/22/2013] [Indexed: 11/04/2022]
Abstract
BACKGROUND Regarding the role and importance of paradigm of evidence based practice and its remarkable impact on the effectiveness and efficiency of clinical services and healthcare, development of an integrated system seems necessary in order to manage dispersed data and ensure using evidence in clinical decision making, thus the aim of this study was designing a model for implementing national system of evidence based health care in Iran. METHODOS THIS PAPER IS A STUDY OF COMPARATIVE TYPE WHICH HAS BEEN WRITTEN IN THREE STAGES: investigation of structure and process of evidence based practice in selected countries, investigation and analysis of current status in Iran in this regard and recommendation of strategies which make model implementation feasible in the country. Such methods as review of literature, focus group discussion and Delphi technique were used for investigation. RESULTS According to studies, insuring an evidence based practice culture in the country requires a system called National Evidence Based Health Care System which consists of three subsystems including national system of clinical knowledge management, national evidence-based practice system and integrated national network of clinical effectiveness. CONCLUSION The ultimate goal of health care system in every country is maintaining and improving community health. Achievement of this goal depends on effectiveness of delivered services and consistency of the services with national and local priorities. In order to achieve clinical effectiveness, the best practice should be realized in the country, implementation of which requires a set of macro and micro strategies enabling facilitation, promotion or guaranteeing clinical knowledge application in the country.
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Affiliation(s)
- Saeed MANAVI
- Dept. of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | - Alireza OLYAEE MANESH
- Dept. of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran
- Dept. of Payment and Financing of Health System, National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram YAZDANI
- School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Lida SHAMS
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Taha NASIRI
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Armin SHIRVANI
- Dept. of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | - Hasan EMAMI RAZAVI
- Dept. of Payment and Financing of Health System, National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
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Mühlhauser I, Meyer G. Evidence base in guideline generation in diabetes. Diabetologia 2013; 56:1201-9. [PMID: 23475367 DOI: 10.1007/s00125-013-2872-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 01/23/2013] [Indexed: 10/27/2022]
Abstract
During recent years much emphasis has been on the validity, reliability, reproducibility, clinical applicability, clarity, multidisciplinary process, scheduled review and documentation of clinical practice guidelines (CPGs). Still, CPGs show substantial variance in methodological quality. The present paper mainly focuses on two aspects that are particularly critical and contemporary from the perspective of evidence-based medicine: patient centredness and shared decision making, and conflict of interest. Sophisticated patient and consumer involvement at all stages of CPG development could be judged as being the gold standard. However, co-opting patients or consumer representatives and using other techniques of active patient involvement does not replace individual patient preferences in clinical decision-making processes. Current CPGs do not meet patient needs, since they do not provide concise, easy-to-read summaries of the benefits and risks of medicines together with more comprehensive scientific data as a prerequisite for informed or shared decision making. The vast majority of CPG panels have a financial conflict of interest (COI) and under-reporting is common. Not all organisations producing CPGs have set up COI policies, and existing policies vary widely. To solve the problem, CPG experts have recommended that methodologists without any important COI should lead the development process and have primary responsibility. There is a lot of room for other improvements through network transnational activities in the field of CPG development. Waste of time and resources should be avoided through sharing published and unpublished data identified, appraised and extracted for guideline development. The EASD could provide such a clearing house.
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Affiliation(s)
- I Mühlhauser
- Unit of Health Sciences and Education, University of Hamburg, Martin-Luther-King Platz 6, 20146, Hamburg, Germany.
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Lange T. Evidence‐based HRM: a scholarship perspective with a difference. EVIDENCE-BASED HRM: A GLOBAL FORUM FOR EMPIRICAL SCHOLARSHIP 2013. [DOI: 10.1108/20493981311318584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to provide an introduction to the new journal, its inspirations, scope and ambitions.Design/methodology/approachThe paper reviews selected strands of the literature on evidence‐based scholarship and discusses some of the observations and remedial recommendations made in the literature to bring research, policy and practice closer together.FindingsDrawing on these observations and recommendations, the paper highlights the roles our authors and their published works can play when contributing to an evidence‐based HR research agenda. Building on these insights, the paper arrives at the journal's editorial vision and encourages the production of scholarly empirical research articles that have a high impact on the HR field as a whole. Embracing the richness of contributions from multiple disciplines and supporting a thematic diversity in the international HR arena, the paper introduces and explains the core principles EBHRM strives to encourage and promote: empirical robustness, analytical rigour and practical significance.Originality/valueIn the spirit of these arguments, the paper makes the case for taking on the challenge of moving scholarship, policy and practice closer together and introduces the first contributions.
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Biondi-Zoccai G, Peruzzi M, Frati G. Commentary: Which Do You Like Better…aBowl of Cheeriosor aBig Mac? Pros and Cons of Meta-Analyses in Endovascular Research. J Endovasc Ther 2013; 20:145-8. [PMID: 23581753 DOI: 10.1583/1545-1550-20.2.145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Hoffer LJ, Bistrian BR. Why critically ill patients are protein deprived. JPEN J Parenter Enteral Nutr 2013; 37:300-9. [PMID: 23459750 DOI: 10.1177/0148607113478192] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Critical illness dramatically increases muscle proteolysis and more than doubles the dietary protein requirement. Yet surprisingly, most critically ill patients receive less than half the recommended amount of protein during their stay in a modern intensive care unit. What could explain the wide gap between the recommendations in clinical care guidelines and actual clinical practice? We suggest that an important aspect of the problem is the failure of guidelines to explain the pathophysiology of protein-energy malnutrition and the ways critical illness modifies protein metabolism. The difficulty created by the lack of a framework for reasoning about appropriate protein provision in critical illness is compounded by the many ambiguous and often contradictory ways the word malnutrition is used in the critical care literature. Failing to elucidate these matters, the recommendations for protein provision in the guidelines are incoherent, unconvincing, and easy to ignore.
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Affiliation(s)
- L John Hoffer
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
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Jiang L, Yang KH, Guan QL, Cao N, Chen Y, Zhao P, Chen YL, Yao L. Laparoscopy-assisted gastrectomy versus open gastrectomy for resectable gastric cancer: an update meta-analysis based on randomized controlled trials. Surg Endosc 2013; 27:2466-80. [PMID: 23361259 DOI: 10.1007/s00464-012-2758-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/12/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND We carry out a meta-analysis to evaluate the effectiveness and safety of laparoscopy-assisted gastrectomy (LAG) versus open gastrectomy for resectable gastric cancer. METHODS We searched EMBASE, the Cochrane Library, PubMed, Science Citation Index (SCI), Chinese biomedicine literature database to identify randomized controlled trials (RCTs) from their inception to April 2012. Meta-analyses were performed using RevMan 5.0 software. It was in line with the preferred reporting items for systematic reviews and meta-analyses statement. The quality of evidence was assessed by GRADEpro 3.6. RESULTS Eight RCTs totaling 784 patients were analyzed. Compared with open gastrectomy group, no significant differences were found in postoperative mortality (OR = 1.49; 95 % CI 0.29-7.79), anastomotic leakage (OR = 1.02; 95 % CI 0.24-4.27) , overall mean number of harvested lymph nodes [weighed mean difference (MD) = -3.17; 95 % CI -6.39 to 0.05]; the overall postoperative complication morbidity (OR = 0.54; 95 % CI 0.36-0.82), estimated blood loss (MD = -107.23; 95 % CI -148.56 to -65.89,) frequency of analgesic administration (MD = -1.69; 95 % CI -2.18 to -1.21, P < 0.00001), incidence of pulmonary complications (OR = 0.43, 95 % CI 0.20-0.93, P = 0.03) were significantly less in LAG group; LAG had shorter time to start first flatus (MD = -0.23; 95 % CI -0.41 to -0.05) and decreased hospital stay (MD = -1.72; 95 % CI -3.40 to 0.04), but, LAG still had longer operation time (MD = 76.70; 95 % CI 51.54-101.87). CONCLUSIONS On the basis of this meta-analysis we conclude that although LAG was still a time-consuming and technically dependent procedure, it has the advantage of better short-term outcome. Long term survival data from other studies are urgently needed to estimate the survival benefit of this technique.
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Affiliation(s)
- Lei Jiang
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 199 Dong Gang Road, Cheng Guan District, Lanzhou 730000, Gansu, China
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Barghouti FF, Yassein NA, Jaber RM, Khader NJ, Al Shokhaibi S, Almohtaseb A, AbuRmaileh N. Short course in evidence-based medicine improves knowledge and skills of undergraduate medical students: a before-and-after study. TEACHING AND LEARNING IN MEDICINE 2013; 25:191-4. [PMID: 23848323 DOI: 10.1080/10401334.2013.797348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Providing evidence-based care is recognized as a key skill for health care workers from diverse professions and cultures. PURPOSE We aimed to assess the effectiveness of a short course in evidence-based medicine (EBM) to change the knowledge and skills of undergraduate medical students and point to possible incorporation of EBM in their curriculum. METHODS This is a before-and-after study that was evaluated by the Fresno questionnaire. A 2-week short course of lectures, seminars, online search, and answering worksheets was conducted on 54 fifth-year medical students rotating through the family medicine department at Jordan University Hospital from September 1 until mid-December 2011. RESULTS The students achieved a mean score of 26.7 out of 200 in the pretest and 119.5 in the posttest. The mean difference between the pre- and posttests was 92.8, a statistically significant result with a 95% confidence interval of 84.7, 101.0 (p<.0001) with an effect size of 4.2 standard deviation units. CONCLUSIONS A short course in EBM will significantly improve the skills and knowledge of undergraduate medical students.
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Affiliation(s)
- Farihan F Barghouti
- Department of Community and Family Medicine, Jordan University, Amman, Jordan.
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Abstract
The issue of how to incorporate the individual's first-hand experience of illness into broader medical understanding is a major question in medical theory and practice. In a philosophical context, phenomenology, with its emphasis on the subject's perception of phenomena as the basis for knowledge and its questioning of naturalism, seems an obvious candidate for addressing these issues. This is a review of current phenomenological approaches to medicine, looking at what has motivated this philosophical approach, the main problems it faces and suggesting how it might become a useful philosophical tool within medicine, with its own individual, but interrelated, contribution to make to current medical debates. After the general background, there is a brief summary of phenomenological ideas and their current usage in a medical context. Next is a critique of four key claims within current phenomenological medical works, concerning both the role phenomenology plays and the supposedly clear divide between phenomenology and other approaches. There are significant problems within these claims, largely because they overlook the complexity of the questions they consider. Finally, there is some more in-depth examination of phenomenology itself and the true complexity of phenomenological debate concerning subjectivity. The aim is to show that it will be both more productive and truer to phenomenology itself, if we use phenomenology as a philosophical method for explicating and gaining deeper understanding of complex and fundamental problems, which are central to medicine, rather than as providing simple, but flawed solutions.
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Affiliation(s)
- Tania L Gergel
- Centre for Humanities and Health, King's College London, London, UK.
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Lefebvre R, Peterson D, Haas M. Evidence-Based Practice and Chiropractic Care. J Evid Based Complementary Altern Med 2012; 18:75-79. [PMID: 23875117 DOI: 10.1177/2156587212458435] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Evidence-based practice has had a growing impact on chiropractic education and the delivery of chiropractic care. For evidence-based practice to penetrate and transform a profession, the penetration must occur at 2 levels. One level is the degree to which individual practitioners possess the willingness and basic skills to search and assess the literature. Chiropractic education received a significant boost in this realm in 2005 when the National Center for Complementary and Alternative Medicine awarded 4 chiropractic institutions R25 education grants to strengthen their research/evidence-based practice curricula. The second level relates to whether the therapeutic interventions commonly employed by a particular health care discipline are supported by clinical research. A growing body of randomized controlled trials provides evidence of the effectiveness and safety of manual therapies.
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Wüsthoff LE, Waal H, Gråwe RW. When research meets reality-lessons learned from a pragmatic multisite group-randomized clinical trial on psychosocial interventions in the psychiatric and addiction field. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2012; 6:95-106. [PMID: 22933843 PMCID: PMC3427035 DOI: 10.4137/sart.s9245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Research on treatments for patients with co-occurring psychiatric and substance use disorders is of core importance and at the same time highly challenging as it includes patients that are normally excluded from clinical studies. Such research may require methodological adaptations which in turn create new challenges. However, the challenges that arise in such studies are insufficiently discussed in the literature. The aim of this methodology paper is, firstly, to discuss the methodological adaptations that may be required in such research; secondly, to describe how such adaptations created new challenges in a group-randomized clinical trial on Integrated Treatment amongst patients with co-occurring psychiatric and substance use disorders. We also discuss how these challenges might be understood and highlight lessons for future research in this field. TRIAL REGISTRATION NCT00447733.
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Affiliation(s)
- Linda E Wüsthoff
- Norwegian Center for Addiction Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Ross S, Milne J, Dwinnell S, Tang S, Wood S. Is it possible to estimate the minimal clinically important treatment effect needed to change practice in preterm birth prevention? Results of an obstetrician survey used to support the design of a trial. BMC Med Res Methodol 2012; 12:31. [PMID: 22429514 PMCID: PMC3364141 DOI: 10.1186/1471-2288-12-31] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 03/19/2012] [Indexed: 11/21/2022] Open
Abstract
Background Sample sizes for obstetrical trials are often based on the opinion of investigators about clinically important effect size. We surveyed Canadian obstetricians to investigate clinically important effect sizes required before introducing new treatments into practice to prevent preterm birth. Methods Questionnaires were mailed to practicing obstetricians, asking the magnitude of pregnancy prolongation required to introduce treatments into practice. The three prophylactic treatments were of increasing invasiveness: vaginal progesterone, intramuscular progesterone, and cervical cerclage. We also asked about the perceived most relevant outcome measures for obstetrical trials and current obstetrical practice in preterm birth prevention. Results 544/1293(42.1%) completed questionnaires were received. The majority of respondents required one or two weeks' increase in length of gestation before introducing vaginal (372,77.1%), and intramuscular progesterone(354,67.9%). At least three weeks increase was required before introducing prophylactic cervical cerclage(326,62.8%). Clinicians who already used a treatment required a smaller difference before introducing it into practice. Decreasing neonatal morbidity was cited as the most important outcome for obstetrical trials (349,72.2%). Conclusion Obstetricians would require a larger increase in treatment effect before introducing more invasive treatments into practice. Although infant morbidity was perceived as a more important outcome, clinicians appeared willing to change practice on the basis of prolongation of pregnancy, a surrogate outcome. We found that there is not a single minimum clinically important treatment effect that will influence all practising clinicians: rather the effect size that will influence physicians is affected by the nature of the treatment, the reported outcome measure and the clinician's own current clinical practice.
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Affiliation(s)
- Sue Ross
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Canada.
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Using MeSH (medical subject headings) to enhance PubMed search strategies for evidence-based practice in physical therapy. Phys Ther 2012; 92:124-32. [PMID: 21979271 DOI: 10.2522/ptj.20100178] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evidence-based practice (EBP) is an important paradigm in health care. Physical therapists report lack of knowledge and time constraints as barriers to EBP. OBJECTIVE The purpose of this technical report is to illustrate how Medical Subject Headings (MeSH), a controlled vocabulary thesaurus of indexing terms, is used to efficiently search MEDLINE, the largest component of PubMed. Using clinical questions, this report illustrates how search terms common to physical therapist practice do or do not map to appropriate MeSH terms. A PubMed search strategy that takes advantage of text words and MeSH terms is provided. RESULTS A search of 139 terms and 13 acronyms was conducted to determine whether they appropriately mapped to a MeSH term. The search results were categorized into 1 of 5 outcomes. Nearly half (66/139) of the search terms mapped to an appropriate MeSH term (outcome 1). When a search term did not appropriately map to a MeSH term, it was entered into the MeSH database to search for an appropriate MeSH term. Twenty-one appropriate MeSH terms were found (outcomes 2 and 4), and there were 52 search terms for which an appropriate MeSH term was not found (outcomes 3 and 5). Nearly half of the acronyms did not map to an appropriate MeSH term, and an appropriate MeSH term was not found in the database. LIMITATIONS The results are based on a limited number of search terms and acronyms. CONCLUSIONS Understanding how search terms map to MeSH terms and using the PubMed search strategy can enable physical therapists to take full advantage of available MeSH terms and should result in more-efficient and better-informed searches.
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Allen NE, Sherrington C, Suriyarachchi GD, Paul SS, Song J, Canning CG. Exercise and motor training in people with Parkinson's disease: a systematic review of participant characteristics, intervention delivery, retention rates, adherence, and adverse events in clinical trials. PARKINSON'S DISEASE 2011; 2012:854328. [PMID: 22191077 PMCID: PMC3236465 DOI: 10.1155/2012/854328] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 08/18/2011] [Indexed: 01/29/2023]
Abstract
There is research evidence that exercise and motor training are beneficial for people with Parkinson's disease (PD), and clinicians seek to implement optimal programs. This paper summarizes important factors about the nature and reporting of randomized controlled trials of exercise and/or motor training for people with PD which are likely to influence the translation of research into clinical practice. Searches identified 53 relevant trials with 90 interventions conducted for an average duration of 8.3 (SD 4.2) weeks. Most interventions were fully supervised (74%) and conducted at a facility (79%). Retention rates were high with 69% of interventions retaining ≥85% of their participants; however adherence was infrequently reported, and 72% of trials did not report adverse events. Overall, the labor-intensive nature of most interventions tested in these trials and the sparse reporting of adherence and adverse events are likely to pose difficulties for therapists attempting to balance benefits and costs when selecting protocols that translate to sustainable clinical practice for people with PD.
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Affiliation(s)
- Natalie E. Allen
- Clinical and Rehabilitation Research Group, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, Sydney, NSW 1825, Australia
| | - Catherine Sherrington
- Musculoskeletal Division, The George Institute for Global Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Gayanthi D. Suriyarachchi
- Clinical and Rehabilitation Research Group, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, Sydney, NSW 1825, Australia
| | - Serene S. Paul
- Clinical and Rehabilitation Research Group, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, Sydney, NSW 1825, Australia
| | - Jooeun Song
- Clinical and Rehabilitation Research Group, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, Sydney, NSW 1825, Australia
| | - Colleen G. Canning
- Clinical and Rehabilitation Research Group, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, Sydney, NSW 1825, Australia
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Strøm A, Kvernbekk T, Fagermoen MS. Parity: (im) possible? Interplay of knowledge forms in patient education. Nurs Inq 2011; 18:94-101. [PMID: 21564390 DOI: 10.1111/j.1440-1800.2011.00517.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A central purpose is to examine the kind of knowledge that patient experience represents; its origin, properties and tenability. We will use the term insider knowledge to designate the knowledge, beliefs and viewpoints constructed by patients about their own illnesses and predicaments more generally. It is our contention that an analysis of insider knowledge is necessary if the value of such knowledge for patient education is to be reasonably assessed. We discuss the epistemological status of professional knowledge and insider knowledge and what it might mean to afford them parity. Basically, we argue that patient-oriented programmes must give insider knowledge a status that acknowledges its privileged access to the insider's own intentions, perceptions, evaluations, decisions, reasons, notions and feelings, and thus yields distinctive insight into these areas. At the same time, patient education will be stunted if the fallibility of such knowledge is not openly addressed.
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Affiliation(s)
- Anita Strøm
- Norwegian Centre for Patient Education, Research and Service Development, Oslo University Hospital, Oslo, Norway.
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Maguire JL, Kulik DM, Laupacis A, Kuppermann N, Uleryk EM, Parkin PC. Clinical prediction rules for children: a systematic review. Pediatrics 2011; 128:e666-77. [PMID: 21859912 DOI: 10.1542/peds.2011-0043] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The degree to which clinical prediction rules (CPRs) for children meet published standards is unclear. OBJECTIVE To systematically review the quality, performance, and validation of published CPRs for children, compare them with adult CPRs, and suggest pediatric-specific changes to CPR methodology. METHODS Medline was searched from 1950 to 2011. Studies were selected if they included the development of a CPR involving children younger than 18 years. Two investigators assessed study quality, rule performance, and rule validation as methodologic standards. RESULTS Of 7298 titles and abstracts assessed, 137 eligible studies were identified. They describe the development of 101 CPRs addressing 36 pediatric conditions. Quality standards met in fewer than half of the studies were blind assessment of predictors (47%), reproducibility of predictors (18%), blind assessment of outcomes (42%), adequate follow-up of outcomes (36%), adequate power (43%), adequate reporting of results (49%), and 95% confidence intervals reported (36%). For rule performance, 48% had a sensitivity greater than 0.95, and 43% had a negative likelihood ratio less than 0.1. For rule validation, 76% had no validation, 17% had narrow validation, 8% had broad validation, and none had impact analysis performed. Compared with CPRs for adult health conditions, quality and rule validation seem to be lower. CONCLUSIONS Many CPRs have been derived for children, but few have been validated. Relative to adult CPRs, several quality indicators demonstrated weaknesses. Existing performance standards may prove elusive for CPRs that involve children. CPRs for children that are more assistive and less directive and include patients' values and preferences in decision-making may be helpful.
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Affiliation(s)
- Jonathon L Maguire
- Department of Pediatrics, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
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Khader YS, Batayha W, Al-Omari M. The effect of evidence-based medicine (EBM) training seminars on the knowledge and attitudes of medical students towards EBM. J Eval Clin Pract 2011; 17:640-3. [PMID: 21114803 DOI: 10.1111/j.1365-2753.2010.01604.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is debate about the most effective method for teaching evidence-based medicine (EBM) in medical schools. This study was conducted to evaluate the effect of integration of EBM training seminars into the curriculum of the community medicine course in changing the knowledge and attitudes of the fourth year medical students towards EBM. METHODS This is a quasi-experimental study conducted on the fourth year medical students who joined the community medicine mandatory summer course at Jordan University of Science and Technology in the period between July 1 and August 31, 2008. We measured medical students' self-reported attitudes about and knowledge of EBM before the integration of EBM seminars into the community medicine course and at the end of course. RESULTS A high proportion of students had positive attitude towards EBM before and after the course. After the course, the vast majority (91.8%) became aware of the presence of guidelines and protocols for diseases compared with 59.0% who were aware of that before (P < 0.005). Only small proportion of students reported that they understand and able to explain the common epidemiological concepts that are used in EBM before the training. After the training, a significantly higher proportion of students reported understanding the epidemiological concepts. CONCLUSION Integration of EBM training course into community course for the fourth year students improved their EBM knowledge. Longitudinal studies are needed to evaluate the long-term effects of EBM curriculum in changing behaviours, practice patterns and patient care outcome.
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Affiliation(s)
- Yousef S Khader
- Faculty of Medicine, Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan.
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