The practice of evidence-based medicine (EBM) in gastroenterology: discrepancies between EBM familiarity and EBM competency

Internet-Specific Epistemic Beliefs in Medicine and Intention to Use Evidence-Based Online Medical Databases Among Health Care Professionals: Cross-sectional Survey

Background

Evidence-based medicine has been regarded as a prerequisite for ensuring health care quality. The increase in health care professionals’ adoption of web-based medical information and the lack of awareness of alternative access to evidence-based online resources suggest the need for an investigation of their information-searching behaviors of using evidence-based online medical databases.

Objective

The main purposes of this study were to (1) modify and validate the internet-specific epistemic beliefs in medicine (ISEBM) questionnaire and (2) explore the associations between health care professionals’ demographics, ISEBM, and intention to use evidence-based online medical databases for clinical practice.

Methods

Health care professionals in a university-affiliated teaching hospital were surveyed using the ISEBM questionnaire. The partial least squares-structural equation modeling was conducted to analyze the reliability and validity of ISEBM. Furthermore, the structural model was analyzed to examine the possible linkages between health professionals’ demographics, ISEBM, and intention to utilize the evidence-based online medical databases for clinical practice.

Results

A total of 273 health care professionals with clinical working experience were surveyed. The results of the measurement model analysis indicated that all items had significant loadings ranging from 0.71 to 0.92 with satisfactory composite reliability values ranging from 0.87 to 0.94 and average variance explained values ranging from 0.70 to 0.84. The results of the structural relationship analysis revealed that the source of internet-based medical knowledge (path coefficient –0.26, P=.01) and justification of internet-based knowing in medicine (path coefficient 0.21, P=.001) were correlated with the intention to use evidence-based online medical databases. However, certainty and simplicity of internet-based medical knowledge were not. In addition, gender (path coefficient 0.12, P=.04) and academic degree (path coefficient 0.15, P=.004) were associated with intention to use evidence-based online medical databases for clinical practice.

Conclusions

Advancing health care professionals’ ISEBM regarding source and justification may encourage them to retrieve valid medical information through evidence-based medical databases. Moreover, providing support for specific health care professionals (ie, females, without a master’s degree) may promote their intention to use certain databases for clinical practice.

Evidence-based medicine, shared decision making and the hidden curriculum: a qualitative content analysis

INTRODUCTION

Medical education should portray evidence-based medicine (EBM) and shared decision making (SDM) as central to patient care. However, misconceptions regarding EBM and SDM are common in clinical practice, and these biases might unintentionally be transmitted to medical trainees through a hidden curriculum. The current study explores how assumptions of EBM and SDM can be hidden in formal curriculum material such as PowerPoint slides.

METHODS

We conducted a qualitative content analysis using a purposive sample of 18 PowerPoints on the management of upper respiratory tract infections. We identified concepts pertaining to decision making using theory-driven codes taken from the fields of EBM and SDM. We then re-analyzed the coded text using a constructivist latent thematic approach to develop a rich description of conceptualizations of decision making in relation to EBM and SDM frameworks.

RESULTS

PowerPoint slides can relay a hidden curriculum, which can normalize: pathophysiological reasoning, unexplained variations in clinical care, the use of EBM mimics, defensive medicine, an unrealistic portrayal of benefits, and paternalism.

DISCUSSION

Addressing the hidden curriculum in formal curricular material should be explored as a novel strategy to foster a positive attitude towards EBM and SDM and to improve patient outcomes by encouraging the use of these skills.

Quality assessment of systematic reviews and meta-analyses published in Saudi journals from 1997 to 2017

Objectives:

To assess the quality of the meta-analyses (MAs) and systematic reviews (SRs) in Saudi journals indexed in PubMed using 2 scales: A MeaSurement tool to assess systematic reviews (AMSTAR) and the overview quality assessment questionnaire (OQAQ).

Methods:

This study focused on SRs/MAs published in 8 Saudi journals. We investigated, screened, and extracted the data, which included recording the main topic of each SRs/MAs and the date of publication. Furthermore, we assessed the quality of each included SRs/MAs using the AMSTAR and the OQAQ. The reviews concluded in January 2018.

Results:

The search uncovered 201 unique articles; of these, the researchers screened 110 full texts and included 103 in this review. Most of the included studies were published in Saudi Medical Journal (50 articles, 48.5%), followed by Saudi Journal of Gastroenterology (21 articles, 20.4%), and Annals of Saudi Medicine (16 articles, 15.5%). The main topics in these published articles were gastroenterology (20 articles, 19.5%), followed by oncology (14 articles, 13.7%), and pharmacology (9 articles, 8.7%). The AMSTAR and the OQAQ scales showed that most SRs/MAs were of medium quality.

Conclusion:

Quality of SRs and MAs published in Saudi journals was distributed in all categories (low, medium, and high) and it can be improved using critical evaluation by authors, journal editors, and readers.

PROSPERO REG. NO. CRD: 42018102210

Clinicians' self-perceived competency in evidence-based practice at Zagazig University Hospitals, Egypt

BACKGROUND AND AIM

Evidence-based medical practice has gained worldwide attention and is an emerging must-know topic for today's physicians. Yet, it continues to puzzle physicians either in its understanding or in its practice, and gaps continue to exist between research-based evidence and clinical practice. This study aimed to evaluate the self perceived EBM competency of the clinicians and staff of Zagazig University Hospital.

STUDY DESIGN AND PARTICIPANTS

A cross-sectional study was carried out on a sample of 184 clinicians during the period of March-July 2012 at five randomly chosen special medicine departments (tropical medicine, rheumatology, neurology, dermatology, and hematology-oncology) using a self-administered, specifically tailored questionnaire.

RESULTS

Sampled clinicians were dichotomized according to their self-reported frequency of evidence-based practice into evidence-based medicine (EBM) nonusers (62.5%) and EBM users (37.5%). There was no significant difference between users and nonusers in total mean scores (21.37±1.86 vs. 21.34±2.2, P=0.119). Users had significantly higher mean score for self-perceived EBM competency compared with nonusers (P=0.000), although both users and nonusers had unsatisfactory mean score for EBM competency (38.33±2.87 vs. 32.96±3.026, respectively) (median, 39 vs. 33, respectively). Users of EBM had a significantly higher score in competencies related to the use of a bibliographic database, understanding of methodological terminology, confidence in their skills in EBM steps, and consequently in cumulative EBM competency (P=0.000).

CONCLUSION AND RECOMMENDATIONS

Our findings support some important facts: first, there is discrepancy between clinicians' perceptions and their competency, as they considered themselves practicing EBM although they were not; second, strategies to promote a change in clinical practice are more likely to be successful if they are based on an analysis of problems. All findings in this study highlighted the importance of training in EBM.

Quality of gastroenterology research published in Saudi Arabian scientific journals

BACKGROUND/AIMS

Evidence-based medicine has established itself in the field of gastroenterology. In this study we aim to assess the types of study designs of gastroenterology-related articles published in Saudi scientific journals.

PATIENTS AND METHODS

An online review using PubMed was carried out to review gastroenterology-related articles published in six Saudi medical journals in the time interval from 2003 to 2012. To classify the level of evidence in these articles we employed the Oxford's levels of evidence. One-way analysis of variance was used to compare the levels of evidence between published articles.

RESULTS

A total of 721 gastroenterology-related articles were reviewed, of which 591 articles met our inclusion criteria; 80.7% were level IV. The three most common types of studies we encountered were cross-sectional (33.9%), case reports (27.9%), and case series (18.8%). Forty-three percent of the published research was in the field of hepatobiliary and spleen. The total number of articles increased from 260 articles in the 1 st 5-year period (2003-2007) to 330 in the 2 nd period (2008-2012). However, no statistically significant difference in the level of evidence was noted. In Annals of Saudi Medicine Journal, articles with level II increased from 0 to 10% with a P value 0.02.

CONCLUSION

In our review of gastroenterology-related published articles in Saudi scientific journals, we observed an increase in the quantity of articles with the quality and level of evidence remaining unchanged. Further research is recommended to explore different reasons affecting the volume and quality of gastroenterology-related research in Saudi scientific journals.

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

Objectives

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

Design

Questionnaire study.

Setting

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

Participants

All obstetrics and gynaecology trainees in East Midland South Deanery.

Main outcome measures

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

Results

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

Conclusions

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

Attitudes toward evidence-based clinical practice among doctors of chiropractic with diplomate-level training in orthopedics

Background

Evidence-based clinical practice (EBCP) is a practice model gaining prominence within healthcare, including the chiropractic profession. The status of EBCP has been evaluated in a variety of healthcare disciplines, but little is known regarding the attitudes doctors of chiropractic (DCs) hold toward this model of healthcare. This project examines the attitudes toward EBCP within a specialty discipline of DCs.

Methods

We identified a survey questionnaire previously used to evaluate EBCP among non-chiropractic complementary and alternative practitioners. We adapted this questionnaire for use among DCs and pretested it in 5 chiropractic college faculty. The final version was administered to DCs with diplomate-level training in orthopedics. The survey was emailed to 299 potential participants; descriptive results were calculated.

Results

144 surveys were returned, resulting in a 48% response rate. The majority of respondents perceived EBCP as an important aspect of chiropractic practice. Respondents also believed themselves to have an above average skill level in EBCP, reported that training originated from their diplomate education, and based the majority of their practice on clinical research.

Conclusion

Doctors of chiropractic with an orthopedic diplomate appear to have favorable attitudes toward EBCP. Further study will help understand EBCP perceptions among general field DCs. A logical next step includes validation of this questionnaire.

Features of effective medical knowledge resources to support point of care learning: a focus group study

OBJECTIVE

Health care professionals access various information sources to quickly answer questions that arise in clinical practice. The features that favorably influence the selection and use of knowledge resources remain unclear. We sought to better understand how clinicians select among the various knowledge resources available to them, and from this to derive a model for an effective knowledge resource.

METHODS

We conducted 11 focus groups at an academic medical center and outlying community sites. We included a purposive sample of 50 primary care and subspecialist internal medicine and family medicine physicians. We transcribed focus group discussions and analyzed these using a constant comparative approach to inductively identify features that influence the selection of knowledge resources.

RESULTS

We identified nine features that influence users' selection of knowledge resources, namely efficiency (with sub-features of comprehensiveness, searchability, and brevity), integration with clinical workflow, credibility, user familiarity, capacity to identify a human expert, reflection of local care processes, optimization for the clinical question (e.g., diagnosis, treatment options, drug side effect), currency, and ability to support patient education. No single existing resource exemplifies all of these features.

CONCLUSION

The influential features identified in this study will inform the development of knowledge resources, and could serve as a framework for future research in this field.