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Nunan D, Lindblad A, Widyahening IS, Bernardo WM, Chi CC, Cowdell F, Becker K, Constantine S, East C, Myrhaug HT, Johnson SG, Jack E, Thompson R, Achilleos H, Berg RC, Snibsøer AK, Puscasiu L, Bartelink MLE, van Peet PG, Berti F, Tilson J, Tikkinen KA, Albarqouni L, Hoegen P. Ten papers for teachers of evidence-based medicine and health care: Sicily workshop 2019. BMJ Evid Based Med 2021; 26:224-227. [PMID: 33172938 DOI: 10.1136/bmjebm-2020-111479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 11/03/2022]
Affiliation(s)
- David Nunan
- Primary Care Health Sciences, University of Oxford, Oxford, UK
- Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
| | - Adrienne Lindblad
- Alberta College of Family Physicians (PEER) and the Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Indah S Widyahening
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Depok, Indonesia
| | | | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Fiona Cowdell
- School of Nursing and Midwifery, Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Karen Becker
- Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Christine East
- School of Nursing and Midwifery & Mercy Health, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Hilde T Myrhaug
- Division For Health Sciences, Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Susanne Grødem Johnson
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Edmund Jack
- Yealm Medical Centre, Yealmton, UK
- PenARC (NIHR) Applied Research Collaboration (ARC) South West Peninsula, Exeter, UK
| | - Rachel Thompson
- Office of Medical Education, University of New South Wales, Sydney, New South Wales, Australia
| | - Haris Achilleos
- Paediatrics, Royal London Hospital Barts Health NHS Trust, London, UK
| | - Rigmor C Berg
- Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Kristin Snibsøer
- Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Lucian Puscasiu
- University of Medicine Pharmacy Science and Technology of Targu Mures, Targu Mures, Romania
| | | | - Petra G van Peet
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Franco Berti
- Gruppo Italiano per la Medicina Basata sulle Evidenze (GIMBE), Bologna, Italy
| | - Julie Tilson
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - Kari Ao Tikkinen
- Departments of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Loai Albarqouni
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Peter Hoegen
- School of Health and Social Care, Avans University of Applied Science, Breda, The Netherlands
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Abstract
OBJECTIVES Suspected transient ischaemic attack (TIA) necessitates an urgent neurological consultation and a rapid start of antiplatelet therapy to reduce the risk of early ischaemic stroke following a TIA. Guidelines for general practitioners (GPs) emphasise the urgency to install preventive treatment as soon as possible. We aimed to give a contemporary overview of both patient and physician delay. METHODS A survey at two rapid-access TIA outpatient clinics in Utrecht, the Netherlands. All patients suspected of TIA were interviewed to assess time delay to diagnosis and treatment, including the time from symptom onset to (1) the first contact with a medical service (patient delay), (2) consultation of the GP and (3) assessment at the TIA outpatient clinic. We used the diagnosis of the consulting neurologist as reference. RESULTS Of 93 included patients, 43 (46.2%) received a definite, 13 (14.0%) a probable, 11 (11.8%) a possible and 26 (28.0%) no diagnosis of TIA. The median time from symptom onset to the visit to the TIA service was 114.5 (IQR 44.0-316.6) hours. Median patient delay was 17.5 (IQR 0.8-66.4) hours, with a delay of more than 24 hours in 36 (38.7%) patients. The GP was first contacted in 76 (81.7%) patients, and median time from first contact with the GP practice to the actual GP consultation was 2.8 (0.5-18.5) hours. Median time from GP consultation to TIA service visit was 40.8 (IQR 23.1-140.7) hours. Of the 62 patients naïve to antithrombotic medication who consulted their GP, 27 (43.5%) received antiplatelet therapy. CONCLUSIONS There is substantial patient and physician delay in the process of getting a confirmed TIA diagnosis, resulting in suboptimal prevention of an early ischaemic stroke.
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Affiliation(s)
- L Servaas Dolmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marie-Louise El Bartelink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Bartelink MLE, Baggen Y, Stevens DE, Smalbrugge M, Scherpbier N, Damoiseaux RA, de Groot E. Facilitators and barriers to brokering between research and care by senior clinical-scientists in general practice and elderly care medicine. Educ Prim Care 2019; 30:80-87. [PMID: 30753793 DOI: 10.1080/14739879.2019.1570349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Clinician-scientists (CSs) are physicians who work in daily care and have an academic role in research or education. They may act as knowledge brokers and help to connect research and clinical practice. There is no data available on CSs' brokering activities and the perceived barriers and facilitators to optimising their role in general practice (GP) and elderly care medicine (EM). AIM To identify the brokering activities of CSs in these fields and the barriers and facilitators they come across whilst sharing knowledge and connecting people in research and frontline health care. DESIGN AND SETTING Qualitative interview study among 17 Dutch senior CSs. METHOD Interview data were audio recorded, transcribed verbatim and thematic interpretative analysis was used to identify themes. RESULTS CSs facilitate collaboration between researchers and practitioners. They exchange knowledge on both sides, make use of extensive networks and constantly and actively involve care in research and research in care. CSs come across barriers as well as facilitators that influence their brokering activities. Some barriers and facilitators are at the individual level, other are related more to the job context and workplace. CONCLUSIONS This study reveals barriers to overcome and facilitators to develop related to the brokering role of CSs. To make the best use of CSs, brokering activities and the added value of CSs should be recognised and supported. Awareness of what CSs need to function effectively in demanding work settings could be important for the future impact of the role on the fields of GP and EM.
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Affiliation(s)
| | - Yvette Baggen
- b Social sciences , Utrecht University , Utrecht , The Netherlands
| | - Diede E Stevens
- b Social sciences , Utrecht University , Utrecht , The Netherlands
| | - Martin Smalbrugge
- c Elderly care medicine , VU Medical Centre , Amsterdam , The Netherlands
| | - Nynke Scherpbier
- d Primary and community care , Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Roger Amj Damoiseaux
- a Julius Centre , University Medical Centre Utrecht, Utrecht University , Utrecht , The Netherlands
| | - Esther de Groot
- a Julius Centre , University Medical Centre Utrecht, Utrecht University , Utrecht , The Netherlands
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Dolmans LS, Rutten FH, El Bartelink ML, Seppenwoolde G, van Delft S, Kappelle LJ, Hoes AW. Serum biomarkers for the early diagnosis of TIA: The MIND-TIA study protocol. BMC Neurol 2015. [PMID: 26215720 PMCID: PMC4517631 DOI: 10.1186/s12883-015-0388-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background A Transient Ischaemic Attack (TIA) bears a high risk of a subsequent ischaemic stroke. Adequate diagnosis of a TIA should be followed immediately by the start of appropriate preventive therapy, including antiplatelets. The diagnosis of a TIA based on symptoms and signs only is notoriously difficult and biomarkers of brain ischaemia might improve the recognition, and target management and prognosis of TIA patients. Our aim is to quantify the added diagnostic value of serum biomarkers of brain ischaemia in patients suspected of TIA. Methods/design Study design: a cross-sectional diagnostic accuracy study with an additional six month follow-up period. Study population: 350 patients suspected of TIA in the primary care setting. Patients suspected of a TIA will be recruited by at least 200 general practitioners (GPs) in the catchment area of seven TIA outpatient clinics willing to participate in the study. In all patients a blood sample will be drawn as soon as possible after the patient has contacted the GP, but at least within 72 h after onset of symptoms. Participants will be referred by the GP to the regional TIA outpatient clinic for additional investigations, including brain imaging. The ‘definite’ diagnosis (reference standard) will be made by a panel consisting of three experienced neurologists who will use all available diagnostic information and the clinical information obtained during the outpatient clinic assessment, and a six month follow-up period. The diagnostic accuracy, and value in addition to signs and symptoms of candidate serum biomarkers will be assessed in terms of discrimination with C statistics, and calibration with plots. We aim to include 350 suspected cases, with 250 patients with indeed definite TIA (or minor stroke) according to the panel. Discussion We hope to find novel biomarkers that will enable a rapid and accurate diagnosis of TIA. This would largely improve the management and prognosis of such patients. Trial registration ClinicalTrials.gov Identifier NCT01954329
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Affiliation(s)
- L Servaas Dolmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Marie-Louise El Bartelink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | - Sanne van Delft
- Saltro Diagnostic Center for Primary Care, Utrecht, The Netherlands.
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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