1
|
Orszulik ST. The quality of antimicrobial susceptibility test discs and implications for clinical outcomes. Diagn Microbiol Infect Dis 2024; 109:116237. [PMID: 38428376 DOI: 10.1016/j.diagmicrobio.2024.116237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
Disc diffusion remains the main technique for evaluating antibiotic activity in clinical microbiology laboratories. However, the assay protocol endorsed by the FDA, DIN, and WHO is invalid. Despite decades of research and practice in this field, the quantitative quality of manufactured discs is largely unknown, potentially leading to adverse clinical outcomes. The usual standards expected for new medical devices in terms of quality control, QA, and evidence-based assessment of outcomes are almost completely lacking. Recent data indicate that a large proportion of discs do not meet the specifications, and that disc diffusion is a poor predictor of clinical outcomes. In addition, lack of harmonisation between EUCAST and CLSI, despite many years of effort, strongly suggests that there are serious flaws in these systems. This area lacks scientific rigour, which may have also contributed to adverse clinical outcomes and the emergence of antimicrobial resistance.
Collapse
Affiliation(s)
- Stefan T Orszulik
- De La Rue Currency, Overton, Basingstoke, Hampshire, United Kingdom.
| |
Collapse
|
2
|
Witte C, Schmidt DM, Cimiano P. Comparing generative and extractive approaches to information extraction from abstracts describing randomized clinical trials. J Biomed Semantics 2024; 15:3. [PMID: 38654304 DOI: 10.1186/s13326-024-00305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Systematic reviews of Randomized Controlled Trials (RCTs) are an important part of the evidence-based medicine paradigm. However, the creation of such systematic reviews by clinical experts is costly as well as time-consuming, and results can get quickly outdated after publication. Most RCTs are structured based on the Patient, Intervention, Comparison, Outcomes (PICO) framework and there exist many approaches which aim to extract PICO elements automatically. The automatic extraction of PICO information from RCTs has the potential to significantly speed up the creation process of systematic reviews and this way also benefit the field of evidence-based medicine. RESULTS Previous work has addressed the extraction of PICO elements as the task of identifying relevant text spans or sentences, but without populating a structured representation of a trial. In contrast, in this work, we treat PICO elements as structured templates with slots to do justice to the complex nature of the information they represent. We present two different approaches to extract this structured information from the abstracts of RCTs. The first approach is an extractive approach based on our previous work that is extended to capture full document representations as well as by a clustering step to infer the number of instances of each template type. The second approach is a generative approach based on a seq2seq model that encodes the abstract describing the RCT and uses a decoder to infer a structured representation of a trial including its arms, treatments, endpoints and outcomes. Both approaches are evaluated with different base models on a manually annotated dataset consisting of RCT abstracts on an existing dataset comprising 211 annotated clinical trial abstracts for Type 2 Diabetes and Glaucoma. For both diseases, the extractive approach (with flan-t5-base) reached the best F 1 score, i.e. 0.547 ( ± 0.006 ) for type 2 diabetes and 0.636 ( ± 0.006 ) for glaucoma. Generally, the F 1 scores were higher for glaucoma than for type 2 diabetes and the standard deviation was higher for the generative approach. CONCLUSION In our experiments, both approaches show promising performance extracting structured PICO information from RCTs, especially considering that most related work focuses on the far easier task of predicting less structured objects. In our experimental results, the extractive approach performs best in both cases, although the lead is greater for glaucoma than for type 2 diabetes. For future work, it remains to be investigated how the base model size affects the performance of both approaches in comparison. Although the extractive approach currently leaves more room for direct improvements, the generative approach might benefit from larger models.
Collapse
Affiliation(s)
- Christian Witte
- Semantic Computing Group, Center for Cognitive Interaction Technology, Bielefeld University, Inspiration 1, Bielefeld, 33619, NRW, Germany
| | - David M Schmidt
- Semantic Computing Group, Center for Cognitive Interaction Technology, Bielefeld University, Inspiration 1, Bielefeld, 33619, NRW, Germany.
| | - Philipp Cimiano
- Semantic Computing Group, Center for Cognitive Interaction Technology, Bielefeld University, Inspiration 1, Bielefeld, 33619, NRW, Germany
| |
Collapse
|
3
|
Rhodes S, Dodd S, Deckert S, Vasanthan L, Qiu R, Rohde JF, Florez ID, Schmitt J, Nieuwlaat R, Kirkham J, Williamson PR. Representation of published core outcome sets in practice guidelines. J Clin Epidemiol 2024; 169:111311. [PMID: 38423401 DOI: 10.1016/j.jclinepi.2024.111311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/14/2023] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES A core outcome set (COS) is an agreed standardized set of outcomes that should be measured and reported, as a minimum, in specific areas of health or health care. A COS is developed through a consensus process to ensure health care outcomes to be measured are relevant to decision-makers, including patients and health-care professionals. Use of COS in guideline development is likely to increase the relevance of the guideline to those decision-makers. Previous work has looked at the uptake of COS in trials, systematic reviews, health technology assessments and regulatory guidance but to date there has been no evaluation of the use of COS in practice guideline development. The objective of this study was to investigate the representation of core outcomes in a set of international practice guidelines. STUDY DESIGN AND SETTING We searched for clinical guidelines relevant to ten high-quality COS (with focus on the United Kingdom, Germany, China, India, Canada, Denmark, United States and World Health Organisation). We matched scope between COS and guideline in terms of condition, population and outcome. We calculated the proportion of guidelines mentioning or referencing COS and the proportion of COS domains specifically, or generally, matching to outcomes specified in each guideline populations, interventions, comparators and outcome (PICO) statement. RESULTS We found 38 guidelines that contained 170 PICO statements matching the scope of the ten COS and of sufficient quality to allow data extraction. None of the guidelines reviewed explicitly mentioned or referenced the relevant COS. The median (range) of the proportion of core outcomes covered either specifically or generally by the guideline PICO was 30% (0%-100%). CONCLUSION There is no evidence that COS are being used routinely to inform the guideline development process, and concordance between outcomes in published guidelines and those in COS is limited. Further work is warranted to explore barriers and facilitators in the use of COS when developing clinical guidelines.
Collapse
Affiliation(s)
- Sarah Rhodes
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Susanna Dodd
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, L63 3GL, UK
| | - Stefanie Deckert
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Lenny Vasanthan
- Physiotherapy Unit, Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, India; Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Ruijin Qiu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
| | - Jeanett Friis Rohde
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000, Frederiksberg, Denmark; The Danish Health Authority, Department of Evidence-Based Medicine, Islands Brygge 67, 2300, Copenhagen, Denmark
| | - Ivan D Florez
- Department of Pediatrics, University of Antioquia, Medellin, Colombia; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Pediatric Intensive Care Unit, Clínica Las Américas-AUNA, Medellín, Antioquia, Colombia
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jamie Kirkham
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Paula R Williamson
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, L63 3GL, UK
| |
Collapse
|
4
|
Cabibbo G, Daniele B, Borzio M, Casadei-Gardini A, Cillo U, Colli A, Conforti M, Dadduzio V, Dionisi F, Farinati F, Gardini I, Giannini EG, Golfieri R, Guido M, Mega A, Minozzi S, Piscaglia F, Rimassa L, Romanini L, Pecorelli A, Sacco R, Scorsetti M, Viganò L, Vitale A, Trevisani F. Multidisciplinary Treatment of Hepatocellular Carcinoma in 2023: Italian practice Treatment Guidelines of the Italian Association for the Study of the Liver (AISF), Italian Association of Medical Oncology (AIOM), Italian Association of Hepato-Bilio-Pancreatic Surgery (AICEP), Italian Association of Hospital Gastroenterologists (AIGO), Italian Association of Radiology and Clinical Oncology (AIRO), Italian Society of Pathological Anatomy and Diagnostic Cytology (SIAPeC-IAP), Italian Society of Surgery (SIC), Italian Society of Gastroenterology (SIGE), Italian Society of Medical and Interventional Radiology (SIRM), Italian Organ Transplant Society (SITO), and Association of Patients with Hepatitis and Liver Disease (EpaC) - Part I - Surgical treatments. Dig Liver Dis 2024; 56:223-234. [PMID: 38030455 DOI: 10.1016/j.dld.2023.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/07/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
Worldwide, hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death. The remarkable improvements in treating HCC achieved in the last years have increased the complexity of HCC management. Following the need to have updated guidelines on the multidisciplinary treatment management of HCC, the Italian Scientific Societies involved in the management of this cancer have promoted the drafting of a new dedicated document. This document was drawn up according to the GRADE methodology needed to produce guidelines based on evidence. Here is presented the first part of guidelines, focused on the multidisciplinary tumor board of experts and surgical treatments of HCC.
Collapse
Affiliation(s)
- Giuseppe Cabibbo
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties PROMISE, University of Palermo, Italy; Gastroenterology Unit, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Palermo, Italy.
| | - Bruno Daniele
- Oncology Unit, Ospedale del Mare, ASL Napoli 1 Centro, Napoli, Italy
| | - Mauro Borzio
- Centro Diagnostico Italiano (CDI), Milano, Italy
| | - Andrea Casadei-Gardini
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Umberto Cillo
- General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, 35128 Padua, Italy
| | - Agostino Colli
- Dipartimento di Medicina Trasfusionale ed Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Vincenzo Dadduzio
- Medical Oncology Unit, "Mons. A.R.Dimiccoli" Hospital, Barletta, ASL BT, Italy
| | - Francesco Dionisi
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute - Rome, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; Gastroenterology Unit, Azienda Ospedale-Università di Padova, 35128 Padova, Italy
| | - Ivan Gardini
- EpaC Onlus, Italian Liver Patient Association, Turin, Italy
| | - Edoardo Giovanni Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Rita Golfieri
- Alma Mater Studiorum" Bologna University, Bologna, Italy; Radiology Unit Madre Fortunata Toniolo Private Hospital, coordinator of Radiology centers Medipass Bologna, Bologna, Italy
| | - Maria Guido
- Department of Medicine, University of Padova, Padova- Italy
| | - Andrea Mega
- Department of Gastronterology, Regional Hospital Bolzano, Italy
| | - Silvia Minozzi
- Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milano, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Laura Romanini
- Radiology Unit, Ospedale di Cremona, ASST Cremona, Cremona, Italy
| | - Anna Pecorelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rodolfo Sacco
- Gastroenterology and Endoscopy Unit, Department of Surgical and Medical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Luca Viganò
- Hepatobiliary Unit, Department of Minimally Invasive General & Oncologic Surgery, Humanitas Gavazzeni University Hospital, Viale M. Gavazzeni 21, 24125 Bergamo, Italy; Department of Biomedical Sciences, Humanitas University, Viale Rita Levi Montalcini 4, 20090 Milan, Italy
| | - Alessandro Vitale
- General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, 35128 Padua, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
| |
Collapse
|
5
|
Cumpston MS, McKenzie JE, Ryan R, Thomas J, Brennan SE. Critical elements of synthesis questions are incompletely reported: survey of systematic reviews of intervention effects. J Clin Epidemiol 2023; 163:79-91. [PMID: 37778736 DOI: 10.1016/j.jclinepi.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES To examine the characteristics of population, intervention and outcome groups and the extent to which they were completely reported for each synthesis in a sample of systematic reviews (SRs) of interventions. STUDY DESIGN AND SETTING We coded groups that were intended (or used) for comparisons in 100 randomly sampled SRs of public health and health systems interventions published in 2018 from the Health Evidence and Health Systems Evidence databases. RESULTS Authors commonly used population, intervention and outcome groups to structure comparisons, but these groups were often incompletely reported. For example, of 41 SRs that identified and/or used intervention groups for comparisons, 29 (71%) identified the groups in their methods description before reporting of the results (e.g., in the Background or Methods), 12 (29%) defined the groups in enough detail to replicate decisions about which included studies were eligible for each synthesis, 6 (15%) provided a rationale, and 24 (59%) stated that the groups would be used for comparisons. Sixteen (39%) SRs used intervention groups in their synthesis without any mention in the methods. Reporting for population, outcome and methodological groups was similarly incomplete. CONCLUSION Complete reporting of the groups used for synthesis would improve transparency and replicability of reviews, and help ensure that the synthesis is not driven by what is reported in the included studies. Although concerted effort is needed to improve reporting, this should lead to more focused and useful reviews for decision-makers.
Collapse
Affiliation(s)
- Miranda S Cumpston
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Joanne E McKenzie
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Rebecca Ryan
- Centre for Health Communication & Participation, La Trobe University, Melbourne, Victoria 3086, Australia
| | - James Thomas
- EPPI-Centre, UCL Social Research Institute, University College London, Gower St, London, WC1E 6BT, UK
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia.
| |
Collapse
|
6
|
Alghamdi AH. Effectiveness of Journal Club Presentation as a Learning Modality in the Endocrinology and Endocrine Surgery Module in an Integrative Undergraduate Medical Curriculum. Adv Med Educ Pract 2023; 14:1209-1220. [PMID: 37928932 PMCID: PMC10625377 DOI: 10.2147/amep.s429167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
Introduction The journal club is widely used in most postgraduate programs of medical institutes; however, the use of journal clubs in undergraduate medical programs is nearly absent or very rare. Aim The aim of this work is to document the insertion of the journal club as a method for learning in the undergraduate starting with the endocrinology/endocrine surgery module to be fully implemented in all modules of the MBBS of FMBU. In addition, the study aimed to outline the steps of designing a journal club by following specific procedures and Identification of students' and faculty satisfaction through 5-years implementation of the journal club. Material and Methods A total of 453 students representing the five consecutive batches of medical students from 2019 to 2023 who studied the endocrinology/endocrine surgery module were entered into the study. Following guidelines for implementation of the journal clubs that were adopted by the quality and accreditation committee, the faculty select the types of papers from the articles chosen by students. The papers discussed were case reports, original research, and review articles. The students were asked to formulate critical appraisal topics, PICO, for each paper. A 20-question test was applied to all participants. The students' attendance, scores, and students/faculty satisfaction were estimated. Results A total of 50 papers were discussed in the 5-year journal club 15 case reports (30%), 26 original research (52%), and 9 review articles (18%). The student's attendance ranged from 72.53±3.74 to 98.07±3.15. The students and faculty's satisfaction were 3.52 and 3.82 respectively. The mean Students' score in A 20-question test in a 5-year journal club was 76.93 ± 9.78 and the lowest score was in the 2nd batch (online batch). Conclusion The insertion of a well-structured journal club in the undergraduate medical program is necessary to improve the knowledge including knowledge among students. In addition, journal clubs inspire students to be lifelong learners.
Collapse
Affiliation(s)
- Ahmed Hasan Alghamdi
- Pediatric Department, Faculty of Medicine, Al-Baha University, Al-Aqiq, Al-Baha Province, Saudi Arabia
| |
Collapse
|
7
|
Schweitzer MK, Dold MN, Genet A, Gossens K, Klein-Hessling T, Löffler N, Rabel M, Rasch A, Reuter EM, Schmelcher J, Wolfram N, Werner S. Shaping a suitable EU HTA dossier template: why the German template is not fit for purpose. Eur J Health Econ 2023:10.1007/s10198-023-01631-5. [PMID: 37843703 DOI: 10.1007/s10198-023-01631-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023]
Abstract
From 2025, Health Technology Developers (HTDs) have to submit EU HTA dossiers. The joint clinical assessment (JCA) aims to streamline HTA processes and access to medicinal products across Europe. Currently, German HTA bodies IQWiG and G-BA actively shape the JCA methodology. Here we examine if German HTA dossier requirements are suitable for the JCA. We compare the number of safety endpoint and subgroup analyses in German dossiers with analyses considered in IQWIG's benefit assessment and evaluate if these analyses were considered by the G-BA. We further investigated how the number of analyses was affected by the latest change in the German dossier template. With the current template, HTDs report in median 2.6 times more analyses on adverse events (AE) and 1.1 times more subgroup categories than in the previous template. IQWiG does not consider 33% of AE analyses and 73% of the subgroup categories presented by the HTD under the current template. G-BA considered the same AE as IQWiG in 76% of cases. Subgroups were uncommented by G-BA in most cases, independent of the template (previous: 93%, current 85%) and unconsidered in the conclusion on additional benefit (previous: 77%, current 69%). Thus, changes in the dossier template drastically increased HTD workload, but additional analyses seem unconsidered by the HTA bodies. With a broader scope in JCA, this effect could be amplified. To mitigate duplicative efforts and ensure prompt availability of medicinal products as envisioned by the HTAR, we suggest well-chosen and precise dossier requirements, early consultations, and early HTD engagement.
Collapse
Affiliation(s)
| | - Manuel Nico Dold
- AMS Advanced Medical Services GmbH, Am Exerzierplatz 2, 68167, Mannheim, Germany
| | - Astrid Genet
- Pfizer Deutschland GmbH, Linkstraße 10, 10785, Berlin, Germany
| | - Klaus Gossens
- AbbVie Deutschland, GmbH & Co. KG, Mainzer Straße 81, 65189, Wiesbaden, Germany
| | | | - Nils Löffler
- Pfizer Deutschland GmbH, Linkstraße 10, 10785, Berlin, Germany
| | - Matthias Rabel
- AMS Advanced Medical Services GmbH, Rosa-Bavarese-Str. 5, 80639, Munich, Germany
| | - Andrej Rasch
- Verband Forschender Arzneimittelhersteller e.V., Hausvogteiplatz 13, 10117, Berlin, Germany
| | - Eva-Maria Reuter
- AMS Advanced Medical Services GmbH, Rosa-Bavarese-Str. 5, 80639, Munich, Germany
| | - Jessica Schmelcher
- AMS Advanced Medical Services GmbH, Rosa-Bavarese-Str. 5, 80639, Munich, Germany
| | - Natalia Wolfram
- AbbVie Deutschland, GmbH & Co. KG, Mainzer Straße 81, 65189, Wiesbaden, Germany
| | - Sebastian Werner
- Verband Forschender Arzneimittelhersteller e.V., Hausvogteiplatz 13, 10117, Berlin, Germany.
| |
Collapse
|
8
|
More S, Bampidis V, Benford D, Bragard C, Hernández‐Jerez A, Bennekou SH, Koutsoumanis KP, Lambré C, Machera K, Mullins E, Nielsen SS, Schlatter J, Schrenk D, Turck D, Younes M, Kraft A, Naegeli H, Tsaioun K, Aiassa E, Arcella D, Barizzone F, Cushen M, Georgiadis M, Gervelmeyer A, Lanzoni A, Lenzi P, Lodi F, Martino L, Messens W, Ramos Bordajandi L, Rizzi V, Stancanelli G, Supej Š, Halldorsson TI. Guidance on protocol development for EFSA generic scientific assessments. EFSA J 2023; 21:e08312. [PMID: 37908452 PMCID: PMC10613941 DOI: 10.2903/j.efsa.2023.8312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
EFSA Strategy 2027 outlines the need for fit-for-purpose protocols for EFSA generic scientific assessments to aid in delivering trustworthy scientific advice. This EFSA Scientific Committee guidance document helps address this need by providing a harmonised and flexible framework for developing protocols for EFSA generic assessments. The guidance replaces the 'Draft framework for protocol development for EFSA's scientific assessments' published in 2020. The two main steps in protocol development are described. The first is problem formulation, which illustrates the objectives of the assessment. Here a new approach to translating the mandated Terms of Reference into scientifically answerable assessment questions and sub-questions is proposed: the 'APRIO' paradigm (Agent, Pathway, Receptor, Intervention and Output). Owing to its cross-cutting nature, this paradigm is considered adaptable and broadly applicable within and across the various EFSA domains and, if applied using the definitions given in this guidance, is expected to help harmonise the problem formulation process and outputs and foster consistency in protocol development. APRIO may also overcome the difficulty of implementing some existing frameworks across the multiple EFSA disciplines, e.g. the PICO/PECO approach (Population, Intervention/Exposure, Comparator, Outcome). Therefore, although not mandatory, APRIO is recommended. The second step in protocol development is the specification of the evidence needs and the methods that will be applied for answering the assessment questions and sub-questions, including uncertainty analysis. Five possible approaches to answering individual (sub-)questions are outlined: using evidence from scientific literature and study reports; using data from databases other than bibliographic; using expert judgement informally collected or elicited via semi-formal or formal expert knowledge elicitation processes; using mathematical/statistical models; and - not covered in this guidance - generating empirical evidence ex novo. The guidance is complemented by a standalone 'template' for EFSA protocols that guides the users step by step through the process of planning an EFSA scientific assessment.
Collapse
|
9
|
Wilken M, Mink CM, Böhme J. [The Need of Evidence-Based Treatment of Early-Onset Feeding Tube Dependency: A Pico- Framework Based Analytic Review of Clinical Features and Treatment of Feeding Tube Dependency]. Prax Kinderpsychol Kinderpsychiatr 2023; 72:529-551. [PMID: 37830885 DOI: 10.13109/prkk.2023.72.6.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Feeding Tube Dependency is a constant increasing perinatal mental health condition, with estimated 350 new cases per year in Germany.The early onset feeding tube dependency is the consequence of a generalized food aversion. To establish an evidence-based nationwide treatment plan, relevant research from the past twenty years were narratively reviewed. Feeding tube dependency is an international increasingmental health condition, with a high symptom persistence and a low spontaneous remission. The generalized food aversion would prevent the transition to oral feeding.The treatment protocols, supported by the German Health System, based on low-frequency individual treatment and intensive inpatient treatments are not supported by the most recent evidence. In treatment outcome research more promising and effective programs can be distinguished from ineffective programs. As a result, treatment which are designed as intensive treatment, home-based or inpatient and are psychodynamicbased are most effective. Day-clinic and behavioral modification programs are not or low in treatment effectiveness.The German Health System approach to assist families with feeding tube dependency is not evidence-based. A new structure of treatment is imperatively required.
Collapse
Affiliation(s)
- Markus Wilken
- Institut für Sondendependenz Alfredstr. 167 45131 Essen Deutschland
| | - Carla Marie Mink
- Institut für Sondendependenz Alfredstr. 167 45131 Essen Deutschland
| | - Johanna Böhme
- Institut für Sondendependenz Alfredstr. 167 45131 Essen Deutschland
| |
Collapse
|
10
|
Keene ON, Lynggaard H, Englert S, Lanius V, Wright D. Why estimands are needed to define treatment effects in clinical trials. BMC Med 2023; 21:276. [PMID: 37501156 PMCID: PMC10375689 DOI: 10.1186/s12916-023-02969-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The estimand for a clinical trial is a precise definition of the treatment effect to be estimated. Traditionally, estimates of treatment effects are based on either an ITT analysis or a per-protocol analysis. However, there are important clinical questions which are not addressed by either of these analyses. For example, consider a trial where patients take a rescue medication. The ITT analysis includes data after use of rescue, while the per-protocol analysis excludes these patients altogether. Neither of these analyses addresses the important question of what the treatment effect would have been if patients did not take rescue medication. MAIN TEXT Trial estimands provide a broader perspective compared to the limitations of ITT and per-protocol analysis. Trial treatment effects depend on how events occurring after treatment initiation such as use of alternative medication or discontinuation of the intervention are included in the definition. These events can be accounted for in different ways, depending on the clinical question of interest. CONCLUSION The estimand framework is an important step forward in improving the clarity and transparency of clinical trials. The centrality of estimands to clinical trials is currently not reflected in methods recommended by the Cochrane group or the CONSORT statement, the current standard for reporting clinical trials in medical journals. We encourage revisions to these guidelines.
Collapse
Affiliation(s)
| | | | - Stefan Englert
- Statistical Modeling & Methodology, Janssen R&D, Janssen-Cilag GmbH, Neuss, Germany
| | - Vivian Lanius
- Statistics & Data Insights, Bayer AG, Wuppertal, Germany
| | - David Wright
- Statistical Innovation, Data Science & Artificial Intelligence, Biopharmaceuticals R&D, AstraZeneca, Cambridge, UK
| |
Collapse
|
11
|
Abstract
An understanding of the research process is an essential skill for designing a study and developing the research protocol. Poor study design can lead to fatal flaws in research methodology, ultimately resulting in rejection for publication or limiting the reliability of the results. Following the steps of the research process and devising the research question and hypothesis prior to study initiation can avoid common problems encountered with research questions and study design. Formulating the research question is the first step in the research process and provides the foundation for framing the hypothesis. Research questions should be feasible, interesting, novel, ethical, and relevant (FINER). Application of the FINER criteria can assist with ensuring the question is valid and will generate new knowledge that has clinical impact. Utilization of the population, intervention, comparison, and outcome (PICO) format helps to structure the question as well as refine and narrow the focus from a broad topic. The hypothesis is derived from the research question and is used to determine the experiments or interventions that will answer the question. This aim of this paper is to provide guidance for developing research questions and forming a testable hypothesis through application of the FINER criteria and the PICO process.
Collapse
Affiliation(s)
- L Denise Willis
- Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas.
| |
Collapse
|
12
|
Meyer J, Roos E, Abbassi Z, Toso C, Buchs CN, Ris F. Does prophylactic negative pressure wound therapy prevent surgical site infection in abdominal surgery? J Wound Care 2023; 32:S28-S34. [PMID: 36630193 DOI: 10.12968/jowc.2023.32.sup1.s28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/12/2023]
Abstract
OBJECTIVE To determine if prophylactic negative pressure wound therapy (pNPWT) allows for the prevention of surgical site infections (SSIs) in abdominal surgery. METHOD A non-systematic review assessing the evidence was conducted in 2020. RESULTS Retrospectve studies comparing patients with pNPWT with patients receiving standard wound dressing after abdominal surgery showed encouragning results in favour of pNPWT for reducing the incidence of SSIs, but randomised controlled trials have so far reported mixed results. CONCLUSION New randomised controlled trials including a sufficient number of patients at risk of SSIs are needed for confirming the results of non-interventional studies.
Collapse
Affiliation(s)
- Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, 1211 Genève 14, Switzerland
| | - Elin Roos
- Department of Public Health Sciences, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Ziad Abbassi
- Division of Digestive Surgery, University Hospitals of Geneva, 1211 Genève 14, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, University Hospitals of Geneva, 1211 Genève 14, Switzerland
| | | | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, 1211 Genève 14, Switzerland
| |
Collapse
|
13
|
Zappia M, Albano D, Aliprandi A, Barile A, Brunese L, Castagna A, Cozzolino A, De Filippo M, Di Pietto F, Di Salvatore MG, Genovese EA, Guarino S, Guerriero P, Merolla G, Messina C, Ranieri R, Romano AM, Russo R, Tumminello M, Rossi PS, Sconfienza LM, Chianca V. Glenoid bone loss in anterior shoulder dislocation: a multicentric study to assess the most reliable imaging method. Radiol Med 2023; 128:93-102. [PMID: 36562906 DOI: 10.1007/s11547-022-01577-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this multicentric study was to assess which imaging method has the best inter-reader agreement for glenoid bone loss quantification in anterior shoulder instability. A further aim was to calculate the inter-method agreement comparing bilateral CT with unilateral CT and MR arthrography (MRA) with CT measurements. Finally, calculations were carried out to find the least time-consuming method. METHOD A retrospective evaluation was performed by 9 readers (or pairs of readers) on a consecutive series of 110 patients with MRA and bilateral shoulder CT. Each reader was asked to calculate the glenoid bone loss of all patients using the following methods: best fit circle area on both MRA and CT images, maximum transverse glenoid width on MRA and CT, CT PICO technique, ratio of the maximum glenoid width to height on MRA and CT, and length of flattening of the anterior glenoid curvature on MRA and CT. Using Pearson's correlation coefficient (PCC), the following agreement values were calculated: the inter-reader for each method, the inter-method for MRA with CT quantifications and the inter-method for CT best-fit circle area and CT PICO. Statistical analysis was carried out to compare the time employed by the readers for each method. RESULTS Inter-reader agreement PCC mean values were the following: 0.70 for MRA and 0.77 for CT using best fit circle diameter, 0.68 for MRA and 0.72 for CT using best fit circle area, 0.75 for CT PICO, 0.64 for MRA and 0.62 for CT anterior straight line and 0.49 for MRA and 0.43 for CT using length-to-width ratio. CT-MRA inter-modality PCC mean values were 0.9 for best fit circle diameter, 0.9 for best fit circle area, 0.62 for anterior straight line and 0.94 for length-to-width methods. PCC mean value comparing unilateral CT with PICO CT methods was 0.8. MRA best fit circle area method was significantly faster than the same method performed on CT (p = 0.031), while no significant difference was seen between CT and MRA for remaining measurements. CONCLUSIONS CT PICO is the most reliable imaging method, but both CT and MRA can be reliably used to assess glenoid bone loss. Best fit circle area CT and MRA methods are valuable alternative measurement techniques.
Collapse
|
14
|
Wang Q, Liao J, Lapata M, Macleod M. PICO entity extraction for preclinical animal literature. Syst Rev 2022; 11:209. [PMID: 36180888 PMCID: PMC9524079 DOI: 10.1186/s13643-022-02074-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 09/12/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Natural language processing could assist multiple tasks in systematic reviews to reduce workflow, including the extraction of PICO elements such as study populations, interventions, comparators and outcomes. The PICO framework provides a basis for the retrieval and selection for inclusion of evidence relevant to a specific systematic review question, and automatic approaches to PICO extraction have been developed particularly for reviews of clinical trial findings. Considering the difference between preclinical animal studies and clinical trials, developing separate approaches is necessary. Facilitating preclinical systematic reviews will inform the translation from preclinical to clinical research. METHODS We randomly selected 400 abstracts from the PubMed Central Open Access database which described in vivo animal research and manually annotated these with PICO phrases for Species, Strain, methods of Induction of disease model, Intervention, Comparator and Outcome. We developed a two-stage workflow for preclinical PICO extraction. Firstly we fine-tuned BERT with different pre-trained modules for PICO sentence classification. Then, after removing the text irrelevant to PICO features, we explored LSTM-, CRF- and BERT-based models for PICO entity recognition. We also explored a self-training approach because of the small training corpus. RESULTS For PICO sentence classification, BERT models using all pre-trained modules achieved an F1 score of over 80%, and models pre-trained on PubMed abstracts achieved the highest F1 of 85%. For PICO entity recognition, fine-tuning BERT pre-trained on PubMed abstracts achieved an overall F1 of 71% and satisfactory F1 for Species (98%), Strain (70%), Intervention (70%) and Outcome (67%). The score of Induction and Comparator is less satisfactory, but F1 of Comparator can be improved to 50% by applying self-training. CONCLUSIONS Our study indicates that of the approaches tested, BERT pre-trained on PubMed abstracts is the best for both PICO sentence classification and PICO entity recognition in the preclinical abstracts. Self-training yields better performance for identifying comparators and strains.
Collapse
Affiliation(s)
- Qianying Wang
- CCBS, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Jing Liao
- CCBS, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Mirella Lapata
- ILCC, School of Informatics, University of Edinburgh, Edinburgh, UK
| | - Malcolm Macleod
- CCBS, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
15
|
Priyadharsini Prabakaran P, Totty JP, Carradice D, Chetter IC, Smith GE. The local physiological effects of a single-use topical negative pressure device in healthy volunteers: the PICO-1 study. J Wound Care 2022; 31:624-632. [PMID: 36001706 DOI: 10.12968/jowc.2022.31.8.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/11/2022]
Abstract
OBJECTIVE This study aimed to investigate the effects of a single-use negative pressure wound therapy (sNPWT) device on tissue perfusion, oxygenation and pressure in the intact skin of healthy volunteers. METHOD Healthy volunteers wore a PICO sNPWT device (Smith+Nephew, UK) on their right medial calf for one week. Perfusion, tissue oxygenation and tissue pressure were recorded in superficial and deep tissues over a period of seven days. At the baseline visit, measurements were recorded before and after dressing application without activation. Macrovascular flow and transduced needle pressure measures were recorded at 0 minutes, 30 minutes and 60 minutes after device activation. Superficial tissue perfusion and both oxygenation measures were recorded continuously over the hour following activation. All outcome measures were repeated at 24 hours and again after seven days, both with the dressing and following dressing removal. RESULTS The device was associated with a measurable increase in perfusion of the limb in 12 healthy volunteers. Superficial tissue oxygenation adjacent to the dressing was reduced during wear, while deeper tissue demonstrated an increase in oxygenation levels. Superficial skin perfusion was observed to differ between skin overlying muscle and that overlying bone. Pressure in tissue underneath the dressing pad was increased throughout dressing wear and returned to baseline levels on dressing removal. CONCLUSION sNPWT produced measurable changes in local physiology in healthy volunteers with intact skin, despite the absence of a wound. Effects may differ according to anatomical site and the composition of underlying tissues. Other factors that promote healing were not explored in this study. DECLARATION OF INTEREST This study was funded by Smith+Nephew investigator-initiated grant IIS 684. The funder had no input into study design, conduct, analysis, manuscript preparation or dissemination. The authors have no conflicts of interest to declare.
Collapse
Affiliation(s)
| | - Joshua P Totty
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK.,Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals, Cottingham, UK
| | - Dan Carradice
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - Ian C Chetter
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - George E Smith
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| |
Collapse
|
16
|
Meyer J, Roos E, Abbassi Z, Buchs NC, Ris F, Toso C. Prophylactic Negative-pressure Wound Therapy Prevents Surgical Site Infection in Abdominal Surgery: An Updated Systematic Review and Meta-analysis of Randomized Controlled Trials and Observational Studies. Clin Infect Dis 2021; 73:e3804-e3813. [PMID: 32818259 DOI: 10.1093/cid/ciaa1203] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Prevention of surgical site infection (SSI) is a public health challenge. Our objective was to determine if prophylactic negative-pressure wound therapy (pNPWT) allows preventing SSI after laparotomy. METHODS Medline, Embase, and Web of Science were searched on 6 October 2019 for original studies reporting the incidences of SSI in patients undergoing open abdominal surgery with and without pNPWT. Risk differences (RDs) between control and pNPWT patients and risk ratios (RRs) for SSI were obtained using random-effects models. RESULTS Twenty-one studies (2930 patients, 5 randomized controlled trials [RCTs], 16 observational studies) were retained for the analysis. Pooled RD between patients with and without pNPWT was -12% (95% confidence interval [CI], -17% to -8%; I2 = 57%; P < .00001) in favor of pNPWT. That risk difference was -12% (95% CI, -22% to -1%; I2 = 69%; P = .03) when pooling only RCTs (792 patients). pNPWT was protective against the incidence of SSI with a RR of 0.53 (95% CI, .40-.71; I2 = 56%; P < .0001). The effect on pNPWT was more pronounced in studies with an incidence of SSI ≥20% in the control arm. The preventive effect of pNPWT on SSI remained after correction for potential publication bias. However, when pooling only high-quality observational studies (642 patients) or RCTs (527 patients), significance was lost. CONCLUSIONS Existing studies suggest that pNPWT on closed wounds is protective against the occurrence of SSI in abdominal surgery, but these findings need to be confirmed by more high-quality evidence, preferentially in subgroups of patients with an incidence of SSI ≥20% in the control arm.
Collapse
Affiliation(s)
- Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
- Unit of Surgical Research, University of Geneva, Geneva, Switzerland
| | - Elin Roos
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ziad Abbassi
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
- Unit of Surgical Research, University of Geneva, Geneva, Switzerland
| | - Nicolas C Buchs
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
- Unit of Surgical Research, University of Geneva, Geneva, Switzerland
| | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
- Unit of Surgical Research, University of Geneva, Geneva, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
- Unit of Surgical Research, University of Geneva, Geneva, Switzerland
| |
Collapse
|
17
|
Abstract
AIM To assess the role and effectiveness of the mnemonic PICO (Population, Intervention, Comparator and Outcome) in evidence-based practice (EBP) pedagogy. BACKGROUND The mnemonic "PICO" is a well-established tool in nursing EBP pedagogy. Nevertheless, application of this tool in nursing curricula is not currently supported by evidence of its effectiveness. Further, there are reports that PICO as a tool is unhelpful in the classroom. DESIGN/METHODS We reviewed the literature on PICO; specifically, the mnemonic's origin, purpose, and effectiveness in practice. RESULTS Our analysis reveals that PICO is limited in terms of its effectiveness and scope of inquiry. CONCLUSION A reevaluation of PICO's role in nursing pedagogy is essential. To start, we propose a de-emphasis on PICO as an exclusive or preferred tool, and an emphasis on critical evaluation of the literature, and the whole of the EBP process. We propose a search for more effective methods to improve matching native clinical questions to the retrieval of data that informs patient care.
Collapse
Affiliation(s)
| | - Frances Chu
- Foley Library, Gonzaga University, USA; University of Washington, School of Nursing, USA.
| |
Collapse
|
18
|
Misra DP, Ravindran V. Systematic reviews: current perspectives and future directions. J R Coll Physicians Edinb 2021; 51:218-220. [PMID: 34528607 DOI: 10.4997/jrcpe.2021.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | | |
Collapse
|
19
|
Roos E, Douissard J, Abbassi Z, Buchs NC, Toso C, Ris F, Meyer J. Prophylactic negative-pressure wound therapy for prevention of surgical site infection in abdominal surgery: a nationwide cross-sectional survey. Updates Surg 2021; 73:1983-1988. [PMID: 33837948 PMCID: PMC8500901 DOI: 10.1007/s13304-021-01017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022]
Abstract
Our objective was to determine current practice in Switzerland regarding the use of pNPWT in abdominal surgery. An online survey was carried out to evaluate the use of pNPWT among abdominal surgeons in Switzerland. One hundred and ten participants replied to the survey from 16.12.2019 to 15.01.2020. Eleven were excluded, leaving 99 responders for analysis. Seventy participants (70.7%) were using pNPWT, 3 (3%) have stopped using it and 26 (26.3%) have never used it. pNPWT was used on midline laparotomy by 63 responders (90%), closed stoma wounds by 21 (30%), closed perineal wounds by 20 (28.6%), Pfannenstiel incisions by 18 (23.7%), groin incisions by 16 (22.9%), subcostal incisions by 13 (18.6%), Mc Burney incisions by 3 (4.3%) and other incisions by 18 (25.7%). Forty-eight participants (68.6%) used pNPWT on less than 10% of patients, 14 (20%) on 10–25% of patients, six (8.6%) on 25–50% of patients and two (2.9%) on 75–100% of patients. Suggestions for improvement to pNPWT were: better sealing, recyclable system, better adaptation to the perineum, smaller device, reduced cost and possibility to check the surgical wound through the dressing. In conclusion, pNPWT is widely used among Swiss surgeons, mostly on midline incisions. However, most of them apply pNPWT on a small proportion of patients only. Suggestions for improvement were a better sealing for complex wounds, reduced cost and possibility to check the wound during the therapy.
Collapse
Affiliation(s)
- Elin Roos
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.,County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Jonathan Douissard
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Medical School, University of Geneva, 1205, Genève, Switzerland
| | - Ziad Abbassi
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Medical School, University of Geneva, 1205, Genève, Switzerland
| | - Nicolas C Buchs
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Medical School, University of Geneva, 1205, Genève, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Medical School, University of Geneva, 1205, Genève, Switzerland
| | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Medical School, University of Geneva, 1205, Genève, Switzerland
| | - Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland. .,Medical School, University of Geneva, 1205, Genève, Switzerland.
| |
Collapse
|
20
|
Cumpston MS, McKenzie JE, Thomas J, Brennan SE. The use of ' PICO for synthesis' and methods for synthesis without meta-analysis: protocol for a survey of current practice in systematic reviews of health interventions. F1000Res 2021; 9:678. [PMID: 33728041 PMCID: PMC7919603 DOI: 10.12688/f1000research.24469.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Systematic reviews involve synthesis of research to inform decision making by clinicians, consumers, policy makers and researchers. While guidance for synthesis often focuses on meta-analysis, synthesis begins with specifying the ’PICO for each synthesis’ (i.e. the criteria for deciding which populations, interventions, comparators and outcomes are eligible for each analysis). Synthesis may also involve the use of statistical methods other than meta-analysis (e.g. vote counting based on the direction of effect, presenting the range of effects, combining P values) augmented by visual display, tables and text-based summaries. This study examines these two aspects of synthesis. Objectives: To identify and describe current practice in systematic reviews of health interventions in relation to: (i) approaches to grouping and definition of PICO characteristics for synthesis; and (ii) methods of summary and synthesis when meta-analysis is not used. Methods: We will randomly sample 100 systematic reviews of the quantitative effects of public health and health systems interventions published in 2018 and indexed in the
Health Evidence and Health Systems Evidence databases. Two authors will independently screen citations for eligibility. Two authors will confirm eligibility based on full text, then extract data for 20% of reviews on the specification and use of PICO for synthesis, and the presentation and synthesis methods used (e.g. statistical synthesis methods, tabulation, visual displays, structured summary). The remaining reviews will be confirmed as eligible and data extracted by a single author. We will use descriptive statistics to summarise the specification of methods and their use in practice. We will compare how clearly the PICO for synthesis is specified in reviews that primarily use meta-analysis and those that do not. Conclusion: This study will provide an understanding of current practice in two important aspects of the synthesis process, enabling future research to test the feasibility and impact of different approaches.
Collapse
Affiliation(s)
- Miranda S Cumpston
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - James Thomas
- EPPI-Centre, UCL Social Research Institute, University College London, London, WC1H 0NR, UK
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| |
Collapse
|
21
|
Affiliation(s)
| | - J Peter Cegielski
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
22
|
Obeid N, Sharma E, Dunstan M, Nisar P, Trivedi P, Madani R, Scott HJ, Trickett JP, Bearn PE, Thomas GP. Negative pressure therapy for stoma closure sites-a nonrandomised case control study. Int J Colorectal Dis 2021; 36:161-7. [PMID: 32929529 DOI: 10.1007/s00384-020-03749-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 02/04/2023]
Abstract
AIM The PICO (Smith & Nephew, UK) dressing is a single use negative pressure wound therapy (NPWT) system that is designed to be used for up to 7 days for closed wounds. We aimed to assess its use for stoma closure wounds. METHOD We conducted a retrospective analysis of stoma reversal wounds from April 2018 to June 2019. The wound was partially closed with an absorbable subcutaneous suture in a purse-string fashion. A 15 cm × 15 cm PICO dressing was applied directly over this wound. A control group who had received partial purse string closure with packing over the same time period was identified. Patients were contacted and information collected using a questionnaire. The primary outcome measure was the number of visits for dressing changes in the community. Further information was collected about length of stay, time to resolution of pain and return to work. RESULTS On average, the patients with PICO dressings attended the community nurses 1.9 times. The patients in the PICO group stated it took 1-2 weeks to return to full work/daily activities. The control group averaged attending the community nurse 11.9 times, and 33% had not returned to work/daily activities in 1-2 weeks. CONCLUSION Those who had a PICO dressing required fewer visits to the community nurse and the majority were able to return to work or resume usual activities within 1 to 2 weeks. This pilot study suggests that negative pressure dressings may be a useful aid for stoma closure site wounds.
Collapse
|
23
|
Comins JD, Brodersen J, Siersma V, Jensen J, Hansen CF, Krogsgaard MR. Choosing the most appropriate PROM for clinical studies in sports medicine. Scand J Med Sci Sports 2020; 31:1209-1215. [PMID: 33342023 DOI: 10.1111/sms.13906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/20/2020] [Accepted: 12/14/2020] [Indexed: 12/16/2022]
Abstract
Choosing the most appropriate patient-reported outcome measure (PROM) for a clinical study is essential in order to achieve trustworthy results. This choice will depend on (a) the objective of the study and hence the research question; (b) the choice of a theoretical framework, such as the World Health Organization's International Classification of Functioning, Disability, and Health (ICF); (c) whether there currently is a PROM that possesses high content validity and high construct validity for the specific patient group and objective, and if not; (d) the decision on whether to use a suboptimal PROM or develop and validate a new PROM. This paper presents the steps that should be followed in order to assess the relevance of PROMs and suggests ways to enhance the choice depending on the goal of the study.
Collapse
Affiliation(s)
- Jonathan D Comins
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Primary Health Care Research Unit, Region Zealand, Sorø, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Jensen
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Christian Fugl Hansen
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Michael R Krogsgaard
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| |
Collapse
|
24
|
Batten J, Brackett A. Ensuring the rigor in systematic reviews: Part 3, the value of the search. Heart Lung 2021; 50:220-2. [PMID: 33340823 DOI: 10.1016/j.hrtlng.2020.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/24/2022]
Abstract
The third column, in this seven part series, highlights: Systematic reviews must include published sources as well as consider including unpublished sources for data collection. Systematic reviews require rigorous search strategies, that are transparent and reproducible. Systematic reviews require adequate reporting of search methods.
Collapse
|
25
|
Lam D, Rindani R, Leslie S, Warrier S, Ahmadi N. Value of Indocyanine Green Angiography to Guide Wound Management and Prevent Necrosis in a Robotic Surgical Procedure. J Endourol Case Rep 2020; 6:156-159. [PMID: 33102715 DOI: 10.1089/cren.2019.0149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/12/2022] Open
Abstract
Background: Inguinal lymph node dissection is performed in penile cancers and has a high complication rate with mostly wound-related complications. This case study demonstrates the use of robotic technique, tissue perfusion assessment, and negative pressure wound dressing to minimize wound-related complications. Case Presentation: A 67-year-old Maltese man was diagnosed with squamous cell carcinoma (SCC) in situ on biopsy of a self-detected penile lump. The patient underwent a partial penectomy and histopathology report confirmed moderately differentiated SCC with clear surgical margins. A positron emission tomography/CT scan was performed preoperatively, which showed several nodes in the right inguinal region with increased metabolic activity and nonspecific findings in the left inguinal region. The patient had a robotic right inguinal node dissection the following month. Assessment of the skin flap was performed using indocyanine green (ICG) angiography with the SPY system and there was excellent vascularity. Further treatment was performed 3 months later with a robotic left inguinal node dissection. Again, assessment of the skin flap was performed using the SPY system but showed an area of poor perfusion in the left femoral triangle, which suggested a high risk of inadequate wound healing and tissue necrosis. The clinical decision to use the negative pressure PICO dressing was made intraoperatively to enhance perfusion of the skin. When the PICO dressing was removed it revealed excellent tissue viability and vascularity of the skin flap. Histopathology analysis showed no evidence of malignancy in the nodes removed and patient was discharged to the outpatient care of their urologist. Conclusion: This case study demonstrates that the use of a tissue perfusion assessment tool avoided a potentially poor clinical outcome for the patient. Robotic inguinal lymph node dissection was performed in coordination with ICG angiography to guide the use of negative pressure wound therapy and facilitate good wound healing.
Collapse
Affiliation(s)
- Danny Lam
- Chris O'Brien Lifehouse, Camperdown, Australia
| | | | | | | | | |
Collapse
|
26
|
Frandsen TF, Bruun Nielsen MF, Lindhardt CL, Eriksen MB. Using the full PICO model as a search tool for systematic reviews resulted in lower recall for some PICO elements. J Clin Epidemiol 2020; 127:69-75. [PMID: 32679315 DOI: 10.1016/j.jclinepi.2020.07.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/16/2020] [Accepted: 07/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The use of the four-part PICO model to facilitate search strategy development for a precise answer is recommended for structuring searches for systematic reviews. Existing guidelines generally recommend that a search strategy should include the population, intervention(s), and types of study design. Consequently, comparison and outcome are not recommended as a part of the search strategy. There is evidence that comparison and particularly outcome is not represented in enough detail, but this needs to be confirmed. STUDY DESIGN AND SETTING The present study examines the presence of PICO elements in the records in two commonly used databases for health sciences research: Embase and PubMed. We examine the field of upper GI and pancreatic diseases as well as the field of pregnancy and childbirth by extracting the included studies as well as the related PICO elements from a random selection of Cochrane reviews within these two areas. RESULTS We find that the PICO elements C and O had a lower retrieval potential across the two Cochrane groups and databases also when combining text words and subject headings. In particular, we find a lower retrieval when searching for both primary and secondary outcomes. CONCLUSION Our results support the existing recommendation not to search for outcomes.
Collapse
Affiliation(s)
- Tove Faber Frandsen
- Department of Design and Communication, University of Southern Denmark, Kolding, Denmark.
| | | | | | - Mette Brandt Eriksen
- Department of Clinical Institute, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
27
|
Knoernschild KL, Campbell SD. Making the Best Clinical Decisions for Patients: The Pros-CAT Protocol TM. Dent Clin North Am 2019; 63:279-296. [PMID: 30825991 DOI: 10.1016/j.cden.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
The Pros-CAT protocol critical appraisal method uses accepted strategies to identify and summarize best evidence to support patient care through evidence-based analysis that includes assessing the patient; developing a concise clinical question; conducting a literature search to identify pertinent research; critically appraising the identified literature for validity, reliability, and applicability to the patient situation; synthesizing the literature into a meaningful conclusion using an organized method; and applying that synthesis to the patient's need. The Pros-CAT protocol is applicable for practicing clinicians, dental students, postgraduate students, and residents. The Pros-CAT index compares evidence strength for patient applicability.
Collapse
Affiliation(s)
- Kent L Knoernschild
- Advanced Education Program in Prosthodontics, Department of Restorative Dentistry, University of Illinois at Chicago College of Dentistry, 801 South Paulina Street, MC555, Chicago, IL 60612, USA.
| | - Stephen D Campbell
- Department of Restorative Dentistry, University of Illinois at Chicago College of Dentistry, 801 South Paulina Street, MC555, Chicago, IL 60612, USA
| |
Collapse
|
28
|
Philbrick AM, Hager KD, Lounsbery JL, Moon JY, Pereira C, Undeberg MR, Westberg SM, Reidt S. Educational Prescriptions to Document Evidence-Based Medicine Questions in Ambulatory Care Advanced Pharmacy Practice Experiences. Am J Pharm Educ 2019; 83:7299. [PMID: 31831906 PMCID: PMC6900823 DOI: 10.5688/ajpe7299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/30/2019] [Indexed: 06/10/2023]
Abstract
Objective. To design, implement, and assess the use of "educational prescriptions" or Education Rx assignments in advanced pharmacy practice experiences (APPEs) in ambulatory care, and to assess the impact of the assignments on Doctor of Pharmacy (PharmD) students' self-efficacy to practice evidence-based medicine (EBM). Methods. Students enrolled in select ambulatory care APPEs completed up to four Education Rx assignments. The assignments required students to report the context of the question, source of information, results, appraisal of validity, and relevance of the evidence, and to answer the clinical question. A rubric was used that contained three subparts: a patient/population, intervention, comparison, outcome (PICO) conformity score (8 points), presence of answer to the PICO (1 point), and quality of answer to the PICO (6 points). Demographic information was collected and students were surveyed at the end of the APPE to rate their self-efficacy executing seven evidence-based medicine (EBM) skills. Results. Thirty students completed 110 Education Rxs. The average score (SD) was 13.6 (2.2) with a PICO conformity subsection score of 7.3 (1.3), and quality of answer subsection score of 5.3 (1.2). Only one Education Rx did not have an answer. Students consulted point-of-care references for a majority of the answers (65%). Sixteen (53%) students completed the self-assessment survey, and all strongly agreed or agreed that the Education Rx activity improved their ability to formulate a well-constructed clinical question and evaluate and apply the evidence. Conclusion. Through Education Rxs, PharmD students' self-confidence and their skills in finding answers to clinical questions increased.
Collapse
Affiliation(s)
- Ann M. Philbrick
- University of Minnesota College of Pharmacy, Minneapolis, Minneapolis
| | - Keri D. Hager
- University of Minnesota College of Pharmacy, Duluth, Minneapolis
| | - Jody L. Lounsbery
- University of Minnesota College of Pharmacy, Minneapolis, Minneapolis
| | - Jean Y. Moon
- University of Minnesota College of Pharmacy, Minneapolis, Minneapolis
| | - Chrystian Pereira
- University of Minnesota College of Pharmacy, Minneapolis, Minneapolis
| | - Megan R. Undeberg
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, Washington
| | - Sarah M. Westberg
- University of Minnesota College of Pharmacy, Minneapolis, Minneapolis
| | | |
Collapse
|
29
|
Franquesa M, Pujol-Busquets G, García-Fernández E, Rico L, Shamirian-Pulido L, Aguilar-Martínez A, Medina FX, Serra-Majem L, Bach-Faig A. Mediterranean Diet and Cardiodiabesity: A Systematic Review through Evidence-Based Answers to Key Clinical Questions. Nutrients 2019; 11:nu11030655. [PMID: 30889891 PMCID: PMC6471908 DOI: 10.3390/nu11030655] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/06/2019] [Accepted: 03/13/2019] [Indexed: 12/24/2022] Open
Abstract
The Mediterranean Diet (MedDiet) has been promoted as a means of preventing and treating cardiodiabesity. The aim of this study was to answer a number of key clinical questions (CQs) about the role of the MedDiet in cardiodiabesity in order to provide a framework for the development of clinical practice guidelines. A systematic review was conducted to answer five CQs formulated using the Patient, Intervention, Comparison, and Outcome (PICO) criteria. Twenty articles published between September 2013 and July 2016 were included, adding to the 37 articles from the previous review. There is a high level of evidence showing that MedDiet adherence plays a role in the primary and secondary prevention of cardiovascular disease (CVD) and improves health in overweight and obese patients. There is moderate-to-high evidence that the MedDiet prevents increases in weight and waist circumference in non-obese individuals, and improves metabolic syndrome (MetS) and reduces its incidence. Finally, there is moderate evidence that the MedDiet plays primary and secondary roles in the prevention of type 2 diabetes mellitus (T2DM). The MedDiet is effective in preventing obesity and MetS in healthy and at-risk individuals, in reducing mortality risk in overweight or obese individuals, in decreasing the incidence of T2DM and CVD in healthy individuals, and in reducing symptom severity in individuals with T2DM or CVD.
Collapse
Affiliation(s)
- Marcella Franquesa
- Faculty of Health Sciences, Universitat Oberta de Catalunya (Open University of Catalonia, UOC), 08018 Barcelona, Spain.
- REMAR-IVECAT Group, Health Science Research Institute Germans Trias i Pujol, Can Ruti Campus, 08916 Badalona, Spain.
| | - Georgina Pujol-Busquets
- Faculty of Health Sciences, Universitat Oberta de Catalunya (Open University of Catalonia, UOC), 08018 Barcelona, Spain.
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, 7725 Cape Town, South Africa.
| | - Elena García-Fernández
- Faculty of Health Sciences, Universitat Oberta de Catalunya (Open University of Catalonia, UOC), 08018 Barcelona, Spain.
| | - Laura Rico
- Faculty of Health Sciences, Universitat Oberta de Catalunya (Open University of Catalonia, UOC), 08018 Barcelona, Spain.
| | - Laia Shamirian-Pulido
- Faculty of Health Sciences, Universitat Oberta de Catalunya (Open University of Catalonia, UOC), 08018 Barcelona, Spain.
| | - Alicia Aguilar-Martínez
- FoodLab Research Group (2017SGR 83), Faculty of Health Sciences, Universitat Oberta de Catalunya (Open University of Catalonia, UOC), 08018 Barcelona, Spain.
| | - Francesc Xavier Medina
- FoodLab Research Group (2017SGR 83), Faculty of Health Sciences, Universitat Oberta de Catalunya (Open University of Catalonia, UOC), 08018 Barcelona, Spain.
| | - Lluís Serra-Majem
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain.
| | - Anna Bach-Faig
- FoodLab Research Group (2017SGR 83), Faculty of Health Sciences, Universitat Oberta de Catalunya (Open University of Catalonia, UOC), 08018 Barcelona, Spain.
- Food and Nutrition Area, Barcelona Official College of Pharmacists, 08009 Barcelona, Spain.
| |
Collapse
|
30
|
Abstract
The primary objective of evidence-based practice is to improve the quality of health care. It helps in making a clinical decision based on recent and advanced research and the best available evidence. Evidence-based dentistry is an integration of best available evidence with clinical expertise and patient’s needs and preferences. However, there are many barriers to apply evidence-based knowledge into practice. Information overflow, inability to select appropriate evidence, and critically appraising the evidence are the main challenges a practitioner may face. The focus of this review is defining a well-structured clinical question, key principles of literature search, type of search studies, and how to appraise an evidence. Furthermore, despite the availability of good evidence, patient’s needs and preferences are crucial factors in making clinical decision. Finally, the clinician’s experience and lack of motivation to change practice is another big challenge to evidence-based practice. This article discusses the six structured steps to apply evidence-based practice in dentistry with examples. Finally, this article will help practitioners to integrate their experience and skill with modern research evidence as well as to educate their patients to reach a final clinical decision.
Collapse
Affiliation(s)
- Durr-E-Sadaf
- Conservative Dentistry Department, College of Dentistry, Qassim University, Qassim, Saudi Arabia, .,Evidence Based Healthcare, Centre of Evidence Based Medicine, University of Oxford, Oxford, UK,
| |
Collapse
|
31
|
Chabou S, Iglewski M. Combination of conditional random field with a rule based method in the extraction of PICO elements. BMC Med Inform Decis Mak 2018; 18:128. [PMID: 30509272 PMCID: PMC6278016 DOI: 10.1186/s12911-018-0699-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/26/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Extracting primary care information in terms of Patient/Problem, Intervention, Comparison and Outcome, known as PICO elements, is difficult as the volume of medical information expands and the health semantics is complex to capture it from unstructured information. The combination of the machine learning methods (MLMs) with rule based methods (RBMs) could facilitate and improve the PICO extraction. This paper studies the PICO elements extraction methods. The goal is to combine the MLMs with the RBMs to extract PICO elements in medical papers to facilitate answering clinical questions formulated with the PICO framework. METHODS First, we analyze the aspects of the MLM model that influence the quality of the PICO elements extraction. Secondly, we combine the MLM approach with the RBMs in order to improve the PICO elements retrieval process. To conduct our experiments, we use a corpus of 1000 abstracts. RESULTS We obtain an F-score of 80% for P element, 64% for the I element and 92% for the O element. Given the nature of the used training corpus where P and I elements represent respectively only 6.5 and 5.8% of total sentences, the results are competitive with previously published ones. CONCLUSIONS Our study of the PICO element extraction shows that the task is very challenging. The MLMs tend to have an acceptable precision rate but they have a low recall rate when the corpus is not representative. The RBMs backed up the MLMs to increase the recall rate and consequently the combination of the two methods gave better results.
Collapse
Affiliation(s)
- Samir Chabou
- Computer Science and Engineering Department, Université du Québec en Outaouais, Gatineau, J8Y 3G5, Canada
| | - Michal Iglewski
- Computer Science and Engineering Department, Université du Québec en Outaouais, Gatineau, J8Y 3G5, Canada.
| |
Collapse
|
32
|
Niimi Y, Ito H, Sakurai H. Negative-pressure wound therapy for fixing full-thickness skin graft on the thumb. JPRAS Open 2018; 18:22-27. [PMID: 32158834 PMCID: PMC7061535 DOI: 10.1016/j.jpra.2018.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/23/2018] [Accepted: 08/01/2018] [Indexed: 11/25/2022] Open
Abstract
Negative-pressure wound therapy (NPWT) is used not only for preparing wound bed but also for fixing the skin graft. However, there is no report describing the use of NPWT after full-thickness skin graft (FTSG) on the digits. Because NPWT causes a leak easily, especially in the digital region, this study reported a new technique using an NPWT device without leaking and the efficacy of NPWT after FTSG. A 51 year old male had 35 × 15 mm skin ulcer on the palmar side of the right thumb after microsurgical replantation surgery for treating a finger amputation. FTSG was performed as day surgery, and the grafted site was covered with an NPWT device. NPWT was fixed by a “sandwich technique” with two sheets covering both the dorsal and pulp sides of the thumb. The graft was perfectly planted, and the morphology was favorable at 12 months after skin grafting. FTSG with NPWT was considered as a cost efficient and effective treatment for the digit.
Collapse
Affiliation(s)
- Yosuke Niimi
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University; Shinjuku-ku, Tokyo, Japan
| | - Hiroshi Ito
- Department of Surgery, Plastic and Reconstructive Surgery Division, University of Miyazaki Faculty of Medicine, Miyazaki-shi, Miyazaki, Japan
| | - Hiroyuki Sakurai
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University; Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
33
|
Tanaydin V, Beugels J, Andriessen A, Sawor JH, van der Hulst RRWJ. Randomized Controlled Study Comparing Disposable Negative-Pressure Wound Therapy with Standard Care in Bilateral Breast Reduction Mammoplasty Evaluating Surgical Site Complications and Scar Quality. Aesthetic Plast Surg 2018; 42:927-935. [PMID: 29442143 PMCID: PMC6097780 DOI: 10.1007/s00266-018-1095-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/25/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Negative pressure wound therapy (NPWT) for postsurgical incision treatment has demonstrated benefits. A prospective randomized study was developed including 32 patients who underwent bilateral breast reduction mammoplasty. Patients served as their own control and received NPWT to one breast and fixation strips to the other breast. METHODS The primary outcome was the number of wound healing complications within 21 days when comparing NPWT treatment with fixation strips. The secondary outcome was aesthetic appearance and quality of scarring using questionnaires [visual analogue scale (VAS) and Patient and Observer Scar Assessment Scale (POSAS)] scored at day 42-, 90-, 180- and 365-day follow-up using additional scar measurement modalities, such as viscoelasticity. RESULTS For the 32 included patients, the number of wound complications was significantly lower (p < 0.004) for the NPWT treated sites compared to fixation strips. POSAS and VAS scores at 42 and 90 days revealed a significantly better quality of scarring in the NPWT treatment breasts than in fixation strips. At 180-day follow-up, there was a significant improvement in total VAS scores, as well as a comparable improvement in POSAS scores. No consistent significant improvement in scar quality was demonstrated with the assays that were used. CONCLUSIONS Our study showed less complications and a significant improvement in quality of scarring in favor of the NPWT-treated sites. The results indicate NPWT to be an attractive option for these patients. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- V Tanaydin
- Maastricht University Medical Center, Maastricht, The Netherlands.
| | - J Beugels
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Andriessen
- Andriessen Consultants, Malden, The Netherlands
- UMC St Radboud Nijmegen, Nijmegen, The Netherlands
| | - J H Sawor
- Maastricht University Medical Center, Maastricht, The Netherlands
- VieCuri Medical Center, Venlo, The Netherlands
| | - R R W J van der Hulst
- Maastricht University Medical Center, Maastricht, The Netherlands
- VieCuri Medical Center, Venlo, The Netherlands
| |
Collapse
|
34
|
Nestor PJ, Altomare D, Festari C, Drzezga A, Rivolta J, Walker Z, Bouwman F, Orini S, Law I, Agosta F, Arbizu J, Boccardi M, Nobili F, Frisoni GB; EANM-EAN Task Force for the Prescription of FDG-PET for Dementing Neurodegenerative Disorders. Clinical utility of FDG-PET for the differential diagnosis among the main forms of dementia. Eur J Nucl Med Mol Imaging 2018; 45:1509-25. [PMID: 29736698 DOI: 10.1007/s00259-018-4035-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/18/2018] [Indexed: 12/14/2022]
Abstract
AIM To assess the clinical utility of FDG-PET as a diagnostic aid for differentiating Alzheimer's disease (AD; both typical and atypical forms), dementia with Lewy bodies (DLB), frontotemporal lobar degeneration (FTLD), vascular dementia (VaD) and non-degenerative pseudodementia. METHODS A comprehensive literature search was conducted using the PICO model to extract evidence from relevant studies. An expert panel then voted on six different diagnostic scenarios using the Delphi method. RESULTS The level of empirical study evidence for the use of FDG-PET was considered good for the discrimination of DLB and AD; fair for discriminating FTLD from AD; poor for atypical AD; and lacking for discriminating DLB from FTLD, AD from VaD, and for pseudodementia. Delphi voting led to consensus in all scenarios within two iterations. Panellists supported the use of FDG-PET for all PICOs-including those where study evidence was poor or lacking-based on its negative predictive value and on the assistance it provides when typical patterns of hypometabolism for a given diagnosis are observed. CONCLUSION Although there is an overall lack of evidence on which to base strong recommendations, it was generally concluded that FDG-PET has a diagnostic role in all scenarios. Prospective studies targeting diagnostically uncertain patients for assessing the added value of FDG-PET would be highly desirable.
Collapse
|
35
|
Dodd S, Clarke M, Becker L, Mavergames C, Fish R, Williamson PR. A taxonomy has been developed for outcomes in medical research to help improve knowledge discovery. J Clin Epidemiol 2017; 96:84-92. [PMID: 29288712 PMCID: PMC5854263 DOI: 10.1016/j.jclinepi.2017.12.020] [Citation(s) in RCA: 290] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 12/13/2017] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Abstract
Objectives There is increasing recognition that insufficient attention has been paid to the choice of outcomes measured in clinical trials. The lack of a standardized outcome classification system results in inconsistencies due to ambiguity and variation in how outcomes are described across different studies. Being able to classify by outcome would increase efficiency in searching sources such as clinical trial registries, patient registries, the Cochrane Database of Systematic Reviews, and the Core Outcome Measures in Effectiveness Trials (COMET) database of core outcome sets (COS), thus aiding knowledge discovery. Study Design and Setting A literature review was carried out to determine existing outcome classification systems, none of which were sufficiently comprehensive or granular for classification of all potential outcomes from clinical trials. A new taxonomy for outcome classification was developed, and as proof of principle, outcomes extracted from all published COS in the COMET database, selected Cochrane reviews, and clinical trial registry entries were classified using this new system. Results Application of this new taxonomy to COS in the COMET database revealed that 274/299 (92%) COS include at least one physiological outcome, whereas only 177 (59%) include at least one measure of impact (global quality of life or some measure of functioning) and only 105 (35%) made reference to adverse events. Conclusions This outcome taxonomy will be used to annotate outcomes included in COS within the COMET database and is currently being piloted for use in Cochrane Reviews within the Cochrane Linked Data Project. Wider implementation of this standard taxonomy in trial and systematic review databases and registries will further promote efficient searching, reporting, and classification of trial outcomes.
Collapse
Affiliation(s)
- Susanna Dodd
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool L69 3GS, UK
| | - Mike Clarke
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health Institute for Health Sciences, Northern Ireland Methodology Hub, Queen's University Belfast, Belfast, UK
| | - Lorne Becker
- Department of Family Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Chris Mavergames
- Department of Informatics and Knowledge Management, Cochrane Central Executive, Freiburg, Germany
| | - Rebecca Fish
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK
| | - Paula R Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool L69 3GS, UK.
| |
Collapse
|
36
|
Niimi Y, Mori S, Takeuchi M. A New Procedure for Wrapped-Negative Pressure Wound Therapy for Congestion After Arterialized Venous Flap Surgery. Clin Med Insights Case Rep 2017; 10:1179547617747279. [PMID: 29270041 PMCID: PMC5731612 DOI: 10.1177/1179547617747279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/10/2017] [Indexed: 11/25/2022]
Abstract
Negative pressure wound therapy (NPWT) is a method for treating wound. However, there are no case reports using NPWT for treating congestion after arterialized venous flap. Therefore, this study reported favorable outcomes after using a single-use NPWT system for managing congestion. A 39-year-old man had his index finger caught by a press machine. The finger had a soft tissue defect at the ventral part. An arterialized venous flap taken from the right forearm was transplanted. Perfusion of the flap was favorable, but on postoperative day 5, congestion and the edema of the flap were found. Then, NPWT was initiated. The congestion and edema in the flap were improved without complications such as flap necrosis and wound infection. At 4 months postoperatively, the morphology of the finger was favorable. In this study, NPWT was speculated to force the deeper blood vessels within the flap to dilate with inducing drainage and the simultaneous reduction in excess blood flow to the cortical layer, resulting in the improvement of congestion. Negative pressure wound therapy was used for treating congestion after the transplantation of arterialized venous flap, and the wound was favorably managed.
Collapse
Affiliation(s)
- Yosuke Niimi
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoko Mori
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Masaki Takeuchi
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| |
Collapse
|
37
|
Sebald-Kinder S, Petty JL. Resources for Hematology On and Off the Web. Crit Care Nurs Clin North Am 2017; 29:377-387. [PMID: 28778297 DOI: 10.1016/j.cnc.2017.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/19/2022]
Abstract
Searching the literature can be challenging because of the large volume of information. It can be time consuming to locate and determine what evidence will provide the best health outcomes for patients. In addition, locating hematology information for patients and family members is one of the most challenging of all health care topics. Hematology can be technical and difficult for most people to understand, especially for those with little or no science background and poor reading skills. This article provides guidance on how and where to locate information to address the needs of both clinicians and patients.
Collapse
Affiliation(s)
- Shirley Sebald-Kinder
- Premier Health Learning Institute, Craig Memorial Library, Miami Valley Hospital, One Wyoming Street, Dayton, OH 45409, USA
| | - Janet L Petty
- Patient and Family Education, Premier Health Learning Institute, Craig Memorial Library, Miami Valley Hospital, One Wyoming Street, Dayton, OH 45409, USA.
| |
Collapse
|
38
|
Abstract
Objective: The use of negative pressure wound therapy (NPWT) for post-surgical cardiothoracic, orthopedic, plastic, and obstetric and gynecologic procedures has been described. However, there are no data regarding its use for lower limb bypass incisions. We aimed to investigate the outcomes of NPWT in preventing surgical site infection (SSI) in patients with lower limb arterial bypass incisions. Materials and Methods: We retrospectively used data of 42 patients who underwent lower limb arterial bypass with reversed great saphenous vein between March 2014 and June 2016 and compared conventional wound therapy and NPWT with regard to preventing SSI. Results: Twenty-eight (67%) patients underwent conventional wound therapy and 14 (33%) underwent NPWT. There were no statistical differences regarding patient characteristics and mean SSI risk scores between the two patient groups (13.7% for conventional wound therapy vs. 13.4% for NPWT; P=0.831). In the conventional group, nine instances of SSI (32%) and three (11%) of these required subsequent surgical wound debridement, whereas in the NPWT group, there was no SSI incidence (P=0.019). Secondary outcomes such as the length of hospital stay, 30-day readmission rate, and need for secondary vascular procedures were not statistically different between the two groups. Conclusion: The use of NPWT for lower limb arterial bypass incisions is superior to that of conventional wound therapy because it may prevent SSIs.
Collapse
Affiliation(s)
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Sriram Narayanan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| |
Collapse
|
39
|
Robson B. Studies in using a universal exchange and inference language for evidence based medicine. Semi-automated learning and reasoning for PICO methodology, systematic review, and environmental epidemiology. Comput Biol Med 2016; 79:299-323. [PMID: 27846446 DOI: 10.1016/j.compbiomed.2016.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/28/2016] [Accepted: 10/11/2016] [Indexed: 11/24/2022]
Abstract
The Q-UEL language of XML-like tags and the associated software applications are providing a valuable toolkit for Evidence Based Medicine (EBM). In this paper the already existing applications, data bases, and tags are brought together with new ones. The particular Q-UEL embodiment used here is the BioIngine. The main challenge is one of bringing together the methods of symbolic reasoning and calculative probabilistic inference that underlie EBM and medical decision making. Some space is taken to review this background. The unification is greatly facilitated by Q-UEL's roots in the notation and algebra of Dirac, and by extending Q-UEL into the Wolfram programming environment. Further, the overall problem of integration is also a relatively simple one because of the nature of Q-UEL as a language for interoperability in healthcare and biomedicine, while the notion of workflow is facilitated because of the EBM best practice known as PICO. What remains difficult is achieving a high degree of overall automation because of a well-known difficulty in capturing human expertise in computers: the Feigenbaum bottleneck.
Collapse
Affiliation(s)
- Barry Robson
- Ingine Inc. Delaware, USA, and The Dirac Foundation Clg, Oxfordshire, UK; St. Matthew's University School of Medicine, Cayman Islands, UK.
| |
Collapse
|
40
|
Wittman D, Kovera C, Sullivan M, Rumore MM. Incorporating a Drug Information Consult into a Pharmacy Practice Course to Build Literature Search and Evaluation Skills Through a 3-Stage Model. J Pharm Pract 2016; 30:306-312. [PMID: 27207995 DOI: 10.1177/0897190016637793] [Citation(s) in RCA: 3] [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: 11/15/2022]
Abstract
OBJECTIVE Pharmacy students need to be equipped with skills to research and evaluate literature to effectively apply evidence-based medicine (EBM) in practice. To prepare them, a 3-stage approach to writing a drug information consult (3sDIC) was incorporated into a pharmacy course. The primary objective was to assess students' abilities to retrieve and analyze literature pursuant to a drug information consult. Secondary objectives were to examine feasibility of faculty participation and continuation of the assignment. DESIGN Ninety students were given a clinical scenario about a patient. The assignment consisted of 3 stages incorporating use of the Population, Intervention, Comparison intervention, Outcome (PICO) method and modified systematic approach (MSA) for stage 1, evaluation of primary literature to write a draft for stage 2, and stage 3, the final consult. All 3 stages were reviewed and graded by faculty. ASSESSMENT All students completed the 3sDIC, with no grade failures. The rubric employed by faculty was effective, providing students the opportunity to improve the consult. The 3sDIC was found to be feasible with adequate faculty support. CONCLUSION The 3sDIC, although not a substitute for a complete drug information course, demonstrated a streamlined approach for Pharmacy year 2 (P2) students to acquire and develop drug information skills.
Collapse
Affiliation(s)
- Deborah Wittman
- 1 Department of Pharmacy Practice, Touro College of Pharmacy, New York, NY, USA
| | - Craig Kovera
- 1 Department of Pharmacy Practice, Touro College of Pharmacy, New York, NY, USA.,2 Janssen Pharmaceutical Companies of Johnson & Johnson, Raritan, NJ, USA
| | - Maureen Sullivan
- 1 Department of Pharmacy Practice, Touro College of Pharmacy, New York, NY, USA
| | - Martha M Rumore
- 3 Department of Social, Behavioral & Administrative Pharmacy, Touro College of Pharmacy, New York, NY, USA
| |
Collapse
|
41
|
Knight SR, Morris PJ, Schneeberger S, Pengel LHM. Trial design and endpoints in clinical transplant research. Transpl Int 2016; 29:870-9. [PMID: 26749215 DOI: 10.1111/tri.12743] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/01/2015] [Accepted: 12/30/2015] [Indexed: 12/11/2022]
Abstract
The number of clinical trials in solid organ transplantation is progressively increasing year on year, but the quality of design and reporting still varies considerably. The constraints on organ availability, improving short-term outcomes, ethics and timescales involved in organ transplantation present unique challenges for trials in this field. An understanding of the methodology and potential pitfalls in clinical research is essential both to interpret trial results and to design robust studies. This review summarizes the scope and quality of reporting in existing transplant clinical trials and details aspects of clinical trial methodology with particular relevance to transplantation. We highlight initiatives designed to improve the quality of this process to ensure that the results of clinical trials are robust, well reported and of use in everyday clinical practice.
Collapse
Affiliation(s)
- Simon R Knight
- Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons of England and the London School of Hygiene and Tropical Medicine, University of London, London, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Peter J Morris
- Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons of England and the London School of Hygiene and Tropical Medicine, University of London, London, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Stefan Schneeberger
- Department of Visceral Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Liset H M Pengel
- Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons of England and the London School of Hygiene and Tropical Medicine, University of London, London, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
42
|
Abu-Gharbieh E, Khalidi DA, Baig MR, Khan SA. Refining knowledge, attitude and practice of evidence-based medicine (EBM) among pharmacy students for professional challenges. Saudi Pharm J 2014; 23:162-6. [PMID: 25972736 PMCID: PMC4421086 DOI: 10.1016/j.jsps.2014.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/10/2014] [Indexed: 11/16/2022] Open
Abstract
Practicing evidence based medicine (EBM) is a professional need for the future clinical pharmacist in UAE and around the world. An attempt was made to evaluate pharmacy student’s knowledge, attitude and proficiency in the practice of EBM. A within-subject study design with pre and post survey and skill test were conducted using case based practice of EBM through a validated questionnaire. The results were tabulated and there was a statistically significant increase in pharmacy students’ perceived ability to go through steps of EBM, namely: formulating PICO questions (95.3%), searching for evidence (97%), appraising the evidence (81%), understanding statistics (78.1%), and applying evidence at point of care (81.2%). In this study, workshops and (Problem Based Learning) PBLs were used as a module of EBM teaching and practices, which has been shown to be an effective educational method in terms of improving students’ skills, knowledge and attitude toward EBM. Incorporating hands on experience, PBLs will become an impetus for developing EBM skills and critical appraisal of research evidence alongside routine clinical practice. This integration would constitute the cornerstone in lifting EBM in UAE up to the needed standards and would enable pharmacy students to become efficient pharmacists that rely on evidence in their health practice.
Collapse
Affiliation(s)
- Eman Abu-Gharbieh
- Department of Pharmacology and Toxicology, Dubai Pharmacy College, Dubai, United Arab Emirates
| | - Doaa Al Khalidi
- Department of Clinical Pharmacy and Pharmacy Practice, Dubai Pharmacy College, Dubai, United Arab Emirates
| | - Mirza R Baig
- Department of Clinical Pharmacy and Pharmacy Practice, Dubai Pharmacy College, Dubai, United Arab Emirates
| | - Saeed A Khan
- Department of Pharmaceutical Chemistry and Natural Products, Dubai Pharmacy College, Dubai, United Arab Emirates
| |
Collapse
|
43
|
Hassanzadeh H, Groza T, Hunter J. Identifying scientific artefacts in biomedical literature: the Evidence Based Medicine use case. J Biomed Inform 2014; 49:159-70. [PMID: 24530879 DOI: 10.1016/j.jbi.2014.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/31/2014] [Accepted: 02/01/2014] [Indexed: 11/30/2022]
Abstract
Evidence Based Medicine (EBM) provides a framework that makes use of the current best evidence in the domain to support clinicians in the decision making process. In most cases, the underlying foundational knowledge is captured in scientific publications that detail specific clinical studies or randomised controlled trials. Over the course of the last two decades, research has been performed on modelling key aspects described within publications (e.g., aims, methods, results), to enable the successful realisation of the goals of EBM. A significant outcome of this research has been the PICO (Population/Problem-Intervention-Comparison-Outcome) structure, and its refined version PIBOSO (Population-Intervention-Background-Outcome-Study Design-Other), both of which provide a formalisation of these scientific artefacts. Subsequently, using these schemes, diverse automatic extraction techniques have been proposed to streamline the knowledge discovery and exploration process in EBM. In this paper, we present a Machine Learning approach that aims to classify sentences according to the PIBOSO scheme. We use a discriminative set of features that do not rely on any external resources to achieve results comparable to the state of the art. A corpus of 1000 structured and unstructured abstracts - i.e., the NICTA-PIBOSO corpus - is used for training and testing. Our best CRF classifier achieves a micro-average F-score of 90.74% and 87.21%, respectively, over structured and unstructured abstracts, which represents an increase of 25.48 percentage points and 26.6 percentage points in F-score when compared to the best existing approaches.
Collapse
Affiliation(s)
| | - Tudor Groza
- School of ITEE, The University of Queensland, Australia.
| | - Jane Hunter
- School of ITEE, The University of Queensland, Australia.
| |
Collapse
|
44
|
Dassopoulos T, Sultan S, Falck-Ytter YT, Inadomi JM, Hanauer SB. American Gastroenterological Association Institute technical review on the use of thiopurines, methotrexate, and anti-TNF-α biologic drugs for the induction and maintenance of remission in inflammatory Crohn's disease. Gastroenterology 2013; 145:1464-78.e1-5. [PMID: 24267475 DOI: 10.1053/j.gastro.2013.10.046] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
45
|
Terdiman JP, Gruss CB, Heidelbaugh JJ, Sultan S, Falck-Ytter YT. American Gastroenterological Association Institute guideline on the use of thiopurines, methotrexate, and anti-TNF-α biologic drugs for the induction and maintenance of remission in inflammatory Crohn's disease. Gastroenterology 2013; 145:1459-63. [PMID: 24267474 DOI: 10.1053/j.gastro.2013.10.047] [Citation(s) in RCA: 175] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jonathan P Terdiman
- Division of Gastroenterology, University of California, San Francisco School of Medicine, San Francisco, California
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
Health care reform authorized by the Affordable Care Act is based on the belief that evidence-based practice (EBP) generates cost savings due to the delivery of more effective care. Published meta-analyses and systematic reviews provide clear, unbiased evidence on the effectiveness of specific interventions. Yet translating the interventions into the practice setting requires additional clinical skills and judgments extending beyond the scientific assessment of the EBP literature. Effective use of EBP interventions requires clinicians effectively answering an additional set of questions specific to the case and clinical context. These questions focus on correctly identifying the problem and increased level of specificity for any given situation. Using a clinical application of the PICO model, the clinician and the patient should be able to achieve a higher level of clinical outcomes.
Collapse
Affiliation(s)
- Michael J Rice
- College of Nursing, Anschutz Medical Center, University of Colorado, Aurora, CO 80054, USA.
| |
Collapse
|
47
|
Baudi P, Campochiaro G, Rebuzzi M, Matino G, Catani F. Assessment of bone defects in anterior shoulder instability. Joints 2013; 1:40-48. [PMID: 25785257 PMCID: PMC4362027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Glenohumeral bone defects are a common finding in shoulder instability and they are strongly correlated with recurrence of dislocation and failure following arthroscopic Bankart repair. Most authors agree that open surgery should be considered in the presence of certain conditions: glenoid bone loss > 25%, a lesion involving > 30% of the humeral head, an engaging Hill-Sachs lesion, bipolar bone lesions even without engagement. A careful imaging evaluation must therefore be performed in order to identify, quantify and characterize the bone defects. Even though magnetic resonance has important additional value in the assessment of the glenoid labrum and rotator cuff, computed tomography scan is the examination of choice for studying bone defects. Several methods have been proposed to quantify the extent of the glenoid bone defect; the most accurate ones utilize two-dimensional computed tomography images with multiplanar reconstructions (PICO method) or more sophisticated three-dimensional reconstruction software. Conversely, the literature lacks studies that accurately quantify humeral bone defects and, above all, that demonstrate definitively the clinical and prognostic significance of the lesion location and size.
Collapse
Affiliation(s)
- Paolo Baudi
- Corresponding author: Dr. Paolo Baudi, Orthopedics and Traumatology Unit, Department of Locomotor System Disorders, University Hospital of Modena Via del Pozzo, 71 - 41100 Modena, e-mail:
| | | | | | | | | |
Collapse
|
48
|
Babiker AMI. A review and practical application of evidence based medicine (EBM): Testicular adrenal rest tumour. Sudan J Paediatr 2012; 12:27-35. [PMID: 27493342 PMCID: PMC4949895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Nowadays, Medical practice is largely based on the best available evidence. However, the evidence may not always be readily available and clinician and/or other health allied professionals may need to learn how to search for it. This article gives highlights on the very vast and growing subject of evidence based medicine (EBM), followed by a practical application of searching for it in the real life, in a situation when the available evidence is limited.
Collapse
Affiliation(s)
- Amir M. I. Babiker
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|