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Roth H, Morcos V, Roberts LM, Hanley L, Homer CSE, Henry A. Preferences of Australian healthcare providers regarding education on long-term health after hypertensive disorders of pregnancy: a qualitative study. BMJ Open 2022; 12:e055674. [PMID: 35618327 PMCID: PMC9137339 DOI: 10.1136/bmjopen-2021-055674] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore Australian healthcare providers' (HCPs') preferred content, format and access to education regarding long-term health after hypertensive disorder of pregnancy (HDP), in order to guide the development of education programmes. DESIGN AND SETTING A qualitative study using a framework analysis was undertaken. Registered HCP who were practising in Australia and previously completed a survey about long-term health after HDP were invited to participate. PARTICIPANTS Twenty HCP were interviewed, including midwives, specialist obstetrician/gynaecologists, general practitioners with a diploma in obstetrics and gynaecology, and cardiologists. PRIMARY AND SECONDARY OUTCOME MEASURES Exploration of preferred content, format and distribution of educational material post-HDP. RESULTS Twenty HCP were interviewed in April to May 2020. Four main categories were identified. 'Obtaining evidence-based information for own learning' addressing own learning with preference for multi-disciplinary education, preferably endorsed or facilitated by professional organisations. 'Optimising the referral process from hospital to community health services' was about the need for structured long-term follow-up to transition from hospital to community health and align with HDP guidelines. 'Facilitating women's health literacy' addressed the need for evidence-based, print or web-based material to assist risk discussions with women. 'Seizing educational opportunities' addressed the responsibility of all HCP to identify education opportunities to initiate key health discussions with women. CONCLUSIONS HCP provided ideas on content, format and access of education regarding long-term health post-HDP within the parameters of the Australian healthcare context. This evidence will guide educational developments for HCP on post-HDP health to ensure they can better care for women and families.
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Affiliation(s)
- Heike Roth
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Discipline of Women's Health, University of New South Wales Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Veronica Morcos
- Discipline of Women's Health, University of New South Wales Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Lynne M Roberts
- Discipline of Women's Health, University of New South Wales Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Women's and Children's Health, Saint George Hospital, Kogarah, New South Wales, Australia
| | - Lisa Hanley
- Maternity Consumer, Saint George Hospital, Kogarah, New South Wales, Australia
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Maternal, Child and Adolescent Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Amanda Henry
- Discipline of Women's Health, University of New South Wales Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Women's Health, The George Institute for Global Health, Newtown, New South Wales, Australia
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152
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Keij SM, de Boer JE, Stiggelbout AM, Bruine de Bruin W, Peters E, Moaddine S, Kunneman M, Pieterse AH. How are patient-related characteristics associated with shared decision-making about treatment? A scoping review of quantitative studies. BMJ Open 2022; 12:e057293. [PMID: 35613791 PMCID: PMC9174801 DOI: 10.1136/bmjopen-2021-057293] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To identify what patient-related characteristics have been reported to be associated with the occurrence of shared decision-making (SDM) about treatment. DESIGN Scoping review. ELIGIBILITY CRITERIA Peer-reviewed articles in English or Dutch reporting on associations between patient-related characteristics and the occurrence of SDM for actual treatment decisions. INFORMATION SOURCES COCHRANE Library, Embase, MEDLINE, PsycInfo, PubMed and Web of Science were systematically searched for articles published until 25 March 2019. RESULTS The search yielded 5289 hits of which 53 were retained. Multiple categories of patient characteristics were identified: (1) sociodemographic characteristics (eg, gender), (2) general health and clinical characteristics (eg, symptom severity), (3) psychological characteristics and coping with illness (eg, self-efficacy) and (4) SDM style or preference. Many characteristics showed no association or unclear relationships with SDM occurrence. For example, for female gender positive, negative and, most frequently, non-significant associations were seen. CONCLUSIONS A large variety of patient-related characteristics have been studied, but for many the association with SDM occurrence remains unclear. The results will caution often-made assumptions about associations and provide an important step to target effective interventions to foster SDM with all patients.
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Affiliation(s)
- Sascha M Keij
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Joyce E de Boer
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Wändi Bruine de Bruin
- Schaeffer Center for Health Policy and Economics, Dornsife Department of Psychology, and Price School of Public Policy, University of Southern California, Los Angeles, California, USA
| | - Ellen Peters
- Center for Science Communication Research, School of Journalism and Communication, University of Oregon, Eugene, Oregon, USA
| | - Saïda Moaddine
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Marleen Kunneman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
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153
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Jovarauskaite L, Murphy D, Truskauskaite-Kuneviciene I, Dumarkaite A, Andersson G, Kazlauskas E. Associations between moral injury and ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD among help-seeking nurses: a cross-sectional study. BMJ Open 2022; 12:e056289. [PMID: 35534083 PMCID: PMC9086640 DOI: 10.1136/bmjopen-2021-056289] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate how moral injury (MI), traumatic experiences and daily stressors were related to the symptoms of post-traumatic stress disorder (PTSD) and International Classification of Diseases 11th revision specific complex PTSD (CPTSD) symptoms of disturbances in self-organisation (DSO) in a treatment-seeking sample of nurses. DESIGN A cross-sectional study. SETTING Nurses from all regions of Lithuania participated in the study. The data were collected between April and May 2021. PARTICIPANTS A total of 206 nurses, mean age 42.34 years (SD=11.68), 97.1% women and with 65% >10 years of work experience. RESULTS The prevalence of PTSD and CPTSD in the treatment-seeking sample of nurses was 9.2% and 10.2%, respectively. The results of structural equation modelling indicated an acceptable model fit for the model regarding the links between trauma exposure, daily stressors, MI, PTSD and DSO symptoms, (χ2 (df)=219.718 (123), p<0.001, Comparative Fit Index/Tucker-Lewis Index=0.937/0.922, root mean square error of approximation (90% CI)=0.062 (0.048 to 0.075), standardised root mean square residual=0.049). MI had a large effect on DSO symptoms, β=0.667, p<0.001, and a medium effect on PTSD symptoms, β=0.394, p<0.001. Daily stress but not trauma exposure was significantly related to MI, β=0.618, p<0.001. CONCLUSIONS The prevalence of PTSD and CPTSD in a treatment-seeking sample of nurses inform healthcare administrators, policymakers and medical staff about the demand for psychosocial interventions for healthcare workers focused on stress management to address their daily stressors and mitigate effects on MI or trauma-focused treatments for PTSD/CPTSD. TRIAL REGISTRATION NUMBER NCT04817995; Pre-results.
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Affiliation(s)
- Lina Jovarauskaite
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Dominic Murphy
- King's Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- Combat Stress, Research Department, Tyrwhitt House, Leatherhead, Surrey, UK
| | | | - Austeja Dumarkaite
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Gerhard Andersson
- 4 Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
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154
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Rohrbasser A, Wong G, Mickan S, Harris J. Understanding how and why quality circles improve standards of practice, enhance professional development and increase psychological well-being of general practitioners: a realist synthesis. BMJ Open 2022; 12:e058453. [PMID: 35508344 PMCID: PMC9073411 DOI: 10.1136/bmjopen-2021-058453] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To understand how and why participation in quality circles (QCs) improves general practitioners' (GPs) psychological well-being and the quality of their clinical practice. To provide evidence-informed and practical guidance to maintain QCs at local and policy levels. DESIGN A theory-driven mixed method. SETTING Primary healthcare. METHOD We collected data in four stages to develop and refine the programme theory of QCs: (1) coinquiry with Swiss and European expert stakeholders to develop a preliminary programme theory; (2) realist review with systematic searches in MEDLINE, Embase, PsycINFO and CINHAL (1980-2020) to inform the preliminary programme theory; (3) programme refinement through interviews with participants, facilitators, tutors and managers of QCs and (4) consolidation of theory through interviews with QC experts across Europe and examining existing theories. SOURCES OF DATA The coinquiry comprised 4 interviews and 3 focus groups with 50 European experts. From the literature search, we included 108 papers to develop the literature-based programme theory. In stage 3, we used data from 40 participants gathered in 6 interviews and 2 focus groups to refine the programme theory. In stage 4, five interviewees from different healthcare systems consolidated our programme theory. RESULT Requirements for successful QCs are governmental trust in GPs' abilities to deliver quality improvement, training, access to educational material and performance data, protected time and financial resources. Group dynamics strongly influence success; facilitators should ensure participants exchange knowledge and generate new concepts in a safe environment. Peer interaction promotes professional development and psychological well-being. With repetition, participants gain confidence to put their new concepts into practice. CONCLUSION With expert facilitation, clinical review and practice opportunities, QCs can improve the quality of standard practice, enhance professional development and increase psychological well-being in the context of adequate professional and administrative support. PROSPERO REGISTRATION NUMBER CRD42013004826.
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Affiliation(s)
- Adrian Rohrbasser
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Medical Center, Medbase, Wil, Switzerland
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Sharon Mickan
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Janet Harris
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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155
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Ludvigsson M, Motamedi A, Westerlind B, Swahnberg K, Simmons J. Responding to Elder Abuse in GERiAtric care (REAGERA) educational intervention for healthcare providers: a non-randomised stepped wedge trial. BMJ Open 2022; 12:e060314. [PMID: 35508341 PMCID: PMC9073413 DOI: 10.1136/bmjopen-2021-060314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Elder abuse is prevalent and associated with different forms of ill health. Despite this, healthcare providers are often unaware of abusive experiences among older patients and many lack training about elder abuse. The overall aim of this study is to determine the effectiveness of an educational intervention on healthcare providers' propensity to ask older patients questions about abusive experiences. METHODS AND ANALYSIS Healthcare providers at hospital clinics and primary healthcare centres in Sweden will undergo full-day education about elder abuse between the fall of 2021 and spring of 2023. The education consists of (1) theory and group discussions; (2) forum theatre, a form of interactive theatre in which participants are given the opportunity to practise how to manage difficult patient encounters; and (3) post-training reflection on changing practices.The design is a non-randomised cluster, stepped wedge trial in which all participants (n=750) gradually transit from control group to intervention group with 6-month interval, starting fall 2021. Data are collected using the Responding to Elder Abuse in GERiAtric care-Provider questionnaire which was distributed to all clusters at baseline. All participants will also be asked to answer the questionnaire in conjunction with participating in the education as well as at 6-month and 12-month follow-up. Main outcome is changes in self-reported propensity to ask older patients questions about abuse post-intervention compared with pre-intervention. Linear mixed models including cluster as a random effect will be used to statistically evaluate the outcome. ETHICS AND DISSEMINATION The study has been approved by the Swedish Ethical Review Authority. The results will be published in peer-reviewed journals and conference proceedings. If the intervention is successful, a manual of the course content will be published so that the education can be disseminated to other clinics. TRIAL REGISTRATION NUMBER NCT05065281.
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Affiliation(s)
- Mikael Ludvigsson
- Department of Psychiatry, and Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
- Department of Acute Internal Medicine and Geriatrics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Atbin Motamedi
- Department of Emergency Medicine in Norrköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Björn Westerlind
- Department of Geriatrics, County Hospital Ryhov, Region Jönköping County, Jonkoping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Katarina Swahnberg
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Johanna Simmons
- Department of Acute Internal Medicine and Geriatrics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
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156
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Osula VO, Sanders JE, Chakare T, Mapota-Masoabi L, Ranyali-Otubanjo M, Hansoti B, McCollum ED. COVID-19 advanced respiratory care educational training programme for healthcare workers in Lesotho: an observational study. BMJ Open 2022; 12:e058643. [PMID: 35487754 PMCID: PMC9058317 DOI: 10.1136/bmjopen-2021-058643] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To develop and implement a 'low-dose, high-frequency' (LDHF) advanced respiratory care training programme for COVID-19 care in Lesotho. DESIGN Prospective pretraining-post-training evaluation. SETTING Lesotho has limited capacity in advanced respiratory care. PARTICIPANTS Physicians and nurses. INTERVENTIONS Due to limited participation in May-September 2020, the LDHF approach was modified into a traditional 1-day offsite training in November 2020 that reviewed respiratory anatomy and physiology, clinical principles for conventional oxygen, heated high-flow nasal cannula and non-invasive ventilation management. Basic mechanical ventilation principles were introduced. OUTCOME MEASURES Participants completed a 20-question multiple choice examination immediately before and after the 1-day training. Paired t-tests were used to evaluate the difference in average participant pretraining and post-training examination scores. RESULTS Pretraining and post-training examinations were completed by 46/53 (86.7%) participants, of whom 93.4% (n=43) were nurses. The overall mean pretraining score was 44.8% (SD 12.4%). Mean scores improved by an average of 23.7 percentage points (95% CI 19.7 to 27.6, p<0.001) on the post-training examination to a mean score of 68.5% (SD 13.6%). Performance on basic and advanced respiratory categories also improved by 17.7 (95% CI 11.6 to 23.8) and 25.6 percentage points (95% CI 20.4 to 30.8) (p<0.001). Likewise, mean examination scores increased on the post-training test, compared with pretraining, for questions related to respiratory management (29.6 percentage points, 95% CI 24.1 to 35.0) and physiology (17.4 percentage points, 95% CI 12.0 to 22.8). CONCLUSIONS An LDHF training approach was not feasible during this early emergency period of the COVID-19 pandemic in Lesotho. Despite clear knowledge gains, the modest post-training examination scores coupled with limited physician engagement suggest healthcare workers require alternative educational strategies before higher advanced care like mechanical ventilation is implementable. Conventional and high-flow oxygen is better aligned with post-training healthcare worker knowledge levels and rapid implementation.
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Affiliation(s)
- Valerie O Osula
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | - Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric D McCollum
- Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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157
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Kim IC, Lee JH, Choi DJ, Park SJ, Lee JH, Park SM, Kim M, Kim HL, Lee S, Kim IJ, Choi S, Bang J, Ali B, Hussain M, Ali T, Lee S. Rationale design and efficacy of a smartphone application for improving self-awareness of adherence to edoxaban treatment: study protocol for a randomised controlled trial (adhere app). BMJ Open 2022; 12:e048777. [PMID: 35477876 PMCID: PMC9047822 DOI: 10.1136/bmjopen-2021-048777] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION High adherence to oral anticoagulants is essential for stroke prevention in patients with atrial fibrillation (AF). We developed a smartphone application (app) that pushes alarms for taking medication and measuring blood pressure (BP) and heart rate (HR) at certain times of the day. In addition to drug alarms, the habit of measuring one's BP and HR may reinforce drug adherence by improving self-awareness of the disease. This pilot study aims to test the feasibility and efficacy of the smartphone app-based intervention for improving drug adherence in patients with AF. METHODS AND ANALYSIS A total of 10 university hospitals in Korea will participate in this randomised control trial. Patients with AF, being treated with edoxaban for stroke prevention will be included in this study. Total of 500 patients will be included and the patients will be randomised to the conventional treatment group (250 patients) and the app conditional feedback group (250 patients). Patients in the app conditional feedback group will use the medication reminder app for medication and BP check alarms. The automatic BP machine will be linked to the smartphone via Bluetooth. The measured BP and HR will be updated automatically on the smartphone app. The primary endpoint is edoxaban adherence by pill count measurement at 3 and 6 months of follow-up. Secondary endpoints are clinical composite endpoints including stroke, systemic embolic event, major bleeding requiring hospitalisation or transfusion, or death during the 6 months. As of 24t November 2021, 80 patients were enrolled. ETHICS AND DISSEMINATION This study was approved by the Seoul National University Bundang Hospital Institutional Review Board and will be conducted according to the principles of the Declaration of Helsinki. The study results will be published in a reputable journal. TRIAL REGISTRATION NUMBER KCT0004754.
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Affiliation(s)
- In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital,Keimyung University School of Medicine, Daegu, Korea
| | - Ji Hyun Lee
- Division of Cardiology and Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong-Ju Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sang Min Park
- Department of Cardiology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Korea
| | - Mina Kim
- Division of Cardiology, Korea University College of Medicine, Seoul, Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sunki Lee
- Division of Cardiology, Hallym University College of Medicine, Gyunggi-do, Korea
| | - In Jai Kim
- Department of Internal Medicine, Bundang CHA Medical Center, CHA University, Seongnam, Korea
| | - Seonghoon Choi
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Jaehun Bang
- Department of Computer Science and Engineering, Kyung Hee University, Yongin, Korea
| | - Bilal Ali
- Department of Computer Science and Engineering, Kyung Hee University, Yongin, Korea
| | - Musarrat Hussain
- Department of Computer Science and Engineering, Kyung Hee University, Yongin, Korea
| | - Taqdir Ali
- Department of Computer Science and Engineering, Kyung Hee University, Yongin, Korea
| | - Sungyoung Lee
- Department of Computer Science and Engineering, Kyung Hee University, Yongin, Korea
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158
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Jang A, Song CE. Internet of things platform technology used in undergraduate nursing student education: a scoping review protocol. BMJ Open 2022; 12:e058556. [PMID: 35440461 PMCID: PMC9020300 DOI: 10.1136/bmjopen-2021-058556] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Future nursing education needs to build a cutting-edge technology-based educational environment to provide a variety of consumer-oriented education. Thus, the sharing of information in nursing education needs to be considered, especially given the advancement of internet of things (IoT) technology. Before developing a horizontal platform, understanding previously developed IoT platforms is necessary to establish services and devices compatible with each other in different service areas. This scoping review aims to explore the technology used in the IoT platform for the education of nursing students in the undergraduate nursing curriculum. METHODS AND ANALYSIS A preliminary search was completed to find initial search terms, on which a full-search strategy was developed. Search results yielded from PubMed (NCBI) were screened to ensure articles were peer-reviewed, published in English from January 1999 to August 2021, and relevant to developing, applying and evaluating IoT platforms at educational institutions for students in undergraduate nursing programmes. A full-text review of relevant articles will be conducted, and data will be extracted using the developed extraction tool. The extracted qualitative data will be analysed using a modified grounded theory approach, informing a working definition of the IoT platform and related terms. ETHICS AND DISSEMINATION The study was exempted from ethical review by the Institutional Review Board of Nambu University, South Korea. Study results will be disseminated through peer-reviewed journals.
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Affiliation(s)
- A Jang
- Department of Nursing, Nambu University, Gwangju, Korea (the Republic of)
| | - C E Song
- Department of Nursing, Nambu University, Gwangju, Korea (the Republic of)
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159
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Truong AT, Winman T, Ekström-Bergström A. Studying intraprofessional and interprofessional learning processes initiated by an educational intervention applying a qualitative design with multimethod approach: a study protocol. BMJ Open 2022; 12:e058779. [PMID: 35437255 PMCID: PMC9016398 DOI: 10.1136/bmjopen-2021-058779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Interprofessional collaboration in education and practice has been highlighted as a premise for providing good care. Both the intraprofessional and interprofessional impacts have bearing on healthcare professionals' performance and learning. Likewise, from the perspective of work-integrated learning, intraprofessional and interprofessional learning play an enduring part in studies about the development of healthcare organisations and professional competence. Educational-intervention research has become significant, which may indicate challenges the healthcare, for example, the area of disabilities is confronting. Earlier studies on intraprofessional and interprofessional learning have often focused on the learning outcome, whereas the learning process remains unexplored. The learning process is complex and is normally influenced by several factors. Therefore, develop knowledge about the intraprofessional and interprofessional learning processes initiated by an educational-intervention and the factors influencing this process may contribute to educational-intervention research, which is also the aim of the forthcoming study. METHODS AND ANALYSIS An inductive qualitative study design with interpretivism as the epistemological stand will be applied. Professionals in healthcare services for people with intellectual disabilities in four residential settings in Sweden are included in the educational-intervention based on web-based training and structured group reflections. Intended data collections are videorecordings of group reflections and individual interviews. An ethnomethodological approach will be applied for studying the details of conversation and interaction in group reflections. The interviews will be analysed using qualitative content analysis to gain participants' viewpoints of the intervention. ETHICS AND DISSEMINATION Approval was obtained from the Swedish Ethical Review Authority, Dnr 35 517. In Addition, a supplemental application to the extended part of the intervention in the forthcoming study has been submitted and approval was received on 21 September 2021. Ethical principles following the Declaration of Helsinki will be strictly followed. TRIAL REGISTRATION NUMBER NCT03390868; Post-results.
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Affiliation(s)
- Anh Thuc Truong
- Department of Health Science, University West, Trollhattan, Sweden
| | - Thomas Winman
- Department of Economy and IT, University West, Trollhattan, Sweden
| | - Anette Ekström-Bergström
- Department of Health Science, University West, Trollhattan, Sweden
- Research Group Family Centerd Health (FamCeH), University of Skövde, Skovde, Sweden
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160
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Torlén Wennlund K, Kurland L, Olanders K, Khoshegir A, Kamil HA, Castrén M, Bohm K. Emergency medical dispatchers' experiences of managing emergency calls: a qualitative interview study. BMJ Open 2022; 12:e059803. [PMID: 35418440 PMCID: PMC9014079 DOI: 10.1136/bmjopen-2021-059803] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To explore the emergency medical dispatchers (EMDs) experiences of managing emergency medical calls. DESIGN A qualitative interview study with an inductive approach. EMDs were interviewed individually using a semistructured interview guide. The verbatim transcripts were analysed using a qualitative content analysis. SETTING EMDs, without a professional background as registered nurses, were recruited from emergency medical communication centers (EMCCs) within Sweden. PARTICIPANTS To achieve a varied description of EMDs' experiences, participants were included from several EMCCs nationally, using a convenience sampling. Interviews were performed up until saturation of data, resulting in 13 EMDs from 7 EMCCs being interviewed. All the EMDs were women, ranging in age from 28 to 61 years (mean 42 years), and had worked in emergency medical dispatching between 1 and 13.5 years (mean 6.5 years). RESULTS The analysis revealed the main category-to attentively manage a multifaceted, interactive task-made up of three categories: utilize creativity to gather information, continuously process and assess complex information, and engage in the professional role. The content of each category was reflected in several subcategories further described and illustrated with representative quotes. CONCLUSIONS Managing emergency medical calls was experienced by EMDs to attentively manage a multifaceted interactive task. Core parts were described as: the ability to utilize creativity to gather information, continuously process and asses complex information, and engage in the professional role. Our results could be beneficial for emergency care managers when designing training programmes and organising EMD work and the EMD work environment, including further development of dispatch protocols and implementation of regular feedback sessions. Moreover, the results indicate that aspects such as self-awareness and emotional challenges encountered during EMD work could be important matters to discuss during staff evaluations.
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Affiliation(s)
- Klara Torlén Wennlund
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Lisa Kurland
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - Knut Olanders
- Department of Intensive and Perioperative Care, Skåne University Hospital Lund, Lund, Sweden
| | - Amanda Khoshegir
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Hussein Al Kamil
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Maaret Castrén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Department of Emergency Medicine, University of Helsinki, Helsinki, Finland
| | - Katarina Bohm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Emergency Department, Södersjukhuset, Stockholm, Sweden
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Jankowski S, Boutron I, Clarke M. Influence of the statistical significance of results and spin on readers' interpretation of the results in an abstract for a hypothetical clinical trial: a randomised trial. BMJ Open 2022; 12:e056503. [PMID: 35396295 PMCID: PMC8996040 DOI: 10.1136/bmjopen-2021-056503] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the impact on readers' interpretation of the results reported in an abstract for a hypothetical clinical trial with (1) a statistically significant result (SSR), (2) spin, (3) both an SSR and spin compared with (4) no spin and no SSR. PARTICIPANTS Health students and professionals from universities and health institutions in France and the UK. INTERVENTIONS Participants completed an online questionnaire using Likert scales and free text, after reading one of the four versions of an abstract about a hypothetical randomised trial evaluating 'Naranex' and 'Bulofil' (two hypothetical drugs) for chronic low back pain. The abstracts differed in (1) reported result of 'mean difference of 1.31 points (95% CI 0.08 to 2.54, p= 0.04)' or 'mean difference of 1.31 points (95% CI -0.08 to 2.70, p= 0.06)' and (2) presence or absence of spin. The effect size for the trial's primary outcome (pain disability score) was the same in each abstract, slightly in favour of Naranex. PRIMARY OUTCOME The reader's interpretation of the trial's results, based on their answer (1, disagree; 4, neutral; 7, agree) to the following statement: 'About the main findings of the study, what is your opinion about the following statement: 'Naranex is better than Bulofil'?' RESULTS Two hundred and ninety-seven of the 404 people randomised to receive one of the four abstracts completed the study. Respondents were more likely to favour Narenex when the abstract reported an SSR without spin, a statistically significant result with spin, a non-statistically significant result with spin, compared with when it reported a non-SSR without spin. CONCLUSION Statistical significance appears to have influenced readers' perception whatever the level of spin, while spin influenced readers' perception when the results were not statistically significant but did not appear to have an impact when results were statistically significant.
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Affiliation(s)
- Sofyan Jankowski
- Université Paris Cité, INSERM, INRAE, CNAM, Centre for Research in Epidemiology and Statistics (CRESS), F-75004, Paris, France
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Isabelle Boutron
- Université Paris Cité, INSERM, INRAE, CNAM, Centre for Research in Epidemiology and Statistics (CRESS), F-75004, Paris, France
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Abstract
OBJECTIVE This study aimed to assess COVID-19 preventive behaviours and their associated factors among university students. METHODS An institution-based cross-sectional study was employed among 405 university students and the study participants were chosen using a stratified simple random selection procedure. A pretested self-administered questionnaire was used to assess participants' perception of and preventive behaviour towards COVID-19. A multivariable logistic regression analysis was employed to identify factors associated with COVID-19 preventive behaviour. RESULT A total of 405 students participated in this study with a response rate of 97.4%. The mean age of the participants was 23.6 (SD ±2.4, range 19-30) years. Two hundred and twenty of the participants (45.7% with 95% CI 41.0% to 51.0%) had good preventive behaviour towards COVID-19. COVID-19 preventive behaviour was significantly associated with age (adjusted OR (AOR)=1.1, 95% CI 1.00 to 1.2), female sex (AOR=1.6, 95% CI 1.02 to 2.60), knowing anyone infected with COVID-19 (AOR=4.05, 95% CI 1.9 to 8.8), participants who had high perceived susceptibility (AOR=2.14, 95% CI 1.44 to 3.35) and participants who were enrolled in health programmes (AOR=4.23, 95% CI 2.6 to 7.0). CONCLUSION AND RECOMMENDATION The overall COVID-19 preventive behaviour among university students is unsatisfactory. Students' COVID-19 preventive behaviour was influenced by age, sex, knowing a COVID-19 infected person, perceived susceptibility and the sort of programme in which they had enrolled. The findings revealed that health communication interventions aimed at changing people's perceptions of COVID-19 and related prevention strategies are urgently needed to improve this population's COVID-19 preventive behaviour.
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Affiliation(s)
- Menen Tsegaw
- Department of Public Health, Ambo University College of Medicine and Public Health, Ambo, Oromia, Ethiopia
| | - Bezawit Mulat
- Department of Human Physiology, college of Medicine and Health sciences,University of Gondar, Gondar, Ethiopia
| | - Kegnie Shitu
- Department of Health Education and Behavioral Sciences, University of Gondar, Gondar, Ethiopia
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Miller H, Seckel E, White CL, Sanchez D, Rubesova E, Mueller C, Bianco K. Gender-based salary differences in academic medicine: a retrospective review of data from six public medical centers in the Western USA. BMJ Open 2022; 12:e059216. [PMID: 35393330 PMCID: PMC8991058 DOI: 10.1136/bmjopen-2021-059216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES We assessed the effect of gender, rank and research productivity on compensation for faculty at academic medical centres. DESIGN A web-based retrospective review of salary for professors in 2016. SETTING Faculty from six state-run, publicly funded academic medical centres in the Western USA. PARTICIPANTS 799 faculty members, 225 assistant (51% women), 200 associate (40% women) and 374 full professors (32% women) from general surgery (26% women), obstetrics and gynaecology (70% women) and radiology (34% women). METHODS Archived online faculty profiles were reviewed for gender, rank and compensation (total, baseline and supplemental). Total compensation was defined as baseline compensation plus supplemental income. Baseline compensation was defined as base salary minus reductions due to participation in the voluntary Employee Reduction in Time and phased retirement programmes. Supplemental income was defined as additional salary for clinical care and research (eg, grants). Elsevier's Scopus was used to collect data on h-index, a measure of research productivity. Linear regression models were estimated to determine the relationship between these factors and salary. RESULTS Total compensation was significantly higher for men across all professorial ranks in both general surgery [Formula: see text] and obstetrics and gynaecology [Formula: see text]. Women faculty members within these departments earned almost US$75 000 less than their men colleagues. The disparity in salary originates from gaps in supplemental income, as baseline compensation was not significantly different between men and women. No significant gender difference in total compensation for radiology was found [Formula: see text]. Higher h-index was associated with higher baseline compensation across all departments as well as with supplemental income for general surgery. Higher h-index was related to lower supplemental income for radiology and was not related to supplemental income for obstetrics and gynaecology. CONCLUSIONS Further investigations should focus on discrepancies in supplemental income, which may preferentially benefit men.
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Affiliation(s)
- Hayley Miller
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
| | - Elizabeth Seckel
- Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Chrislyn L White
- Obstetrics & Gynecology, Kaiser Permanente San Leandro Medical Center, San Leandro, California, USA
| | - Diana Sanchez
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Erika Rubesova
- Department of Radiology, Stanford University, Palo Alto, California, USA
| | - Claudia Mueller
- Department of Surgery, Stanford University, Palo Alto, California, USA
| | - Katherine Bianco
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
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Cormi C, Parpex G, Julio C, Ecarnot F, Laplanche D, Vannieuwenhuyse G, Duclos A, Sanchez S. Understanding the surgeon's behaviour during robot-assisted surgery: protocol for the qualitative Behav'Robot study. BMJ Open 2022; 12:e056002. [PMID: 35393313 PMCID: PMC8991054 DOI: 10.1136/bmjopen-2021-056002] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Robot-assisted surgery is spreading worldwide, accounting for more than 1.2 million procedures in 2019. Data are sparse in the literature regarding the surgeon's mechanisms that mediate risk-taking during a procedure, especially robot-assisted. This study aims to describe and understand the behaviour of the surgeons during robot-assisted surgery and the change in their behaviour with increasing experience in using the robot. METHODS AND ANALYSIS This is a qualitative study using semistructured interviews with surgeons who perform robot-assisted surgery. An interview guide comprising open questions will be used to ensure that the points to be discussed are systematically addressed during each interview (ie, (1) difference in behaviour and preparation of the surgeon between a standard procedure and a robot-assisted procedure; (2) the influence of proprioceptive modifications, gain in stability and cognitive biases, inherent in the use of a surgical robot and (3) the intrinsic effect of the learning curve on the behaviour of the surgeons. After transcription, interviews will be analysed with the help of NVivo software, using thematic analysis. ETHICS AND DISSEMINATION Since this project examines professional practices in the field of social and human sciences, ethics committee was not required in accordance with current French legislation (Decree no 2017-884, 9 May 2017). Consent from the surgeons is implied by the fact that the interviews are voluntary. Surgeons will nonetheless be informed that they are free to interrupt the interview at any time.Results will be presented in peer-reviewed national and international congresses and submitted to peer-reviewed journals for publication. The communication and publication of the results will be placed under the responsibility of the principal investigator and publications will be prepared in compliance with the ICMJE uniform requirements for manuscripts. TRIAL REGISTRATION NUMBER NCT04869995.
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Affiliation(s)
- Clément Cormi
- Pôle Territorial Santé Publique et Performance des Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, Troyes, France
- LIST3N/Tech-CICO, Université de Technologie de Troyes, Troyes, France
| | - Guillaume Parpex
- Department of Gynecology Obstetrics II and Reproductive Medicine, Hôpital Cochin, Paris, France
| | - Camille Julio
- Department of Digestive Surgery, Hôpital Saint-Louis, Paris, France
| | - Fiona Ecarnot
- EA3920, Burgundy Franche-Comté University, Besancon, France
| | - David Laplanche
- Pôle Territorial Santé Publique et Performance des Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, Troyes, France
| | - Geoffrey Vannieuwenhuyse
- Département de chirurgie gynécologique, mammaire et carcinologique, Centre Hospitalier de Troyes, Troyes, France
| | - Antoine Duclos
- Health Data Department, Hospices Civils de Lyon, Lyon, France
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, Lyon, France
| | - Stéphane Sanchez
- Pôle Territorial Santé Publique et Performance des Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, Troyes, France
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den Bakker CR, Ommering BW, van Leeuwen TN, Dekker FW, De Beaufort AJ. Assessing publication rates from medical students' mandatory research projects in the Netherlands: a follow-up study of 10 cohorts of medical students. BMJ Open 2022; 12:e056053. [PMID: 35379628 PMCID: PMC8981330 DOI: 10.1136/bmjopen-2021-056053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The medical field is facing a clinician-scientist shortage. Medical schools could foster the clinician-scientist workforce by offering students research opportunities. Most medical schools offer elective research programmes. Subsequently, a subset of doctors graduates without any research experience. Mandatory research projects may be more sufficient to develop clinician-scientist, but take more supervision and curricular time. There is limited insight in the scientific outcomes of mandatory research experiences. This study aims to examine publication rates of a mandatory research experience, identify factors associated with publication, and includes postgraduate research engagement. DESIGN AND SETTING Prospective follow-up study involving 10 cohorts of medical students' mandatory research projects from Leiden University Medical Center. PARTICIPANTS All medical students who conducted their research project between 2008 and 2018 (n=2329) were included. MAIN OUTCOME MEASURE Publication rates were defined as peer-reviewed scientific publications, including research papers, reviews, and published meeting abstracts. Postgraduate research engagement was defined as research participation and dissemination of research at scientific conferences or in journals. RESULTS In total, 644 (27.7%) of all mandatory research experiences resulted in publication, with students mainly as first (n=984, 42.5%) or second author (n=587, 25.3%) and above world average citation impact (mean normalised journal score 1.29, mean normalised citation score 1.23). Students who conducted their research in an academic centre (adjusted OR 2.82; 95% CI 2.10 to 3.77), extended their research (adjusted OR 1.73; 95% CI 1.35 to 2.20), were involved in an excellency track (adjusted OR 2.08; 95% CI 1.44 to 3.01), or conducted clinical (adjusted OR 2.08; 95% CI 1.15 to 3.74) or laboratory (adjusted OR 2.16; 95% CI 1.16 to 4.01) research published their research more often. Later as junior doctors, this group significantly more often disseminate their research results at scientific conferences (adjusted OR 1.89; 95% CI 1.11 to 3.23) or in journals (adjusted OR 1.98; 95% CI 1.14 to 3.43). CONCLUSIONS Our findings suggest that a significant subset of hands-on mandatory research projects with flexible learning pathways result in tangible research output with proper impact and that such successful experiences can be considered as diving board towards a research-oriented career.
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Affiliation(s)
- Charlotte R den Bakker
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Belinda Wc Ommering
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Thed N van Leeuwen
- Centre for Science and Technology Studies, Leiden University, Leiden, The Netherlands
| | - Friedo W Dekker
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arnout Jan De Beaufort
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
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Haynes NA, Saint-Joy V, Swain J, Ezekwesili A, Vernet FV, Dawson C, Laneau D, Tierney A, Shea JA, Ambrose MS. Implementation of a virtual international cardiology curriculum to address the deficit of cardiovascular education in Haiti: a pilot study. BMJ Open 2021; 11:e048690. [PMID: 34155081 PMCID: PMC8217944 DOI: 10.1136/bmjopen-2021-048690] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide, conferring a disparate burden on low-income and middle-income countries (LMICs). Haiti represents a resource-constrained setting, limited by a paucity of resources and trained cardiovascular professionals equipped to address the increasing burden of CVD. OBJECTIVE Here, we describe the creation of a comprehensive cardiology curriculum delivered through a virtual classroom. The curriculum was created to augment cardiovascular education in LMICs such as Haiti. METHODS Over one academic year (May 2019-2020), International Cardiology Curriculum Accessible by Remote Distance Learning-Haiti consisted of biweekly, live-streamed, synchronous didactic lectures, seminars and case presentations broadcasted to 16 internal medicine (IM) residents at Hôpital Universitaire de Mirebalais, one of only four IM training programmes in Haiti. The virtual classroom was created using commercially available videoconferencing and data-sharing platforms. Prelecture and postlecture surveys and an end of the year survey were administered to assess the impact of the curriculum. RESULTS Participant performance analysis revealed that 80% of the curriculum demonstrated a positive trend in knowledge acquisition postintervention. Based on the end of the year evaluation, 94% of participants reported that the curriculum was educational and relevant to medical practice in Haiti and 100% reported that the curriculum was good to excellent. Additionally, the curriculum was cited as an effective means of maintaining trainee education during the COVID-19 pandemic. CONCLUSION This international medical education pilot study demonstrates the feasibility of augmenting cardiology education in LMICs by creating a virtual curriculum made possible by local partnerships, internet access and technology.
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Affiliation(s)
| | - Veauthyelau Saint-Joy
- Cardiology, Centre Hospitalier d Antibes Juan les Pins, Antibes, Provence-Alpes-Côte d'Azu, France
| | - JaBaris Swain
- Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Agnes Ezekwesili
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Fritz Verly Vernet
- Internal Medicine, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Calixte Dawson
- Internal Medicine, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Davidson Laneau
- Internal Medicine, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Ann Tierney
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Judy A Shea
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Albarqouni L, Glasziou P, Bakhit M, Del Mar C, Hoffmann TC. Development of a contemporary evidence-based practice workshop for health professionals with a focus on pre-appraised evidence and shared decision-making: a before-after pilot study. BMJ Evid Based Med 2020; 25:1-2. [PMID: 31471315 DOI: 10.1136/bmjebm-2019-111220] [Citation(s) in RCA: 4] [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] [Accepted: 08/21/2019] [Indexed: 11/04/2022]
Abstract
Shared decision-making (SDM) has emerged as a key skill to assist clinicians in applying evidence-based practice (EBP). We aimed to develop and pilot a new approach to teaching EBP, which focuses on teaching knowledge and skills about SDM and pre-appraised evidence. We designed a half-day workshop, informed by an international consensus on EBP core competencies and invited practicing clinicians to participate. Skills in SDM and communicating evidence were assessed by audio-recording consultations between clinicians and standardised patients (immediately pre-workshop and post-workshop). These were rated by two independent assessors using the OPTION (Observing Patient Involvement, 0 to 100 points) and ACEPP (Assessing Communication about Evidence and Patient Preferences, 0 to 5 points) tools. Participants also completed a feedback questionnaire (9 Likert scale and four open-ended questions). Fourteen clinicians participated. Skills in SDM and communicating research evidence improved from pre-workshop to post-workshop (mean increase in OPTION score=5.5, 95% CI 1.0 to 9.9; increase in ACEPP score=0.5, 95% CI 0.02 to 1.06). Participant feedback was positive, with most indicating 'agree' or 'strongly agree' to the questions. A contemporary approach to teaching clinicians EBP, with a focus on SDM and pre-appraised evidence, was feasible, perceived as useful, and showed modest improvements in skills. Results should be interpreted cautiously because of the small study size and pre-post design.
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Affiliation(s)
- Loai Albarqouni
- The Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
| | - Paul Glasziou
- The Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
| | - Mina Bakhit
- The Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
| | - Chris Del Mar
- The Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
| | - Tammy C Hoffmann
- The Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
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Sam AH, Westacott R, Gurnell M, Wilson R, Meeran K, Brown C. Comparing single-best-answer and very-short-answer questions for the assessment of applied medical knowledge in 20 UK medical schools: Cross-sectional study. BMJ Open 2019; 9:e032550. [PMID: 31558462 PMCID: PMC6773319 DOI: 10.1136/bmjopen-2019-032550] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The study aimed to compare candidate performance between traditional best-of-five single-best-answer (SBA) questions and very-short-answer (VSA) questions, in which candidates must generate their own answers of between one and five words. The primary objective was to determine if the mean positive cue rate for SBAs exceeded the null hypothesis guessing rate of 20%. DESIGN This was a cross-sectional study undertaken in 2018. SETTING 20 medical schools in the UK. PARTICIPANTS 1417 volunteer medical students preparing for their final undergraduate medicine examinations (total eligible population across all UK medical schools approximately 7500). INTERVENTIONS Students completed a 50-question VSA test, followed immediately by the same test in SBA format, using a novel digital exam delivery platform which also facilitated rapid marking of VSAs. MAIN OUTCOME MEASURES The main outcome measure was the mean positive cue rate across SBAs: the percentage of students getting the SBA format of the question correct after getting the VSA format incorrect. Internal consistency, item discrimination and the pass rate using Cohen standard setting for VSAs and SBAs were also evaluated, and a cost analysis in terms of marking the VSA was performed. RESULTS The study was completed by 1417 students. Mean student scores were 21 percentage points higher for SBAs. The mean positive cue rate was 42.7% (95% CI 36.8% to 48.6%), one-sample t-test against ≤20%: t=7.53, p<0.001. Internal consistency was higher for VSAs than SBAs and the median item discrimination equivalent. The estimated marking cost was £2655 ($3500), with 24.5 hours of clinician time required (1.25 s per student per question). CONCLUSIONS SBA questions can give a false impression of students' competence. VSAs appear to have greater authenticity and can provide useful information regarding students' cognitive errors, helping to improve learning as well as assessment. Electronic delivery and marking of VSAs is feasible and cost-effective.
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Affiliation(s)
- Amir H Sam
- Faculty of Medicine, Imperial College London, London, UK
| | - Rachel Westacott
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Mark Gurnell
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Rebecca Wilson
- Faculty of Medicine, Imperial College London, London, UK
| | - Karim Meeran
- Faculty of Medicine, Imperial College London, London, UK
| | - Celia Brown
- Warwick Medical School (WMS), The University of Warwick, Coventry, UK
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Moore KJ, Candy B, Davis S, Gola A, Harrington J, Kupeli N, Vickerstaff V, King M, Leavey G, Nazareth I, Omar RZ, Jones L, Sampson EL. Implementing the compassion intervention, a model for integrated care for people with advanced dementia towards the end of life in nursing homes: a naturalistic feasibility study. BMJ Open 2017; 7:e015515. [PMID: 28694253 PMCID: PMC5541605 DOI: 10.1136/bmjopen-2016-015515] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Many people with dementia die in nursing homes, but quality of care may be suboptimal. We developed the theory-driven 'Compassion Intervention' to enhance end-of-life care in advanced dementia. OBJECTIVES To (1) understand how the Intervention operated in nursing homes in different health economies; (2) collect preliminary outcome data and costs of an interdisciplinary care leader (ICL) to facilitate the Intervention; (3) check the Intervention caused no harm. DESIGN A naturalistic feasibility study of Intervention implementation for 6 months. SETTINGS Two nursing homes in northern London, UK. PARTICIPANTS Thirty residents with advanced dementia were assessed of whom nine were recruited for data collection; four of these residents' family members were interviewed. Twenty-eight nursing home and external healthcare professionals participated in interviews at 7 (n=19), 11 (n=19) and 15 months (n=10). INTERVENTION An ICL led two core Intervention components: (1) integrated, interdisciplinary assessment and care; (2) education and support for paid and family carers. DATA COLLECTED Process and outcome data were collected. Symptoms were recorded monthly for recruited residents. Semistructured interviews were conducted at 7, 11 and 15 months with nursing home staff and external healthcare professionals and at 7 months with family carers. ICL hours were costed using Department of Health and Health Education England tariffs. RESULTS Contextual differences were identified between sites: nursing home 2 had lower involvement with external healthcare services. Core components were implemented at both sites but multidisciplinary meetings were only established in nursing home 1. The Intervention prompted improvements in advance care planning, pain management and person-centred care; we observed no harm. Six-month ICL costs were £18 255. CONCLUSIONS Implementation was feasible to differing degrees across sites, dependent on context. Our data inform future testing to identify the Intervention's effectiveness in improving end-of-life care in advanced dementia. TRIAL REGISTRATION ClinicalTrials.gov:NCT02840318: Results.
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Affiliation(s)
- Kirsten J Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Sarah Davis
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Anna Gola
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Jane Harrington
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health & Wellbeing, University of Ulster, Derry Londonderry, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, UK
| | - Rumana Z Omar
- Department of Statistical Science, University College London, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
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Abstract
BACKGROUND Physicians working in prehospital care are expected to handle radio communication both within their own sector as well as with other divisions of the National Emergency Services. To date, no study has been conducted on the level of training received by physicians in the use of the equipment provided or on the level of competency acquired by physicians. METHODS In order to investigate the self-assessed skill level acquired in the use of the TETRA (TErrestrial Trunked RAdio) authority radio for communication in a prehospital setting, a cross-sectional study was conducted by questionnaire circulated to all 454 physicians working in the Danish Emergency Medical Services. RESULTS A lack of training was found among physicians working in prehospital care in Denmark in relation to the proper use of essential communication equipment. Prior to starting their first shift in a prehospital setting 38% of physicians reported having received no training in the use of the equipment, while 80% of physicians reported having received one1 hour of training or less. Among the majority of physicians their current level of training was sufficient for their everyday needs for prehospital communication but for 28% of physicians their current level of training was insufficient as they were unable to handle communication at this level. CONCLUSION As the first study in its field, this study investigated the training received in the use of essential communication equipment among physicians working in prehospital care in Denmark. The study found that competency does not appear to have been prioritised as highly as other technical skills needed to function in these settings. For the majority of physicians their current level of training was sufficient for everyday use but for a substantial minority further training is required, especially if the redundancy of the prehospital system is to be preserved.
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Affiliation(s)
- Jimmy Højberg Holm
- Department of Anesthesiology and Intensive Care, Mobile Emergency Care Unit, Odense University Hospital, Odense, Denmark
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
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171
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Ginsburg LR, Dhingra-Kumar N, Donaldson LJ. What stage are low-income and middle-income countries (LMICs) at with patient safety curriculum implementation and what are the barriers to implementation? A two-stage cross-sectional study. BMJ Open 2017; 7:e016110. [PMID: 28619782 PMCID: PMC5726095 DOI: 10.1136/bmjopen-2017-016110] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES The improvement of safety in healthcare worldwide depends in part on the knowledge, skills and attitudes of staff providing care. Greater patient safety content in health professional education and training programmes has been advocated internationally. While WHO Patient Safety Curriculum Guides (for Medical Schools and Multi-Professional Curricula) have been widely disseminated in low-income and middle-income countries (LMICs) over the last several years, little is known about patient safety curriculum implementation beyond high-income countries. The present study examines patient safety curriculum implementation in LMICs. METHODS Two cross-sectional surveys were carried out. First, 88 technical officers in Ministries of Health and WHO country offices were surveyed to identify the pattern of patient safety curricula at country level. A second survey followed that gathered information from 71 people in a position to provide institution-level perspectives on patient safety curriculum implementation. RESULTS The majority, 69% (30/44), of the countries were either considering whether to implement a patient safety curriculum or actively planning, rather than actually implementing, or embedding one. Most organisations recognised the need for patient safety education and training and felt a safety curriculum was compatible with the values of their organisation; however, important faculty-level barriers to patient safety curriculum implementation were identified. Key structural markers, such as dedicated financial resources and relevant assessment tools to evaluate trainees' patient safety knowledge and skills, were in place in fewer than half of organisations studied. CONCLUSIONS Greater attention to patient safety curriculum implementation is needed. The barriers to patient safety curriculum implementation we identified in LMICs are not unique to these regions. We propose a framework to act as a global standard for patient safety curriculum implementation. Educating leaders through the system in order to embed patient safety culture in education and clinical settings is a critical first step.
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Affiliation(s)
- Liane R Ginsburg
- Health Policy & Management, York University, Toronto, Ontario, Canada
| | | | - Liam J Donaldson
- London School of Hygiene and Tropical Medicine, Non-Communicable Disease Epidemiology, London, UK
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172
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Abstract
OBJECTIVES In a bid to promote high-quality postgraduate education and training and support the General Medical Council's (GMC) implementation plan for trainer recognition, the Wales Deanery developed the Educational Supervision Agreement (EdSA). This is a three-way agreement between Educational Supervisors, Local Education Providers and the Wales Deanery which clarifies roles, responsibilities and expectations for all. This paper reports on the formative evaluation of the EdSA after 1 year. DESIGN Evaluation of pan-Wales EdSA roll-out (2013-2015) employed a mixed-methods approach: questionnaires (n=191), interviews (n=11) with educational supervisors and discussion with key stakeholders (GMC, All-Wales Trainer Recognition Group, Clinical Directors). Numerical data were analysed in SPSS V.20; open comments underwent thematic content analysis. PARTICIPANTS The study involved Educational Supervisors working in different specialties across Wales, UK. RESULTS At the point of data collection, survey respondents represented 14% of signed agreements. Respondents believed the Agreement professionalises the Educational Supervisor role (85%, n=159 agreed), increases the accountability of Educational Supervisors (87%; n=160) and health boards (72%, n=131), provides leverage to negotiate supporting professional activities' (SPA) time (76%, n=142) and continuing professional development (CPD) activities (71%, n=131). Factor analysis identified three principal factors: professionalisation of the educational supervisor role, supporting practice through training and feedback and implementation of the Agreement. CONCLUSIONS Our evidence suggests that respondents believed the Agreement would professionalise and support their Educational Supervisor role. Respondents showed enthusiasm for the Agreement and its role in maintaining high standards of training.
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Affiliation(s)
- Katie Louise Webb
- Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMDE), School of Social Sciences, Cardiff University, Cardiff, Wales, UK
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMDE), School of Social Sciences, Cardiff University, Cardiff, Wales, UK
| | - Caroline Groves
- Wales Deanery, Postgraduate Medical and Dental Education, Cardiff University, Wales, UK
| | - Anton Gerhard Saayman
- Wales Deanery, Postgraduate Medical and Dental Education, Cardiff University, Wales, UK
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173
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Atkinson LZ, Forrest A, Marriner L, Geddes J, Cipriani A. Implementing tools to support evidence-based practice: a survey and brief intervention study of the National Elf Service across Oxford Health NHS Foundation Trust. Evid Based Ment Health 2017; 20:41-45. [PMID: 28363988 PMCID: PMC10688520 DOI: 10.1136/eb-2017-102665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/01/2017] [Revised: 03/10/2017] [Accepted: 03/13/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Technology and the internet has enabled rapid access to research but most mental health professionals do not have time to keep up with the vast and growing scientific literature. Secondary information sources, such as the National Elf Service (NES), aim to summarise the most important and up-to-date research to improve mental health professionals' access to information to support evidence-based medicine (EBM). OBJECTIVE To explore mental health professionals' attitudes towards evidence-based practice and methods used to keep up-to-date with research. To promote use of a digital evidence-based platform (the National Elf Service), assess its use and explore its potential to impact clinical practice. METHODS Baseline and follow-up surveys were distributed among staff of 5 adult mental health community teams and 2 early intervention services (n=331) in Oxford Health Foundation Trust (OHFT) prior to and following an intervention raising awareness of the National Elf Service. FINDINGS Of 133 baseline survey responders, the majority of staff reported their clinical practice was informed by evidence, mostly using existing clinical guidelines and online resources. Few had used the National Elf Service. 122 staff members completed the follow-up survey. Postintervention, 42 staff members indicated they had used the National Elf Service (compared with 13 preintervention) and that it had improved access to research. Lack of time was most often the barrier restricting evidence-based practice. CONCLUSIONS Mental health professionals are engaged with EBM and those that used the National Elf Service felt it did, or could have the potential to impact on their clinical practice. CLINICAL IMPLICATIONS Barriers and challenges to implement EBM more widely suggest targeted efforts should be made to embed evidence-based practice into the working culture.
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Affiliation(s)
- Lauren Z Atkinson
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK;
| | - Alexandra Forrest
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK;
| | - Leah Marriner
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK;
| | - John Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK;
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK;
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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174
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Leece P, Buchman DZ, Hamilton M, Timmings C, Shantharam Y, Moore J, Furlan AD. Improving opioid safety practices in primary care: protocol for the development and evaluation of a multifaceted, theory-informed pilot intervention for healthcare providers. BMJ Open 2017; 7:e013244. [PMID: 28446522 PMCID: PMC5719659 DOI: 10.1136/bmjopen-2016-013244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION In North America, drug overdose deaths are reaching unprecedented levels, largely driven by increasing prescription opioid-related deaths. Despite the development of several opioid guidelines, prescribing behaviours still contribute to poor patient outcomes and societal harm. Factors at the provider and system level may hinder or facilitate the application of evidence-based guidelines; interventions designed to address such factors are needed. METHODS AND ANALYSIS Using implementation science and behaviour change theory, we have planned the development and evaluation of a comprehensive Opioid Self-Assessment Package, designed to increase adherence to the Canadian Opioid Guideline among family physicians. The intervention uses practical educational and self-assessment tools to provide prescribers with feedback on their current knowledge and practices, and resources to improve their practice. The evaluation approach uses a pretest and post-test design and includes both quantitative and qualitative methods at baseline and 6 months. We will recruit a purposive sample of approximately 10 family physicians in Ontario from diverse practice settings, who currently treat patients with long-term opioid therapy for chronic pain. Quantitative data will be analysed using basic descriptive statistics, and qualitative data will be analysed using the Framework Method. ETHICS AND DISSEMINATION The University Health Network Research Ethics Board approved this study. Dissemination plan includes publications, conference presentations and brief stakeholder reports. This evidence-informed, theory-driven intervention has implications for national application of opioid quality improvement tools in primary care settings. We are engaging experts and end users in advisory and stakeholder roles throughout our project to increase its national relevance, application and sustainability. The performance measures could be used as the basis for health system quality improvement indicators to monitor opioid prescribing. Additionally, the methods and approach used in this study could be adapted for other opioid guidelines, or applied to other areas of preventive healthcare and clinical guideline implementation processes.
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Affiliation(s)
| | - Daniel Z Buchman
- Public Health Ontario, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
- University of Toronto Joint Centre for Bioethics, Toronto, Ontario, Canada
| | - Michael Hamilton
- Institute for Safe Medication Practices Canada, Toronto, Ontario, Canada
| | - Caitlyn Timmings
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Yalnee Shantharam
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Julia Moore
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Andrea D Furlan
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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175
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Lanhers C, Walther G, Chapier R, Lesourd B, Naughton G, Pereira B, Duclos M, Vinet A, Obert P, Courteix D, Dutheil F. Long-term cost reduction of routine medications following a residential programme combining physical activity and nutrition in the treatment of type 2 diabetes: a prospective cohort study. BMJ Open 2017; 7:e013763. [PMID: 28416496 PMCID: PMC5775459 DOI: 10.1136/bmjopen-2016-013763] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To demonstrate that lifestyle modifications will reduce the cost of routine medications in individuals with type 2 diabetes (T2D), through a mechanism involving glycaemic control. DESIGN A within-trial cost-medication analysis with a 1-year time horizon. SETTING Controlled environment within the spa resort of Chatel-Guyon, France. PARTICIPANTS Twenty-nine participants (aged 50-70 years) with T2D. INTERVENTIONS A 1-year follow-up intervention, beginning with a 3-week residential programme combining high exercise volume (15-20 hours/week), restrictive diet (-500 kcal/day) and education. Participants continued their routine medication, independently managed by their general practitioner. MAIN OUTCOME MEASURES Number of medications, number of pills, cost of medications and health-related outcomes. RESULTS Twenty-six participants completed the 1-year intervention. At 1 year, 14 patients out of 26 (54%) stopped/decreased their medications whereas only 5 (19%) increased or introduced new drugs (χ2=6.3, p=0.02). The number of pills per day decreased by 1.3±0.3 at 12 months (p<0.001). The annual cost of medications for T2D were lower at 1 year (€135.1±43.9) versus baseline (€212.6±35.8) (p=0.03). The regression coefficients on costs of routine medication were 0.507 (95% CI 0.056 to 0.959, p=0.027) for HbA1c and 0.156 (95% CI -0.010 to 0.322, p=0.06) for blood glucose levels. Diabetics patients with HbA1c >6.5% in the highest (last) quartile doubled their routine medication costs (66% vs 33%, p=0.037). CONCLUSIONS Individuals with T2D reduced routine medication costs following a long-term lifestyle intervention that started with a 3-week residential programme. Combining high exercise volume, restrictive diet and education effectively supported the health of T2D. The main factor explaining reduced medication costs was better glycaemic control, independent of weight changes. Despite limitations precluding generalisability, cost-effective results of reduced medication should contribute to the evidence base required to promote lifestyle interventions for individuals with T2D. TRIAL REGISTRATION NUMBER NCT00917917; Post-results.
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Affiliation(s)
- Charlotte Lanhers
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and psychosocial stress, CHU Clermont-Ferrand, Preventive and Occupational Medicine, Sports Medicine, F-63000 Clermont-Ferrand, France
| | - Guillaume Walther
- Université d'Avignon, LaPEC EA4278, Laboratory of Cardiovascular Pharm-Ecology, F-84000 Avignon, France
| | - Robert Chapier
- Université Clermont Auvergne, Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological conditions (AME2P), F-63000 Clermont-Ferrand, France
| | - Bruno Lesourd
- Université Clermont Auvergne, Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological conditions (AME2P), F-63000 Clermont-Ferrand, France
| | - Geraldine Naughton
- Australian Catholic University, Faculty of Health, School of Exercise Science, Melbourne, Victoria 3065, Australia
| | - Bruno Pereira
- CHU Clermont-Ferrand, the Clinical Research and Innovation Direction, F-63000 Clermont-Ferrand, France
| | - Martine Duclos
- Université Clermont Auvergne, INRA, UNH, Unité de Nutrition Humaine, CRNH Auvergne, CHU Clermont-Ferrand, Sports Medicine, F-63000 Clermont-Ferrand, France
| | - Agnès Vinet
- Université d'Avignon, LaPEC EA4278, Laboratory of Cardiovascular Pharm-Ecology, F-84000 Avignon, France
| | - Philippe Obert
- Université d'Avignon, LaPEC EA4278, Laboratory of Cardiovascular Pharm-Ecology, F-84000 Avignon, France
- Australian Catholic University, Faculty of Health, School of Exercise Science, Melbourne, Victoria 3065, Australia
| | - Daniel Courteix
- Université Clermont Auvergne, Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological conditions (AME2P), F-63000 Clermont-Ferrand, France
- Australian Catholic University, Faculty of Health, School of Exercise Science, Melbourne, Victoria 3065, Australia
| | - Frédéric Dutheil
- Australian Catholic University, Faculty of Health, School of Exercise Science, Melbourne, Victoria 3065, Australia
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and psychosocial stress, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, F-63000 Clermont-Ferrand, France
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176
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Thiel M, Evans S, Sawdy R. Women's healthcare consultations on operations: a multidisciplinary provider questionnaire. J ROY ARMY MED CORPS 2017; 163:394-396. [PMID: 28400524 DOI: 10.1136/jramc-2016-000693] [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: 07/27/2016] [Revised: 03/22/2017] [Accepted: 03/26/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND 30% of UK primary care consultations relate to gynaecology. Servicewomen access healthcare in general more frequently than their NHS counterparts, so military medical professionals are thus more likely to be managing significant numbers of gynaecological conditions on deployed military operations. Little is known about their confidence and preparedness in managing female-specific complaints. This study aimed to assess clinicians' views as to their training and confidence in managing gynaecological conditions; to gauge the need for developing treatment guidelines and specific training opportunities and to establish the frequency and scope of female-specific presentations on a military deployment. METHOD A retrospective questionnaire-based service evaluation of clinical practice was undertaken via an anonymised questionnaire, which was distributed to 44 randomly selected Afghanistan-based UK military medical professionals in May 2014. All clinicians with sick parade duties were eligible for inclusion. RESULTS 23 (57.5%) military medical professionals reported managing one or more gynaecological conditions per month while deployed and 4 (25%) doctors treated more than 5 per month. Of those questioned, 21 (52.5%) felt underprepared to manage gynaecological conditions confidently. Two-thirds would attend a short course on the subject, 13 (32.5%) thought gynaecology should be included in medical predeployment training (PDT) and 26 (65%) wanted management guidelines included within Clinical Guidelines for Operations (CGOs). CONCLUSIONS Military medical professionals treat servicewomen with gynaecological problems on deployment. Half of the medical professionals questioned felt they had insufficient training and experience to do so confidently. Training packages, as part of PDT or stand alone, were reported as acceptable methods of improving confidence and knowledge. The common gynaecological acute presentations were suggested as topics to be included in CGOs.
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Affiliation(s)
- Magdalena Thiel
- Obstetric and Gynaecology Department, Queen Alexandra Hospital, Portsmouth, UK
| | - S Evans
- Obstetric and Gynaecology Department, Frimley Park Hospital, Frimley, UK
| | - R Sawdy
- Obstetrics and Gynecology Department, Poole Hospital, Poole, UK
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177
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Blencowe NS, Glasbey JC, McElnay PJ, Bhangu A, Gokani VJ, Harries RL. Integrated surgical academic training in the UK: a cross-sectional survey. Postgrad Med J 2017; 93:581-586. [PMID: 28408726 PMCID: PMC5629952 DOI: 10.1136/postgradmedj-2016-134737] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/10/2016] [Revised: 02/13/2017] [Accepted: 03/05/2017] [Indexed: 11/22/2022]
Abstract
Objectives This study aimed to explore variations in the provision of integrated academic surgical training across the UK. Design This is an online cross-sectional survey (consisting of 44 items with a range of free-text, binomial and 5-point Likert scale responses) developed by the Association of Surgeons in Training. Setting A self-reported survey instrument was distributed to academic surgical trainees across the UK (n=276). Participants 143 (51.9%) responses were received (81% male, median age: 34 years), spanning all UK regions and surgical specialties. Of the 143 trainees, 29 were core trainees (20.3%), 99 were specialty trainees (69.2%) and 15 (10.5%) described themselves as research fellows. Results The structure of academic training varied considerably, with under a third of trainees receiving guaranteed protected time for research. Despite this, however, 53.1% of the respondents reported to be satisfied with how their academic training was organised. Covering clinical duties during academic time occurred commonly (72.7%). Although most trainees (n=88, 61.5%) met with their academic supervisor at least once a month, six (4.2%) never had an academic supervisory meeting. Most trainees (n=90, 62.9%) occupied a full-time rota slot and only 9.1% (n=13) described their role as ‘supernumerary’. Although 58.7% (n=84) of the trainees were satisfied with their clinical competence, 37.8% (n=54) felt that clinical time focused more on service provision than the acquisition of technical skills. 58 (40.6%) had experienced some form of negative sentiment relating to their status as an academic trainee. Conclusions Integrated academic training presents unique challenges and opportunities within surgery. This survey has identified variation in the quality of current programmes, meaning that the future provision of integrated surgical academic training should be carefully considered.
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Affiliation(s)
| | - James C Glasbey
- Association of Surgeons in Training, Lincoln's Inn Fields, London, UK
| | - Philip J McElnay
- Association of Surgeons in Training, Lincoln's Inn Fields, London, UK
| | - Aneel Bhangu
- Association of Surgeons in Training, Lincoln's Inn Fields, London, UK
| | - Vimal J Gokani
- Association of Surgeons in Training, Lincoln's Inn Fields, London, UK
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178
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Abstract
An increasing number of metrics are used to measure the impact of research papers. Despite being the most commonly used, the 2-year impact factor is limited by a lack of generalisability and comparability, in part due to substantial variation within and between fields. Similar limitations apply to metrics such as citations per paper. New approaches compare a paper's citation count to others in the research area, while others measure social and traditional media impact. However, none of these measures take into account an individual author's contribution to the paper or the number of authors, which we argue are key limitations. The UK's 2014 Research Exercise Framework included a detailed bibliometric analysis comparing 15 selected metrics to a 'gold standard' evaluation of almost 150 000 papers by expert panels. We outline the main correlations between the most highly regarded papers by the expert panel in the Psychiatry, Clinical Psychology and Neurology unit and these metrics, most of which were weak to moderate. The strongest correlation was with the SCImago Journal Rank, a variant of the journal impact factor, while the amount of Twitter activity showed no correlation. We suggest that an aggregate measure combining journal metrics, field-standardised citation data and alternative metrics, including weighting or colour-coding of individual papers to account for author contribution, could provide more clarity.
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Affiliation(s)
- Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Achim Wolf
- Department of Psychiatry, University of Oxford, Oxford, UK
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179
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Abstract
OBJECTIVES The introduction of competency-based training has necessitated development and implementation of accompanying mechanisms for assessment. Procedure-based assessments (PBAs) are an example of workplace-based assessments that are used to examine focal competencies in the workplace. The primary objective was to understand surgical trainees' perspective on the value of PBA. DESIGN Semistructured interviews with 10 surgical trainees individually interviewed to explore their views. Interviews were audio-recorded and transcribed; following this, they were open and axial coded. Thematic analysis was then performed. RESULTS Semistructured interviews yielded several topical and recurring themes. In trainees' experience, the use of PBAs as a summative tool limits their educational value. Trainees reported a lack of support from seniors and variation in the usefulness of the tool based on stage of training. Concerns related to the validity of PBAs for evaluating trainees' performance with reports of 'gaming' the system and trainees completing their own assessments. Trainees did identify the significant value of PBAs when used correctly. Benefits included the identification of additional learning opportunities, standardisation of assessment and their role in providing a measure of progress. CONCLUSIONS The UK surgical trainees interviewed identified both limitations and benefits to PBAs; however, we would argue based on their responses and our experience that their use as a summative tool limits their formative use as an educational opportunity. PBAs should either be used exclusively to support learning or solely as a summative tool; if so, further work is needed to audit, validate and standardise them for this purpose.
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Affiliation(s)
- Joseph Shalhoub
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
| | | | - Kate Ippolito
- Educational Development Unit, School of Professional Development, Imperial College London, London, UK
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180
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Davies F, Wood F, Bullock A, Wallace C, Edwards A. Interventions to improve the self-management support health professionals provide for people with progressive neurological conditions: protocol for a realist synthesis. BMJ Open 2017; 7:e014575. [PMID: 28320798 PMCID: PMC5372053 DOI: 10.1136/bmjopen-2016-014575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Supporting self-management among people with long-term conditions is recognised as an important component of healthcare. Progressive neurological conditions (PNCs), for example, Parkinson's disease and multiple sclerosis are associated with problems such as fatigue and cognitive impairment which may make self-management more challenging. Health professionals may need to develop specific skills in order to provide effective self-management support for these patients. The review aims to develop explanatory theories about how health professional-targeted interventions to improve self-management support provision for people with PNCs operate in different circumstances. METHODS AND ANALYSIS A realist synthesis of the evidence is proposed. There are 2 priority questions for the review to address. These relate to the role of a shared concept of self-management support within the healthcare team, and the need to tailor the support provided to the requirements of people with PNCs. Key stakeholders will be involved throughout the process. The initial search strategy uses terms relating to (1) self-management, (2) health professionals and (3) PNCs. Searching, data extraction and synthesis will occur in parallel. Studies will be prioritised for inclusion based on anticipated contribution to generating explanatory theories. Key informant interviews are planned to direct supplementary searches and help further refine the theories developed. Results will be expressed in the form of context-mechanism-outcome configurations. ETHICS AND DISSEMINATION Publication guidelines on realist synthesis will be followed. The results will be published in a peer-reviewed journal and made available to organisations involved in the provision of health professional training.
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Affiliation(s)
- Freya Davies
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Fiona Wood
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education, Cardiff University, Cardiff, UK
| | - Carolyn Wallace
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
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181
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Abstract
OBJECTIVES Exposure to family medicine (FM) can serve to promote students' interest in this field. This study aimed at identifying clerkship characteristics which decrease or increase students' interest in FM. DESIGN This cross-sectional questionnaire study analysed students' clerkship evaluations between the years 2004 and 2014. Descriptive statistics were used to compare four predefined groups: (1) high interest in FM before and after the clerkship (Remained high), (2) poor interest before and after the clerkship (Remained low), (3) poor interest before the clerkship which improved (Increased) and (4) high interest before the clerkship which decreased (Decreased). SETTING Students' evaluations of FM clerkships in the fourth of 6 years of medical school. PARTICIPANTS All questionnaires with complete answers on students' interest in FM and its change as a result of the clerkship (2382 of 3963; 60.1%). The students' mean age was 26 years (± 3.9), 62.7% (n=1505) were female. OUTCOME MEASURE The outcome was a change in students' interest in FM after completing the clerkship. RESULTS Interest in FM after the clerkship was as follows: 40.1% (n=954) Remained high, 5.5% (n=134) Remained low, 42.1% (n=1002) Increased and 12.3% (n=292) Decreased. Students with decreased interest had performed a below-average number of learning activities (4 vs 6 activities). A total of 45.9% (n=134 of 292) of the students with decreased interest reported that the difficulty of the challenge was inadequate for their educational level: 81.3% (n=109) felt underchallenged and 18.7% (n=25) overchallenged. CONCLUSIONS In more than 50% of cases, the clerkship changed the students' interest in FM. Those with decreased interest were more frequently underchallenged. We observed an increase in FM if at least six learning activities were trained. Our findings stress the importance of well-designed FM clerkships. There is a need for standardised educational strategies which enable teaching physicians to operationalise educational requirements.
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Affiliation(s)
- Anna Herwig
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anja Viehmann
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anika Thielmann
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stefan Gesenhues
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Birgitta Weltermann
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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182
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Williams M, Boohan M, Thurston A. Scoping systematic review on the extent, nature and quality of evidence underlying ophthalmic and paraophthalmic education. Evid Based Med 2017; 22:23-26. [PMID: 27993941 DOI: 10.1136/ebmed-2016-110542] [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] [Indexed: 05/13/2023]
Abstract
BACKGROUND Effective education of relevant professionals underpins provision of quality eye healthcare. OBJECTIVES This scoping systematic review had 2 aims: first to investigate the extent and nature of scholarly output published on ophthalmic and paraophthalmic education, and second to focus on the quality of reporting of randomised controlled trials (RCTs) identified. STUDY SELECTION A search strategy was created and applied to PubMed. Any scholarly publications on any aspect of education of those involved in the care of patients with visual problems as the main theme or context was selected. Predefined data were extracted. FINDINGS Of 255 studies included, the most common type of scholarly publications were descriptions of an educational innovation, opinion pieces and descriptive studies. RCTs made up 5.5% of the sample. Most of the 14 RCTs failed to report most of the items recommended in the CONSORT guidelines. CONCLUSIONS This review highlights the need for investigators, ethical committees and journals to insist on a better quality of RCT conduct than is presently apparent, but also that clinicians should not be blind to the strengths of non-RCT-based studies in the field of education.
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Affiliation(s)
- Michael Williams
- Centre for Medical Education, Queen's University of Belfast, Belfast, UK
| | - Mairead Boohan
- Centre for Medical Education, Queen's University of Belfast, Belfast, UK
| | - Allen Thurston
- Centre for Medical Education, Queen's University of Belfast, Belfast, UK
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183
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Lydon S, O'Connor P, Mongan O, Gorecka M, McVicker L, Stankard A, Byrne D. A mixed method, multiperspective evaluation of a near peer teaching programme. Postgrad Med J 2017; 93:541-548. [PMID: 28235793 DOI: 10.1136/postgradmedj-2016-134464] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/14/2016] [Accepted: 01/28/2017] [Indexed: 11/03/2022]
Abstract
PURPOSE OF STUDY Peer teaching (PT) has become increasingly popular. PT may offer benefits for students, tutors and institutions. Although resistance to PT has been identified among faculty, research has typically focused on students' experiences and perceptions, rather than those of the peer tutors or senior doctors/medical faculty. The current study comprised of a comprehensive, multiperspective evaluation of a near PT programme delivered by interns to final-year medical students in the Republic of Ireland. STUDY DESIGN This study employed a mixed methods design, using both interviews and questionnaires to assess students' (n=130), interns' (n=49) and medical faculty's or senior doctors' (n=29) perceptions of the programme. RESULTS All three groups were emphatic about the programme's benefits, although senior doctors and faculty reported significantly more positive attitudes than the others. Mean ratings of the programme's value, out of 10, were 8.2 among students, 8.2 among interns and 9.1 among senior doctors and faculty. Challenges identified were largely organisational in nature. Perceived benefits for students included the informality of teaching sessions, increased opportunities in the clinical environment and improvements in exam preparedness. Perceived benefits for the interns included improvements in knowledge and teaching ability and experience as a role model. CONCLUSIONS PT programmes have been posited as an 'easy fix' to growing numbers of students. However, it is apparent that PT has substantial value outside of this. Future research that conducts economic evaluations of such programmes and that collects objective data on teaching quality and student learning would be of much interest.
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Affiliation(s)
- Sinéad Lydon
- School of Medicine, National University of Ireland Galway, County Galway, Ireland
| | - Paul O'Connor
- School of Medicine, National University of Ireland Galway, County Galway, Ireland
| | - Orla Mongan
- University Hospital Galway, County Galway, Ireland
| | | | | | | | - Dara Byrne
- School of Medicine, National University of Ireland Galway, County Galway, Ireland.,University Hospital Galway, County Galway, Ireland
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184
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Budhathoki SS, Zwanikken PAC, Pokharel PK, Scherpbier AJ. Factors influencing medical students' motivation to practise in rural areas in low-income and middle-income countries: a systematic review. BMJ Open 2017; 7:e013501. [PMID: 28232465 PMCID: PMC5337703 DOI: 10.1136/bmjopen-2016-013501] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES There is a shortage of doctors working in rural areas all over the world, especially in low-income and middle-income countries. The choice to practise medicine in a rural area is influenced by many factors. Motivation developed as a medical student is one key determinant of this choice. This study explores influences on medical students' motivation to practise in rural areas of low-income and middle-income countries following graduation. DESIGN A systematic review was conducted to identify influences on medical students' motivation to work in rural areas in low-income and middle-income countries. Papers reporting influences on motivation were included, and content analysis was conducted to select the articles. Articles not published in English were excluded from this review. RESULTS A rural background (ie, being brought up in a rural area), training in rural areas with a community-based curriculum, early exposure to the community during medical training and rural location of medical school motivate medical students to work in rural areas. Perceived lack of infrastructure, high workload, poor hospital management and isolation are among the health facility factors that demotivate medical students for medical practice in rural areas. CONCLUSIONS Medical school selection criteria focusing on a rural background factor and medical education curriculum focusing on rural area are more relevant factors in low-income and middle-income countries. The factors identified in this review may assist the planners, medical educators and policymakers in low-income and middle-income countries in designing relevant interventions to positively influence rural choices where the shortage of rural physicians is an ongoing and increasing concern.
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Affiliation(s)
- Shyam Sundar Budhathoki
- School of Public Health & Community Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Paras K Pokharel
- School of Public Health & Community Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Albert J Scherpbier
- Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
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185
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Lafleur A, Leppink J, Côté L. Clinical examination in the OSCE era: are we maintaining the balance between OS and CE? Postgrad Med J 2017; 93:241. [PMID: 28209914 DOI: 10.1136/postgradmedj-2016-134776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/10/2017] [Accepted: 01/28/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Alexandre Lafleur
- Department of Medicine, Laval University Faculty of Medicine, Quebec City, Quebec, Canada
| | - Jimmie Leppink
- School of Health Professions Education, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Luc Côté
- Department of Family and Emergency Medicine, Laval University Faculty of Medicine, Quebec City, Quebec, Canada
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186
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Jelley B, Long S, Butler J, Hewitt J. Cohort profile: the Welsh Geriatric Registrar-Led Research Network (WeGeN): rationale, design and description. BMJ Open 2017; 7:e013031. [PMID: 28196947 PMCID: PMC5318578 DOI: 10.1136/bmjopen-2016-013031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/08/2016] [Accepted: 12/22/2016] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Medical trainees are required to undertake audit and quality improvement projects. They must also have an understanding of the principles of research and are encouraged to participate in research projects. However, the constraints of time, a lack of formal training and rotation between different training posts create barriers to audit cycle completion and pursuing research. This leads to trainees being reluctant to undertake research, facilitates poor quality research and risks incomplete audit. PARTICIPANTS The Welsh Geriatricians Network (WeGeN) has been created with the aims of facilitating collaborative, trainee-led research within Geriatric Medicine in Wales, promoting research engagement and improving the research evidence base for older patients. By coordinating collaborative research projects across different sites within Wales, trainees continue existing projects at new sites, allowing completion of projects and establishing the long-term infrastructure and experienced personnel needed for high-quality research data to be gathered. FINDINGS WeGeN has facilitated 4 national audits, all of which are intended for peer review publication. The first project considers the service provision for the older person in the emergency department, the second Parkinson's disease, the third reviews delirium management and the fourth project considers epidemiology of surgical disease in older people. FUTURE PLANS The objective of this project is to further establish and develop WeGeN as a group which facilitates high-quality research and provides the opportunity for geriatric trainees to engage in research activity. It is anticipated that the establishment of this research platform will provide a blueprint for the development of other such networks in the UK and beyond.
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Affiliation(s)
- Benjamin Jelley
- Department of Gerontology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Sara Long
- Aneurin Bevan University Health Board, Newport, UK
| | - John Butler
- Department of Gerontology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jonathan Hewitt
- Department of Geriatric Medicine, Cardiff University, Cardiff, UK
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187
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Griffin A, McKeown A, Viney R, Rich A, Welland T, Gafson I, Woolf K. Revalidation and quality assurance: the application of the MUSIQ framework in independent verification visits to healthcare organisations. BMJ Open 2017; 7:e014121. [PMID: 28196952 PMCID: PMC5318568 DOI: 10.1136/bmjopen-2016-014121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES We present a national evaluation of the impact of independent verification visits (IVVs) performed by National Health Service (NHS) England as part of quality assuring medical revalidation. Organisational visits are central to NHS quality assurance. They are costly, yet little empirical research evidence exists concerning their impact, and what does exist is conflicting. SETTING The focus was on healthcare providers in the NHS (in secondary care) and private sector across England, who were designated bodies (DBs). DBs are healthcare organisations that have a statutory responsibility, via the lead clinician, the responsible officer (RO), to implement medical revalidation. PARTICIPANTS All ROs who had undergone an IVV in England in 2014 and 2015 were invited to participate. 46 ROs were interviewed. Ethnographic data were gathered at 18 observations of the IVVs and 20 IVV post visit reports underwent documentary analysis. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were the findings pertaining to the effectiveness of the IVV system in supporting the revalidation processes at the DBs. Secondary outcomes were methodological, relating to the Model for Understanding Success in Quality (MUSIQ) and how its application to the IVV reveals the relevance of contextual factors described in the model. RESULTS The impact of the IVVs varied by DB according to three major themes: the personal context of the RO; the organisational context of the DB; and the visit and its impact. ROs were largely satisfied with visits which raised the status of appraisal within their organisations. Inadequate or untimely feedback was associated with dissatisfaction. CONCLUSIONS Influencing teams whose prime responsibility is establishing processes and evaluating progress was crucial for internal quality improvement. Visits acted as a nudge, generating internal quality review, which was reinforced by visit teams with relevant expertise. Diverse team membership, knowledge transfer and timely feedback made visits more impactful.
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Affiliation(s)
- Ann Griffin
- Research Department for Medical Education, UCL Medical School, London, UK
| | - Alex McKeown
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Rowena Viney
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Antonia Rich
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Trevor Welland
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Irene Gafson
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Katherine Woolf
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
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188
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Burns DS, Fletcher D, Johnston K, Bailey MS, Campbell K. Novel porcine model of cutaneous myiasis: a training tool for healthcare workers. J ROY ARMY MED CORPS 2017; 163:339-341. [PMID: 28193747 DOI: 10.1136/jramc-2016-000737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/25/2016] [Revised: 01/09/2017] [Accepted: 01/13/2017] [Indexed: 11/04/2022]
Abstract
Cutaneous myiasis is a well-described problem in travellers to endemic regions including military personnel. Realistic training is important to ensure that healthcare workers have the confidence and expertise to recognise cutaneous myiasis and safely remove larvae if required. A model is described here that is simple, reproducible and realistic, and will allow for training of military healthcare workers in safe surgical removal of larvae when required.
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Affiliation(s)
- Daniel S Burns
- Department of Infection and Tropical Medicine, Heartlands Hospital, Birmingham, UK.,Army Medical Directorate, Camberley, UK
| | - D Fletcher
- Venning Barracks, DPHC Wales-West Midlands HQ, Telford, Shropshire, UK
| | - K Johnston
- Venning Barracks, DPHC Wales-West Midlands HQ, Telford, Shropshire, UK
| | - M S Bailey
- Department of Infection and Tropical Medicine, Heartlands Hospital, Birmingham, UK.,Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - K Campbell
- Venning Barracks, DPHC Wales-West Midlands HQ, Telford, Shropshire, UK
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189
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Maggio LA, Capdarest-Arest N. Practising evidence-based medicine (EBM): a descriptive analysis of medical students' whole-task EBM assignments. Evid Based Med 2017; 22:41-44. [PMID: 28167494 DOI: 10.1136/ebmed-2016-110593] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Researchers have suggested whole-task learning activities to practice and teach evidence-based medicine (EBM); however, limited description exists of their use in EBM curricula. This article describes medical students' execution of a whole-task EBM assignment and characterises themes emerging from assignment submissions. Between 2013 and 2015, Stanford University's paediatric clerkship students completed a whole-task EBM assignment based on a patient encounter. The assignment captured students' efforts to perform all EBM steps and describe their patient scenario and future knowledge needs strategies. Assignments were analysed using descriptive statistics and qualitative description. 123 students completed the assignment. Students formulated therapy (n=76), prognosis (n=18), diagnosis (n=15), harm (n=9) and aetiology (n=2) questions, and used a single (n=58) or multiple information resources (n=57). Based on evidence appraisal, 95 students indicated that the found evidence would inform future practice while 16 were sceptical of its conclusivity. 65 learners wanted to share evidence with colleagues; 33 with patients and families. To meet future knowledge needs, learners suggested using a structured approach (eg, PICO (patient, intervention, comparison and outcome); n=58), reading more primary literature (n=22) and creating question logs (n=21). This article provides a glimpse into students' EBM process and demonstrates the feasibility of whole-task activities for use in EBM training. Findings related to students' clinical uncertainty and information sharing raise questions about coverage of these topics in current EBM training and suggest that further investigation is warranted.
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Affiliation(s)
- Lauren A Maggio
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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190
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Naumann DN, Eisenstein N, Burns DS, Stapley SA. Towards research combat readiness: prepared, prospective and preapproved. J ROY ARMY MED CORPS 2017; 163:233-234. [PMID: 28148551 DOI: 10.1136/jramc-2016-000741] [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: 11/08/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 11/03/2022]
Abstract
Research drives the advancement of medical knowledge during war, but planning and execution are too slow to enable early data acquisition. Future conflicts are likely to be shorter and more dispersed, requiring innovation to avoid missing out on the crucial early stages. To seize the initiative, we suggest that a collection of preapproved research studies be designed, stored and maintained within the medical command structure so that they are ready for immediate implementation at the onset of future conflicts, even during the most kinetic early phases of deployment.
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Affiliation(s)
- David N Naumann
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - N Eisenstein
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - D S Burns
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - S A Stapley
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK
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191
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Gulayin P, Irazola V, Lozada A, Chaparro M, Santero M, Gutierrez L, Poggio R, Beratarrechea A, Rubinstein A. Educational intervention to improve effectiveness in treatment and control of patients with high cardiovascular risk in low-resource settings in Argentina: study protocol of a cluster randomised controlled trial. BMJ Open 2017; 7:e014420. [PMID: 28143840 PMCID: PMC5293870 DOI: 10.1136/bmjopen-2016-014420] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Hypercholesterolaemia is estimated to cause 2.6 million deaths annually and one-third of the cases of ischaemic heart disease. In Argentina, the prevalence of hypercholesterolaemia increased between 2005 and 2013 from 27.9% to 29.8%. Only one out of four subjects with a self-reported diagnosis of coronary heart disease is taking statins. Since 2014, statins (simvastatin 20 mg) are part of the package of drugs provided free-of-charge for patients according to cardiovascular disease (CVD) risk stratification. The goal of this study is to test whether a complex intervention targeting physicians and pharmacist assistants improves treatment and control of hypercholesterolaemia among patients with moderate-to-high cardiovascular risk in Argentina. METHODS AND ANALYSIS This is a cluster trial of 350 patients from 10 public primary care centres in Argentina to be randomised to either the intervention or usual care. The study is designed to have 90% statistical power to detect a 0.7 mmol/L reduction in low-density lipoproteins cholesterol from baseline to 12 months. The physician education programme consists of a 2-day initial intensive training and certification workshop followed by educational outreach visits (EOVs) conducted at 3, 6 and 9 months from the outset of the study. An on-site training to pharmacist assistants during the first EOV is performed at each intervention clinic. In addition, two intervention support tools are used: an app installed in physician's smartphones to serve as a decision aid to improve prescription of statins according to patient's CVD risk and a web-based platform tailored to send individualised SMS messages to patients. ETHICS AND DISSEMINATION Ethical approval was obtained from an independent ethics committee. Results of this study will be presented to the Ministry of Health of Argentina for potential dissemination and scale-up of the intervention programme to the entire national public primary care network in Argentina. TRIAL REGISTRATION NUMBER NCT02380911.
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Affiliation(s)
- Pablo Gulayin
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Martin Chaparro
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Marilina Santero
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Laura Gutierrez
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Rosana Poggio
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Andrea Beratarrechea
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Adolfo Rubinstein
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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192
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Leow MQH, Cao T, Loke AMK, Tay SC. Use of X-rays to study acupuncture points of the hand: implications for education. Acupunct Med 2017; 35:233-235. [PMID: 28082267 DOI: 10.1136/acupmed-2016-011307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/26/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Mabel Qi He Leow
- Biomechanics Laboratory, Singapore General Hospital, Singapore, Singapore
| | - Taige Cao
- Medical Department, National Skin Centre, Singapore, Singapore.,Singapore College of Traditional Chinese Medicine, Singapore, Singapore
| | | | - Shian Chao Tay
- Biomechanics Laboratory, Singapore General Hospital, Singapore, Singapore.,Department of Hand Surgery, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore
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193
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Affiliation(s)
- Anne Cole
- Centre for Pharmacy Postgraduate Education (CPPE), University of Manchester, Manchester, UK
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194
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Evans LR, Fitzgerald MC, Mitra B, Varma D. Emergency department interpretation of CT of the brain: a systematic review. Postgrad Med J 2016; 93:454-459. [PMID: 28011895 DOI: 10.1136/postgradmedj-2016-134491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/26/2016] [Accepted: 12/03/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES CT of the brain (CTB) is one of the most common radiological investigations performed in the emergency department (ED). Emergency clinicians rely upon this imaging modality to aid diagnosis and guide management. However, their capacity to accurately interpret CTB is unclear. This systematic review aims to determine this capacity and identify the potential need for interventions directed towards improving the ability of emergency clinicians in this important area. METHODS A systematic review of the literature was conducted without date restrictions. We searched MEDLINE, EMBASE and Cochrane databases and studies reporting the primary outcome of concordance of CTB interpretation between a non-radiologist and a radiology specialist were identified. Studies were assessed for heterogeneity and a subgroup analysis of pooled data based on medical specialty was carried out to specifically identify the concordance of ED clinicians. The quality of evidence was assessed using the GRADE criteria. RESULTS There were 21 studies included in this review. Among the included studies, 12 reported on the concordance of emergency clinicians, 5 reported on radiology trainees and 4 on surgeons. Clinical and statistical heterogeneity between studies was high (I2=97.8%, p<0.01). The concordance in the emergency subgroup was the lowest among all subgroups with a range of 0.63-0.95 and a clinically significant error rate ranging from 0.02 to 0.24. CONCLUSIONS Heterogeneity and the presence of bias limit our confidence in these findings. However, the variance in the interpretation of CTB between emergency clinicians and radiologists suggests that interventions towards improving accuracy may be useful.
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Affiliation(s)
- Lachlan R Evans
- National Trauma Research Institute, Monash Alfred Injury Network, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Mark C Fitzgerald
- National Trauma Research Institute, Monash Alfred Injury Network, Melbourne, Australia.,Trauma Service, The Alfred Hospital, Melbourne, Australia
| | - Biswadev Mitra
- National Trauma Research Institute, Monash Alfred Injury Network, Melbourne, Australia.,Department of Epidemiology & Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Dinesh Varma
- Department of Radiology, The Alfred Hospital, Melbourne, Australia
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195
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196
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Lowe DJ, Dewar A, Lloyd A, Edgar S, Clegg GR. Optimising clinical performance during resuscitation using video evaluation. Postgrad Med J 2016; 93:449-453. [PMID: 27986970 DOI: 10.1136/postgradmedj-2016-134357] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 07/07/2016] [Revised: 11/02/2016] [Accepted: 11/23/2016] [Indexed: 11/04/2022]
Abstract
Video evaluation of resuscitation is becoming increasingly integrated into practice in a number of clinical settings. The purpose of this review article is to examine how video may enhance clinical care during resuscitation. As healthcare and available therapeutic interventions evolve, re-evaluation of accepted paradigms requires data to describe current practice and support change. Analysis of video recordings affords creation of a framework to evaluate individual and team performance and develop unique and tailored strategies to optimise care delivery. While video has been used in a number of non-clinical settings, there has been a recent increase of video systems in the prehospital and other clinical areas. This paper reviews the key opportunities in the emergency department-based resuscitation setting to enhance ergonomics, technical and non-technical skills-at both team and individual level-through video-assisted care performance analysis and feedback.
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Affiliation(s)
- David J Lowe
- Resuscitation Research Group, Royal Infirmary Edinburgh, Edinburgh, UK.,Department of Anaesthesia, Critical Care & Pain, University of Glasgow, Glasgow, UK.,Emergency Department, Glasgow Royal Infirmary, Glasgow, UK
| | - Alistair Dewar
- Resuscitation Research Group, Royal Infirmary Edinburgh, Edinburgh, UK.,Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Adam Lloyd
- Resuscitation Research Group, Royal Infirmary Edinburgh, Edinburgh, UK.,Nursing Studies, University of Edinburgh, Edinburgh, UK
| | - Simon Edgar
- Resuscitation Research Group, Royal Infirmary Edinburgh, Edinburgh, UK.,Directorate of Medical Education and Department of Anaesthesia, University of Edinburgh, Edinburgh, UK
| | - Gareth R Clegg
- Resuscitation Research Group, Royal Infirmary Edinburgh, Edinburgh, UK.,Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
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197
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Ball L, Barnes K, Laur C, Crowley J, Ray S. Setting priorities for research in medical nutrition education: an international approach. BMJ Open 2016; 6:e013241. [PMID: 27974369 PMCID: PMC5168600 DOI: 10.1136/bmjopen-2016-013241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/02/2016] [Accepted: 10/21/2016] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To identify the research priorities for medical nutrition education worldwide. DESIGN A 5-step stakeholder engagement process based on methodological guidelines for identifying research priorities in health. PARTICIPANTS 277 individuals were identified as representatives for 30 different stakeholder organisations across 86 countries. The stakeholder organisations represented the views of medical educators, medical students, doctors, patients and researchers in medical education. INTERVENTIONS Each stakeholder representative was asked to provide up to three research questions that should be deemed as a priority for medical nutrition education. MAIN OUTCOME MEASURES Research questions were critically appraised for answerability, sustainability, effectiveness, potential for translation and potential to impact on disease burden. A blinded scoring system was used to rank the appraised questions, with higher scores indicating higher priority (range of scores possible 36-108). RESULTS 37 submissions were received, of which 25 were unique research questions. Submitted questions received a range of scores from 62 to 106 points. The highest scoring questions focused on (1) increasing the confidence of medical students and doctors in providing nutrition care to patients, (2) clarifying the essential nutrition skills doctors should acquire, (3) understanding the effectiveness of doctors at influencing dietary behaviours and (4) improving medical students' attitudes towards the importance of nutrition. CONCLUSIONS These research questions can be used to ensure future projects in medical nutrition education directly align with the needs and preferences of research stakeholders. Funders should consider these priorities in their commissioning of research.
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Affiliation(s)
- Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- The Need for Nutrition Education/Innovation Programme, C/O MRC Elsie Widdowson Laboratory, The University of Cambridge, Cambridge, UK
| | - Katelyn Barnes
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Celia Laur
- The Need for Nutrition Education/Innovation Programme, C/O MRC Elsie Widdowson Laboratory, The University of Cambridge, Cambridge, UK
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jennifer Crowley
- The Need for Nutrition Education/Innovation Programme, C/O MRC Elsie Widdowson Laboratory, The University of Cambridge, Cambridge, UK
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sumantra Ray
- The Need for Nutrition Education/Innovation Programme, C/O MRC Elsie Widdowson Laboratory, The University of Cambridge, Cambridge, UK
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Karlsen B, Oftedal B, Stangeland Lie S, Rokne B, Peyrot M, Zoffmann V, Graue M. Assessment of a web-based Guided Self-Determination intervention for adults with type 2 diabetes in general practice: a study protocol. BMJ Open 2016; 6:e013026. [PMID: 27965253 PMCID: PMC5168684 DOI: 10.1136/bmjopen-2016-013026] [Citation(s) in RCA: 8] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Self-management is deemed the cornerstone in overall diabetes management. Web-based self-management interventions have potential to support adults with type 2 diabetes (T2DM) in managing their disease. Owing to somewhat ambiguous results of such interventions, interventions should be theory-based and incorporate well-defined counselling methods and techniques for behavioural change. This study is designed to assess the effectiveness of a theory-driven web-based Guided Self-Determination (GSD) intervention among adults with T2DM in general practice to improve diabetes self-management behaviours and glycosylated haemoglobin (HbA1c). METHODS AND ANALYSIS A complex intervention design based on the framework of the UK Medical Research Council is employed as a guide for developing the intervention, assessing its feasibility and evaluating its effectiveness. The study consists of three phases: (1) the modelling phase adapting the original GSD programme for adults with T2DM, using a qualitative design, (2) feasibility assessment of the adapted intervention on the web, employing qualitative and quantitative methods and (3) evaluating the effectiveness of the intervention on diabetes self-management behaviours and HbA1c, using a quasi-experimental design. The first phase, which is completed, and the second phase, which is underway, will provide important information about the development of the intervention and its acceptability, whereas the third phase will assess the effectiveness of this systematically developed intervention. ETHICS AND DISSEMINATION The Norwegian Regional Committee for Medical and Health Research Ethics (REK west number 2015/60) has approved the study design. Patients recruited in the different phases will fill out an informed consent form prior to inclusion and will be guaranteed anonymity and the right to withdraw from the study at any time. The results of the study will be published in peer-reviewed journals, electronically and in print, and presented at research conferences. TRIAL REGISTRATION NUMBER NCT02575599.
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Affiliation(s)
- Bjørg Karlsen
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| | - Bjørg Oftedal
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| | | | - Berit Rokne
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Mark Peyrot
- Sociology Department, Loyola University Maryland, Baltimore, Maryland, USA
| | - Vibeke Zoffmann
- Juliane Marie Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Marit Graue
- Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway
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Alahdab F, Alabed S, Al-Moujahed A, Al Sallakh MA, Alyousef T, Alsharif U, Fares M, Murad MH. Evidence-based medicine: a persisting desire under fire. ACTA ACUST UNITED AC 2016; 22:9-11. [PMID: 27965267 DOI: 10.1136/ebmed-2016-110608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Healthcare infrastructure and medical schools in Syria have been greatly compromised by military conflict and humanitarian disaster. Medical students and healthcare professionals reached out for remote learning opportunities. Surprisingly, they desired a curriculum in evidence-based medicine. We report on a curriculum that was delivered to 126 learners using an online remote delivery platform. This experience demonstrates the feasibility of this approach in disaster-stricken areas and underscores the importance of evidence-based medicine even under such conditions.
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200
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Kinnear J, Jackson R. Constructing diagnostic likelihood: clinical decisions using subjective versus statistical probability. Postgrad Med J 2016; 93:425-429. [PMID: 27941006 DOI: 10.1136/postgradmedj-2016-134496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/30/2016] [Revised: 11/02/2016] [Accepted: 11/20/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although physicians are highly trained in the application of evidence-based medicine, and are assumed to make rational decisions, there is evidence that their decision making is prone to biases. One of the biases that has been shown to affect accuracy of judgements is that of representativeness and base-rate neglect, where the saliency of a person's features leads to overestimation of their likelihood of belonging to a group. This results in the substitution of 'subjective' probability for statistical probability. METHODS This study examines clinicians' propensity to make estimations of subjective probability when presented with clinical information that is considered typical of a medical condition. The strength of the representativeness bias is tested by presenting choices in textual and graphic form. Understanding of statistical probability is also tested by omitting all clinical information. RESULTS For the questions that included clinical information, 46.7% and 45.5% of clinicians made judgements of statistical probability, respectively. Where the question omitted clinical information, 79.9% of clinicians made a judgement consistent with statistical probability. There was a statistically significant difference in responses to the questions with and without representativeness information (χ2 (1, n=254)=54.45, p<0.0001). CONCLUSIONS Physicians are strongly influenced by a representativeness bias, leading to base-rate neglect, even though they understand the application of statistical probability. One of the causes for this representativeness bias may be the way clinical medicine is taught where stereotypic presentations are emphasised in diagnostic decision making.
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Affiliation(s)
- John Kinnear
- Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK.,Department of Anaesthetics, Southend University Hospital NHS Foundation Trust, Southend, UK
| | - Ruth Jackson
- Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK
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