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Romero-Robles MA, Soriano-Moreno DR, García-Gutiérrez FM, Condori-Meza IB, Sing-Sánchez CC, Bulnes Alvarez SP, Alarcon-Ruiz CA, Taype-Rondan A, Viteri‐García A. Self-perceived competencies on evidence-based medicine in medical students and physicians registered in a virtual course: a cross-sectional study. MEDICAL EDUCATION ONLINE 2022; 27:2010298. [PMID: 34919030 PMCID: PMC8725743 DOI: 10.1080/10872981.2021.2010298] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Evidence-based medicine (EBM) is defined as the integration of the best available evidence from scientific studies with clinical experience (and context) and with patients' values and preferences. The objective of the present study was to describe self-perceived EBM competencies in physicians and medical students enrolled in a massive virtual EBM course. METHODS Analytical cross-sectional study. People interested in a free virtual EBM course fulfilled their data in a virtual form for their registration in September 2020. In this form, 22 competencies related to four dimensions of EBM were evaluated: asking a clinical question, search, analysis, and application; using a 5-option Likert scale. The resulting database was analyzed, selecting people who claimed to be physicians or medical students of 18 years or more. RESULTS 1793 participants were included: 1130 medical students and 663 physicians; more than 80% lived in Peru. The frequency of participants who agreed or strongly agreed with feeling qualified in each competence ranged: from 39.2% to 57.8% for the competencies of the 'Asking a clinical question' dimension, from 39.2% to 56.1% for 'Search,' from 19.9% to 32.0% for 'Analysis,' and from 19.6% to 29.9% for 'Application.' Both in physicians and students, the lowest frequencies were for the competencies of interpretation of impact measures, graphs, and results of systematic reviews; as well as shared decision making and calculation of expected benefit. Physicians who graduated more recently scored better on competencies from search and analysis dimensions. CONCLUSION Among physicians and medical students enrolled in the course, self-perception of competencies was lower in the dimensions of analysis and application. More recently graduated physicians seem to have a greater self-perception of their research and analysis skills, probably due to curricular updates.List of abbreviations: EBM: Evidence-based medicine; CIMBE, for its acronym in Spanish: International Course on Evidence-Based Medicine; SOCIMEP, for its acronym in Spanish: Peruvian Medical Student Scientific Society.
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Affiliation(s)
- Milton A. Romero-Robles
- Escuela de Medicina, Universidad Nacional Del Santa, Nuevo Chimbote, Ancash, Perú
- Comité Permanente Académico, Sociedad Científica Médico Estudiantil Peruana, Lima, Perú
| | - David R. Soriano-Moreno
- Comité Permanente Académico, Sociedad Científica Médico Estudiantil Peruana, Lima, Perú
- Escuela de Medicina, Universidad Peruana Unión, Lima, Perú
| | - Fabrizio M. García-Gutiérrez
- Comité Permanente Académico, Sociedad Científica Médico Estudiantil Peruana, Lima, Perú
- Escuela de Medicina, Universidad Nacional de Trujillo, Trujillo, Perú
| | - I. Benjamín Condori-Meza
- Comité Permanente Académico, Sociedad Científica Médico Estudiantil Peruana, Lima, Perú
- Escuela de Medicina, Universidad Peruana Unión, Lima, Perú
| | - Caroline C. Sing-Sánchez
- Escuela de Medicina, Universidad Nacional Del Santa, Nuevo Chimbote, Ancash, Perú
- Comité Permanente Académico, Sociedad Científica Médico Estudiantil Peruana, Lima, Perú
| | - Sandy P. Bulnes Alvarez
- Comité Permanente Académico, Sociedad Científica Médico Estudiantil Peruana, Lima, Perú
- Escuela de Medicina, Universidad César Vallejo, Piura, Perú
| | - Christoper A. Alarcon-Ruiz
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Perú
| | - Alvaro Taype-Rondan
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Perú
| | - Andres Viteri‐García
- Centro de Investigación de Salud Pública Y Epidemiología Clínica (Cispec). Facultad de Ciencias de La Salud Eugenio Espejo, Universidad Ute, Quito, Ecuador
- Fundación Epistemonikos, Santiago, Chile
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Evidence-based Medicine: Perceptions, Attitudes, and Skills Among European Urology Residents. EUR UROL SUPPL 2022; 45:44-49. [DOI: 10.1016/j.euros.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
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Roa VT, López BJV, Solano C, Carvajal LC, Pulido JSD, Yepes CG, Barbosa PP. Enseñanza en Investigación en Urología. Análisis Bibliométrico. Rev Urol 2020. [DOI: 10.1055/s-0040-1721330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Resumen
Objetivo Caracterizar el panorama de la educación en investigación en urología mediante un análisis bibliométrico.
Métodos Realizamos un análisis bibliométrico, utilizando artículos publicados entre 1955- 2019, sin restricción en el idioma. Se utilizaron las herramientass estadísticass PubMed, FABUMED y PubReminer para la obtención de la información de las variables y realización del análisis bibliométrico. Analisis de mapeo utilizando el software: VOSviewer,. Para la obtención del factor de impacto (FI), se utilizó el Journal Citation Reports 2017/2018.
Resultados Desde 1955 hasta 2019 se publicaron 718 referencias en 245 revistas. A partir del 2000 encontramos un aumento significativo en el número de publicaciones con un punto de corte en el año 2009. Las revistas con mayores publicaciones fueron: J Urol (8.6%), BJU Int (6.8%) y Urology (6.5%). De las 20 revistas con mayor número de publicaciones, sólo desolo 5 un FI mayor a 3. Los paises con mayor publicacion fueron: Estados Unidos (23,6%), Reino Unido (20,2%). El país de América Latina con mayor publicacion fué Brasil (0,8%).
Conclusiones El estado de la educación en investigación en urología demuestra un crecimiento en la producción científica , con una baja contribución por parte de los países latinoamericanos. Para poder desarrollar una creación intelectual de calidad se deberá invertir tiempo y recursos en un adecuado entrenamiento en investigación en los programas de formación en urología.
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Evidence summary resources may influence clinical decision making: A case-based scenario evaluation of an evidence summary tool. J Crit Care 2019; 55:9-15. [PMID: 31670150 DOI: 10.1016/j.jcrc.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/02/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Evidence summary resources are popular with clinicians but it is unknown whether they can influence clinical decision making. We evaluated whether an extremely condensed and explicit evidence summary tool could influence clinical decision making. MATERIALS AND METHODS An evidence summary tool was developed using a formal mapping exercise and graphic design principles. An invitation to participate was sent to subscribers of a critical care e-mail discussion list. Participants received a study package (evidence summary tool précising prone positioning in severe ARDS; case-based scenario describing a patient with severe ARDS plus evaluation questionnaire). Influence on clinical decisions was captured regarding six competing interventions, with Belief in benefit measured before and after reading the summary tool. RESULTS Among 93 participants, 87% were male with a mean age of 49.6(SD9.3) years. Mean ICU experience was 20.0(SD9.9) years. The evidence summary tool significantly influenced clinical decision making: belief in benefit of prone positioning increased (P < .001), belief in benefit of higher PEEP decreased (P = .002) and belief in benefit in ECMO decreased (P = .07). CONCLUSIONS Using a before-after evaluation, we demonstrated an extremely condensed and explicit information format can influence clinical decision making. Evidence summary tools may be a useful adjunct to support closing evidence-practice gaps.
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Snow JE, Leach MJ, Clare BA. Attitudes, skill and use of evidence-based practice among US Western herbal medicine providers: a national survey. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2017; 14:/j/jcim.ahead-of-print/jcim-2015-0101/jcim-2015-0101.xml. [PMID: 28207415 DOI: 10.1515/jcim-2015-0101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 08/15/2016] [Indexed: 12/23/2022]
Abstract
Background Evidence-based practice (EBP) has been the focus of increasing attention in the teaching and delivery of both complementary and conventional healthcare. Western herbal medicine (WHM) is a system of complementary healthcare rooted in tradition. How WHM practitioners perceive, are prepared for, and use EBP, has to date been largely ignored. We therefore examined the use, opinion, skills, and training in EBP, and barriers and facilitators of EBP uptake, among herbal practitioners in the United States (US). Methods The study utilized a cross-sectional, descriptive survey design. A sample of US clinical herbalists was invited to complete a validated online questionnaire, the Evidence-Based practice Attitude and utilization SurvEy (EBASE). Results Seventy-four US herbal practitioners completed the survey (response rate=35 %). Participants demonstrated a generally positive attitude toward EBP (median attitude subscore 31 [possible range=8-40]), a moderate to high level of self-assessed skill in EBP (median skill subscore 46 [13-65]) and a moderate level of EBP uptake (median use subscore 12 [0-24]). Apart from a lack of clinical evidence in herbal medicine, there were few perceived barriers to EBP uptake among herbal practitioners. Access to the Internet, online databases and full-text journal articles were considered most useful in facilitating the uptake of EBP in WHM practice. Conclusions Respondents' attitudes, skill level, and uptake of EBP were generally consistent with other complementary and alternative medicine providers. Educational initiatives, including those focused on the appraisal and application of evidence, may help to optimize the use of EBP among WHM practitioners.
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Austvoll-Dahlgren A, Semakula D, Nsangi A, Oxman AD, Chalmers I, Rosenbaum S, Guttersrud Ø. Measuring ability to assess claims about treatment effects: the development of the 'Claim Evaluation Tools'. BMJ Open 2017; 7:e013184. [PMID: 28515181 PMCID: PMC5777467 DOI: 10.1136/bmjopen-2016-013184] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To describe the development of the Claim Evaluation Tools, a set of flexible items to measure people's ability to assess claims about treatment effects. SETTING Methodologists and members of the community (including children) in Uganda, Rwanda, Kenya, Norway, the UK and Australia. PARTICIPANTS In the iterative development of the items, we used purposeful sampling of people with training in research methodology, such as teachers of evidence-based medicine, as well as patients and members of the public from low-income and high-income countries. Development consisted of 4 processes: (1) determining the scope of the Claim Evaluation Tools and development of items; (2) expert item review and feedback (n=63); (3) cognitive interviews with children and adult end-users (n=109); and (4) piloting and administrative tests (n=956). RESULTS The Claim Evaluation Tools database currently includes a battery of multiple-choice items. Each item begins with a scenario which is intended to be relevant across contexts, and which can be used for children (from age 10 and above), adult members of the public and health professionals. People with expertise in research methods judged the items to have face validity, and end-users judged them relevant and acceptable in their settings. In response to feedback from methodologists and end-users, we simplified some text, explained terms where needed, and redesigned formats and instructions. CONCLUSIONS The Claim Evaluation Tools database is a flexible resource from which researchers, teachers and others can design measurement instruments to meet their own requirements. These evaluation tools are being managed and made freely available for non-commercial use (on request) through Testing Treatments interactive (testingtreatments.org). TRIAL REGISTRATION NUMBERS PACTR201606001679337 and PACTR201606001676150; Pre-results.
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Affiliation(s)
| | - Daniel Semakula
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Allen Nsangi
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | | | - Øystein Guttersrud
- Norwegian Centre for Science Education, University of Oslo, Oslo, Norway
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Thornley P, de Sa D, Evaniew N, Farrokhyar F, Bhandari M, Ghert M. An international survey to identify the intrinsic and extrinsic factors of research studies most likely to change orthopaedic practice. Bone Joint Res 2016; 5:130-6. [PMID: 27105650 PMCID: PMC4921052 DOI: 10.1302/2046-3758.54.2000578] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/09/2016] [Indexed: 11/10/2022] Open
Abstract
Objectives Evidence -based medicine (EBM) is designed to inform clinical decision-making within all medical specialties, including orthopaedic surgery. We recently published a pilot survey of the Canadian Orthopaedic Association (COA) membership and demonstrated that the adoption of EBM principles is variable among Canadian orthopaedic surgeons. The objective of this study was to conduct a broader international survey of orthopaedic surgeons to identify characteristics of research studies perceived as being most influential in informing clinical decision-making. Materials and Methods A 29-question electronic survey was distributed to the readership of an established orthopaedic journal with international readership. The survey aimed to analyse the influence of both extrinsic (journal quality, investigator profiles, etc.) and intrinsic characteristics (study design, sample size, etc.) of research studies in relation to their influence on practice patterns. Results A total of 353 surgeons completed the survey. Surgeons achieved consensus on the ‘importance’ of three key designs on their practices: randomised controlled trials (94%), meta-analyses (75%) and systematic reviews (66%). The vast majority of respondents support the use of current evidence over historical clinical training; however subjective factors such as journal reputation (72%) and investigator profile (68%) continue to influence clinical decision-making strongly. Conclusion Although intrinsic factors such as study design and sample size have some influence on clinical decision-making, surgeon respondents are equally influenced by extrinsic factors such as investigator reputation and perceived journal quality. Cite this article: Dr M. Ghert. An international survey to identify the intrinsic and extrinsic factors of research studies most likely to change orthopaedic practice. Bone Joint Res 2016;5:130–136. DOI: 10.1302/2046-3758.54.2000578.
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Affiliation(s)
- P Thornley
- McMaster University, 1280 Main Street West Hamilton, Ontario, L8S 4L8, Canada
| | - D de Sa
- McMaster University, 1280 Main Street West Hamilton, Ontario, L8S 4L8, Canada
| | - N Evaniew
- McMaster University, 1280 Main Street West Hamilton, Ontario, L8S 4L8, Canada
| | - F Farrokhyar
- McMaster University, 39 Charlton Avenue East Hamilton, Ontario, L8N 1Y3, Canada
| | - M Bhandari
- McMaster University, 293 Wellington Street North Hamilton, Ontario, L8L 8E7, Canada
| | - M Ghert
- McMaster University, 711 Concession Street Level B3 Surgical Offices Hamilton, Ontario, L6J 4J9, Canada
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Sadeghi-Ghyassi F, Mostafaie A, Hajebrahimi S, Ghojazadeh M, Mostafaie H. Ophthalmologist knowledge of evidence-based medicine and clinical practice guideline recommendations. ACTA ACUST UNITED AC 2016; 21:49-54. [PMID: 26919872 DOI: 10.1136/ebmed-2015-110262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Fatemeh Sadeghi-Ghyassi
- Iranian Evidence Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Mostafaie
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Iranian Evidence Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Mostafaie
- Student's Research Committee, Iranian Evidence Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
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Silva TM, Costa LCM, Costa LOP. Evidence-Based Practice: a survey regarding behavior, knowledge, skills, resources, opinions and perceived barriers of Brazilian physical therapists from São Paulo state. Braz J Phys Ther 2015; 19:294-303. [PMID: 26443977 PMCID: PMC4620978 DOI: 10.1590/bjpt-rbf.2014.0102] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: Evidence-Based Practice (EBP) has been widely used by health professionals.
However, no study in Brazil has investigated the data regarding the knowledge and
difficulties related to EBP from a representative sample of physical therapists.
OBJECTIVE: To identify behavior, knowledge, skills, resources, opinions and perceived
barriers of Brazilian physical therapists from the state of São Paulo regarding
EBP. METHOD: A customized questionnaire about behavior, knowledge, skills, resources, opinions
and perceived barriers regarding EBP was sent by email to a sample of 490 physical
therapists registered by the Registration Board of São Paulo, Brazil. Physical
therapists who did not respond to the questionnaire were contacted by telephone
and/or letter. The data were analyzed descriptively. RESULTS: The final response rate was 64.4% (316/490). Because 60 physical therapists were
no longer practicing, 256 answers were analyzed. The physical therapists reported
that they routinely read scientific papers (89.5%) as a resource for professional
development, followed by continuing education courses (88.3%) and books (86.3%).
Approximately 35% of the respondents reported a clear understanding of the
implementation of research findings in their practice; approximately 37% reported
no difficulties in critically appraising scientific papers; and 67.2% strongly
agreed that EBP is important for their practice. The most commonly reported
barriers were related to difficulties in obtaining full-text papers (80.1%), using
EBP may represent higher cost (80.1%) and the language of publication of the
papers (70.3%). CONCLUSION: Physical therapists from São Paulo state believe that they have knowledge and
skills to use EBP. Although they have favorable opinions regarding its
implementation, they still encounter difficulties in implementing EBP
successfully.
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Pynnonen MA, Randolph GW, Shin JJ. Evidence-Based Medicine in Otolaryngology, Part 5: Patient Decision Aids. Otolaryngol Head Neck Surg 2015; 153:357-63. [PMID: 26124269 DOI: 10.1177/0194599815592366] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 06/01/2015] [Indexed: 11/16/2022]
Abstract
Modern medical decision making is a complex task requiring collaboration between patients and physicians. Related clinical evidence may delineate a clearly favorable path, but in other instances, uncertainty remains. Even in these circumstances, however, there are techniques that optimize decision making by blending existing evidence with individual patient values in the context of physician counseling. This installment of "Evidence-Based Medicine in Otolaryngology" focuses on the crucial issue of how practitioners may approach clinical situations where the data do not delineate a single irrefutable path. We describe decision aids-tools that can educate patients about data related to complex clinical decisions. We review their definition, quality standards, patient interface, benefits, and limitations. We also discuss the related concept of option grids and the role of decision aids in evidence-based practice.
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Affiliation(s)
- Melissa A Pynnonen
- Department of Otolaryngology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Gregory W Randolph
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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Dahm P, N’Dow J, Holmberg L, Hamdy F. The Future of Randomised Controlled Trials in Urology. Eur Urol 2014; 66:1-3. [DOI: 10.1016/j.eururo.2014.01.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 01/15/2014] [Indexed: 11/27/2022]
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Attitudes toward evidence-based clinical practice among doctors of chiropractic with diplomate-level training in orthopedics. Chiropr Man Therap 2013; 21:43. [PMID: 24314309 PMCID: PMC4029280 DOI: 10.1186/2045-709x-21-43] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 09/29/2013] [Indexed: 11/24/2022] Open
Abstract
Background Evidence-based clinical practice (EBCP) is a practice model gaining prominence within healthcare, including the chiropractic profession. The status of EBCP has been evaluated in a variety of healthcare disciplines, but little is known regarding the attitudes doctors of chiropractic (DCs) hold toward this model of healthcare. This project examines the attitudes toward EBCP within a specialty discipline of DCs. Methods We identified a survey questionnaire previously used to evaluate EBCP among non-chiropractic complementary and alternative practitioners. We adapted this questionnaire for use among DCs and pretested it in 5 chiropractic college faculty. The final version was administered to DCs with diplomate-level training in orthopedics. The survey was emailed to 299 potential participants; descriptive results were calculated. Results 144 surveys were returned, resulting in a 48% response rate. The majority of respondents perceived EBCP as an important aspect of chiropractic practice. Respondents also believed themselves to have an above average skill level in EBCP, reported that training originated from their diplomate education, and based the majority of their practice on clinical research. Conclusion Doctors of chiropractic with an orthopedic diplomate appear to have favorable attitudes toward EBCP. Further study will help understand EBCP perceptions among general field DCs. A logical next step includes validation of this questionnaire.
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Heighes PT, Doig GS. Intensive care specialists' knowledge, attitudes, and professional use of published research evidence: a mail-out questionnaire survey of appropriate use of research evidence in clinical practice. J Crit Care 2013; 29:116-22. [PMID: 24331946 DOI: 10.1016/j.jcrc.2013.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/04/2013] [Accepted: 10/19/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE This survey investigates the knowledge, attitudes, and use of published research in clinical practice by intensive care specialists. MATERIALS AND METHODS A mail-out questionnaire was sent to randomly selected intensive care specialists registered with the Australian and New Zealand College of Intensive Care Medicine. RESULTS The response rate was 55.9% (133/238). The average score for research knowledge was 2.9 of 6. Eighty-five (65.4%) of 130 respondents reported positive feelings toward using published research evidence in clinical practice, with 96.6% (126/130) reporting use of the concepts of evidence-based medicine at least sometimes. Randomized trials were rated as the most frequently read evidence (rank score, 3.7 of 5), with "Information obtained from the Cochrane Library" the least frequently read (rank score, 2.8 of 5). The most inhibiting barrier to use of published research evidence in practice was "a lack of good evidence providing meaningful answers to clinical problems" (rank score, 3.5 of 5). Eighty-eight (67.7%) of 130 respondents appropriately used published research evidence in clinical practice. CONCLUSIONS Respondents reported generally positive attitudes toward using published research evidence, in clinical practice; however, room for improvement in technical knowledge relating to published research evidence was noted.
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Affiliation(s)
- Philippa T Heighes
- Northern Clinical School Intensive Care Research Unit, University of Sydney, Sydney, Australia
| | - Gordon S Doig
- Northern Clinical School Intensive Care Research Unit, University of Sydney, Sydney, Australia.
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Pignataro GS, Lins TÁ, Oliveira JRALMD, Moraes VYD, Okamura A, Belloti JC, Faloppa F. Prospective Non-randomized Studies in Orthopaedics and Traumatology: Systematic Assessment of its Methodological Quality. Rev Bras Ortop 2013; 48:126-130. [PMID: 31211117 PMCID: PMC6565849 DOI: 10.1016/j.rboe.2012.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 05/28/2012] [Indexed: 10/26/2022] Open
Abstract
In surgical interventions, randomization and blinding may be difficult to implement. In this situation, non-randomized prospective studies (EPNR) can generate the best evidence. The objective of this study is to evaluate, by means of the scale proposed by Downs & Black, the quality of EPNR published in our country and to assess the interobserver reproducibility of this scale. EPNR published in Acta Ortopedica Brasileira and Revista Brasileira de Ortopedia until 2011 and prior to 2006 were included. Two of us independently applied the Downs & Black scale. The studies were stratified by period of publication, journal and type of intervention. The scores obtained were considered to assess the reliability of the scale and groups comparison. 59 studies were considered, seven excluded during the assessments. There were no differences between the scores, except for the type of intervention, which showed better methodological quality for studies involving clinical interventions (p < 0.001). The correlation coefficient for the Downs & Black score was 0.79 (95% CI 0.65 to 0.88), demonstrating good reliability. EPNR present methodological quality similar when stratified by the periodic publication and publication period. Studies with clinical interventions have better methodological quality. The Downs & Black scale shows good interobserver reproducibility.
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Affiliation(s)
- Gustavo Soriano Pignataro
- Third-year Resident Physician, Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Theophilo Ásfora Lins
- Third-year Resident Physician, Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | | | - Vinícius Ynoe de Moraes
- Third-year Resident Physician, Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Aldo Okamura
- Third-year Resident Physician, Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - João Carlos Belloti
- Adjunct Professor, Department of Orthopedics and Traumatology, Escola Paulista de Medicina, UNIFESP, Sao Paulo, SP, Brazil
| | - Flávio Faloppa
- Titular Professor, Department of Orthopedics and Traumatology, Escola Paulista de Medicina, UNIFESP, Sao Paulo, SP, Brazil
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Pignataro GS, Lins TÁ, Oliveira JRALMD, Moraes VYD, Okamura A, Belloti JC, Faloppa F. Estudos prospectivos e não randomizados na ortopedia e traumatologia: avaliação sistemática da qualidade metodológica. Rev Bras Ortop 2013. [DOI: 10.1016/j.rbo.2012.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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MacDermid JC, Law M, Buckley N, Haynes RB. "Push" versus "Pull" for mobilizing pain evidence into practice across different health professions: a protocol for a randomized trial. Implement Sci 2012; 7:115. [PMID: 23176444 PMCID: PMC3520813 DOI: 10.1186/1748-5908-7-115] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 10/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Optimizing pain care requires ready access and use of best evidence within and across different disciplines and settings. The purpose of this randomized trial is to determine whether a technology-based "push" of new, high-quality pain research to physicians, nurses, and rehabilitation and psychology professionals results in better knowledge and clinical decision making around pain, when offered in addition to traditional "pull" evidence technology. A secondary objective is to identify disciplinary variations in response to evidence and differences in the patterns of accessing research evidence. METHODS Physicians, nurses, occupational/physical therapists, and psychologists (n = 670) will be randomly allocated in a crossover design to receive a pain evidence resource in one of two different ways. Evidence is extracted from medical, nursing, psychology, and rehabilitation journals; appraised for quality/relevance; and sent out (PUSHed) to clinicians by email alerts or available for searches of the accumulated database (PULL). Participants are allocated to either PULL or PUSH + PULL in a randomized crossover design. The PULL intervention has a similar interface but does not send alerts; clinicians can only go to the site and enter search terms to retrieve evidence from the cumulative and continuously updated online database. Upon entry to the trial, there is three months of access to PULL, then random allocation. After six months, crossover takes place. The study ends with a final three months of access to PUSH + PULL. The primary outcomes are uptake and application of evidence. Uptake will be determined by embedded tracking of what research is accessed during use of the intervention. A random subset of 30 participants/ discipline will undergo chart-stimulated recall to assess the nature and depth of evidence utilization in actual case management at baseline and 9 months. A different random subset of 30 participants/ discipline will be tested for their skills in accessing evidence using a standardized simulation test (final 3 months). Secondary outcomes include usage and self-reported evidence-based practice attitudes and behaviors measured at baseline, 3, 9, 15 and 18 months. DISCUSSION The trial will inform our understanding of information preferences and behaviors across disciplines/practice settings. If this intervention is effective, sustained support will be sought from professional/health system initiatives with an interest in optimizing pain management. TRIAL REGISTRATION Registered as NCT01348802 on clinicaltrials.gov.
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Affiliation(s)
- Joy C MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
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Wallace J, Nwosu B, Clarke M. Barriers to the uptake of evidence from systematic reviews and meta-analyses: a systematic review of decision makers' perceptions. BMJ Open 2012; 2:e001220. [PMID: 22942232 PMCID: PMC3437427 DOI: 10.1136/bmjopen-2012-001220] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 07/30/2012] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To review the barriers to the uptake of research evidence from systematic reviews by decision makers. SEARCH STRATEGY We searched 19 databases covering the full range of publication years, utilised three search engines and also personally contacted investigators. Reference lists of primary studies and related reviews were also consulted. SELECTION CRITERIA Studies were included if they reported on the views and perceptions of decision makers on the uptake of evidence from systematic reviews, meta-analyses and the databases associated with them. All study designs, settings and decision makers were included. One investigator screened titles to identify candidate articles then two reviewers independently assessed the quality and the relevance of retrieved reports. DATA EXTRACTION Two reviewers described the methods of included studies and extracted data that were summarised in tables and then analysed. Using a pre-established taxonomy, the barriers were organised into a framework according to their effect on knowledge, attitudes or behaviour. RESULTS Of 1726 articles initially identified, we selected 27 unique published studies describing at least one barrier to the uptake of evidence from systematic reviews. These studies included a total of 25 surveys and 2 qualitative studies. Overall, the majority of participants (n=10 218) were physicians (64%). The most commonly investigated barriers were lack of use (14/25), lack of awareness (12/25), lack of access (11/25), lack of familiarity (7/25), lack of usefulness (7/25), lack of motivation (4/25) and external barriers (5/25). CONCLUSIONS This systematic review reveals that strategies to improve the uptake of evidence from reviews and meta-analyses will need to overcome a wide variety of obstacles. Our review describes the reasons why knowledge users, especially physicians, do not call on systematic reviews. This study can inform future approaches to enhancing systematic review uptake and also suggests potential avenues for future investigation.
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Affiliation(s)
- John Wallace
- DPhil International Programme in Evidence-based Healthcare, University of Oxford, Oxford, UK
| | - Bosah Nwosu
- First Episode Psychosis Study, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mike Clarke
- MRC All-Ireland Hub for Trials Methodology Research, Queen's University, Belfast, Ireland
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Abstract
PURPOSE Clinical practice guidelines play a critical role in guiding the evidence-based clinical practice of urology. We describe a systematic approach to critical appraisal of urology guidelines. MATERIALS AND METHODS Based on a focused clinical question derived from a clinical scenario, we identified a relevant clinical practice guideline that we critically appraised using the Users' Guide to the Medical Literature framework as to whether the results are valid, what are the results, and can they be applied to the care of an individual patient. RESULTS A clinical practice guideline by the National Institute for Clinical Excellence on the use of sunitinib as the first line treatment for patients with metastatic renal cell carcinoma was identified. The guideline development process was found to be appropriately rigorous and included an explicit rating of the quality of evidence. The recommendations were clearly stated and appeared applicable to the specific patient in the clinical scenario. CONCLUSIONS Clinical practice guidelines should be developed using rigorous evidence-based methodology. Urologists should have the skills and knowledge to critically appraise a guideline before applying it to the care of their patients.
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Affiliation(s)
- Adrian B Clubb
- University of Florida, Departments of Urology and Prostate Disease Center, College of Medicine, Gainesville, Florida, USA
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Thoma A, Cornacchi SD, Farrokhyar F, Bhandari M, Goldsmith CH. How to assess a survey in surgery. Can J Surg 2012; 54:394-402. [PMID: 21939608 DOI: 10.1503/cjs.025910] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Achilleas Thoma
- Surgical Outcomes Research Centre, Department of Surgery, McMaster University and St. Joseph's Healthcare, Hamilton, Ontario.
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20
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Hall G. Attitudes of chiropractors to evidence-based practice and how this compares to other healthcare professionals: A qualitative study. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.clch.2011.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Buscaglia J, Nagula S, Yuan J, Bucobo JC, Kumar A, Forsmark CE, Draganov PV. The practice of evidence-based medicine (EBM) in gastroenterology: discrepancies between EBM familiarity and EBM competency. Therap Adv Gastroenterol 2011; 4:283-94. [PMID: 21922027 PMCID: PMC3165209 DOI: 10.1177/1756283x11412240] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Evidence-based medicine (EBM) has become increasingly important in the practice of gastroenterology and endoscopy, and the training of future gastroenterology physicians. The objectives were to assess the attitudes/opinions of gastroenterology specialists towards EBM, and evaluate possible gaps in education for certain EBM-related concepts. METHODS An internet-based survey was emailed to 4073 gastroenterology specialists. The main outcome measurements were physicians' endorsement of EBM, impact of EBM on clinical practice, utilization of EBM-specific resources, self-assessed understanding of EBM concepts (EBM familiarity score), and actual knowledge of EBM concepts (EBM competency score). RESULTS A total of 337 gastroenterology specialists participated. On a sale of 1-10, there was widespread agreement that EBM improves patient care (median score = 9, interquartile range (IQR) = 7-10), and physicians should be familiar with techniques for critical appraisal of studies (median = 9, IQR = 8-10). Most (64.0%) utilized the EBM-related resource UpToDate™ regularly, as opposed to PubMed™ (47.1%) or Clinical Evidence™ (5.4%). The mean EBM familiarity score was 3.4 ± 0.6 on a scale of 1-4. Out of a maximum 49 points, the mean EBM competency score was 35 ± 4.9. There was poor concordance among EBM familiarity and competency scores (r = 0.161; p = 0.005). Academic practice (p < 0.001), research/teaching (p < 0.001), advanced degree (p = 0.012), and recent EBM training (p = 0.001) were all associated with improved EBM competency. CONCLUSION The attitudes and opinions of EBM are extremely favorable among gastroenterology physicians. Although gastroenterology physicians report familiarity with most EBM-related concepts, there is poor correlation with their actual knowledge of EBM. Further educational initiatives should be undertaken to address methods in which EBM skills are reinforced among all gastroenterology practitioners.
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Scales CD. Education and training in evidence-based urology. World J Urol 2011; 29:325-9. [PMID: 21293963 DOI: 10.1007/s00345-011-0651-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 01/18/2011] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Urologists believe evidence-based clinical practice improves patient care. Competence in critical appraisal skills is necessary to successfully implement evidence-based practice. However, practicing urologists, urology program training directors, and residents have identified the need for urology-specific resources to promote competence in evidence-based practice. The objective of this review is to identify urology-specific educational resources for critical appraisal skills. METHODS The PubMed(®) database was searched using the terms "evidence-based urology", "training" and "medical education." Results were limited to systematic reviews. Reference lists for manuscripts were manually searched to identify additional relevant publications. Additional educational resources and training opportunities were identified via direct communication with authors. RESULTS New urology-specific educational resources are being developed to support evidence-based clinical practice. Resources exist in the medical literature, including the User's Guide to the Urological Literature series and the Evidence-Based Urology in Practice series. Electronic resources include the Evidence Based Reviews in Urology program sponsored by the American Urological Association. Finally, workshops exist for live training to develop expertise in teaching EBM skills to others. CONCLUSION Educational support for the nascent evidence-based clinical practice movement in urology is growing. Journals provide the majority of urology-specific educational material for evidence-based medicine training. Additional online and live training opportunities should be developed to encourage competence and leadership in evidence-based urology.
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Affiliation(s)
- Charles D Scales
- Division of Urologic Surgery, Duke University Medical Center, Box 2922, Durham, NC 27710, USA.
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Shin JJ, Rauch SD, Wasserman J, Coblens O, Randolph GW. Evidence-based medicine in otolaryngology, part 2: the current state of affairs. Otolaryngol Head Neck Surg 2011; 144:331-7. [PMID: 21493192 DOI: 10.1177/0194599810393856] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
What is the current state of evidence-based medicine in otolaryngology? This question inquires about the state of our literature, our attitudes and capabilities, and our patients' desires. Thus, this installment of "Evidence-Based Medicine in Otolaryngology" focuses on these 3 topics. First, the authors consider the literature relative to benchmarks for study design. Second, the data regarding otolaryngologists' and other surgical specialists' attitudes and understanding of clinical data are discussed. Third, patient-based efforts to promote and participate in evidence-based practice are explored. In addition, a discussion of the relevant supportive efforts made by our professional organizations is included.
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Affiliation(s)
- Jennifer J Shin
- Division of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
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MacDonald SL, Canfield SE, Fesperman SF, Dahm P. Assessment of the Methodological Quality of Systematic Reviews Published in the Urological Literature From 1998 to 2008. J Urol 2010; 184:648-53. [PMID: 20639030 DOI: 10.1016/j.juro.2010.03.127] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Indexed: 12/24/2022]
Affiliation(s)
- Susan L. MacDonald
- Department of Urology, Albert Einstein College of Medicine, New York, New York
| | - Steven E. Canfield
- M. D. Anderson Cancer Center and University of Texas Medical School, Houston, Texas
| | - Susan F. Fesperman
- Department of Urology, College of Medicine, University of Florida, Gainesville, Florida
| | - Philipp Dahm
- Department of Urology, College of Medicine, University of Florida, Gainesville, Florida
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A Call for the Reporting of Effect Sizes in Research Reports to Enhance Critical Appraisal and Evidence-Based Practice. Worldviews Evid Based Nurs 2009; 6:125-9. [DOI: 10.1111/j.1741-6787.2009.00166.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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