Radiologists' perspectives about evidence-based medicine and their clinical practice: a semistructured interview study

Jordanian Radiologists' Perspectives and Application of Evidence-Based Radiology in Clinical Practice

PURPOSE

To evaluate radiologists' education, knowledge and skills of research, attitude toward evidence-based radiology (EBR), understanding of terms and use of related published work in clinical practice and the association between these variables and sociodemographic characteristics. We also aim to assess the availability of resources and to identify sources and the main barriers to implementing EBR.

MATERIALS AND METHODS

A total of 87 radiologists completed a questionnaire, which consisted of eight sections related to radiologists' demographic characteristics, and EBR-related questions. Descriptive statistics were used, and the association between EBR-related parts and sociodemographic characteristics was performed.

RESULTS

Ninety-three percent of the radiologists believed that EBR is necessary in practice. Only 40% received formal training in search strategies and 29.9% in critical appraisal of research literature during academic preparation. Moreover, 21-62% of the respondents completely understand specific terms related to EBR. Sixty-three percent stated that they can access relevant databases and the Internet at workplace. Research articles were only used by 24% to make a clinical decision. Almost 50% reported that they read or reviewed ≤1 article per month. The primary barrier to implementing EBR was the lack of colleagues' support. Understanding terms and the number of articles used in clinical decision were significantly related to education (P-value=0.001, 0.007) and hospital section (P-value=0.002, 0.027) respectively.

CONCLUSION

Radiologists showed positive attitude toward EBR. However, there is a lack in information resources, colleagues' support, use of published literature, understanding of research terms and the ability of radiologists to access relevant databases at workplaces.

Awareness, attitudes, barriers, and knowledge about evidence-based medicine among family physicians in Croatia: a cross-sectional study

BACKGROUND

Evidence-based medicine (EBM) aims to assist physicians in making medical decisions based on the integration of the current best evidence, clinical expertise, and patients' values. Extensive research has been conducted regarding physicians' awareness, attitudes, barriers, and knowledge about EBM. In Croatia, there is a lack of research on this topic, especially among family physicians (FP). The aim of this study was to assess the awareness, attitudes, barriers, and knowledge about EBM among FPs in Croatia after six years of educational activities organized and provided by Cochrane Croatia.

METHODS

In a cross-sectional study, conducted in 2016, we offered to FPs in Croatia a printed or online validated questionnaire to assess attitudes toward and barriers when considering the use of EBM, awareness about sources of evidence, and their level of understanding of evidence-based medicine terminology. The physicians were approached during mandatory continuing medical education courses and through their professional associations. We compared results from two groups of physicians, one with family medicine specialization and the other without.

RESULTS

295 (14%) of all officially registered FPs responded to the questionnaire. Respondents were very positive toward the promotion and usage of EBM. 160 (67%) indicated that they did not have access to the Cochrane Library. The majority reported lack of time available for finding evidence (80%), and patients' unrealistic expectations that influence doctors' choice of treatment (72%). Between the two groups of physicians, more family medicine specialists reported time restrictions for finding evidence. The highest level of EBM terminology understanding was reported for study design terms, and the lowest for statistical terms.

CONCLUSIONS

This study demonstrated that FPs in Croatia had very positive attitudes toward the use of EBM, they agreed that EBM improves patient care, and they estimated that more than two thirds of their practice is EBM-based. Compared to the results of the first assessment of physicians in 2010, there was some increase in the level of EBM awareness among FPs. However, to further increase the quality of EBM practice in Croatia better access to EBM sources and further educational activities are needed.

De la sécurité des patients à la résilience des systèmes de soins: un état de l’art

Résumé La sécurité des patients est devenue une priorité des politiques de santé publique. En 30 ans, les systèmes de santé se sont approprié les outils de gestion des risques conçus pour les industries. L’objectif de cette revue de littérature est de décrire les modèles et les démarches de sécurité actuellement déployés dans les systèmes de santé et d’explorer les nouvelles perspectives. La recherche bibliographique a été réalisée à partir de trois bases de données, en français et en anglais. L’analyse thématique du matériel retenu (48 références) a guidé la construction de l’article et l’identification d’une typologie de démarches de prévention. Après une présentation des démarches « classiques », nous exposons les limites de ces démarches dans le contexte spécifique des soins. Puis nous présenterons les perspectives scientifiques actuellement envisagées pour construire de nouvelles approches de prévention en santé. Ces perspectives interrogent, en conclusion, la nécessité d’un changement de paradigme, comme le propose le courant de l’« ingénierie de la résilience ».

Young Kidney Professionals' Perspectives and Attitudes about Consuming Scientific Information: A Focus Group Study

The digital era has seen rapid changes in how information is consumed. Traditional dissemination of scholarly work through biomedical journals may not be optimally tailored to the preferences of younger clinicians and researchers. We aimed to describe the perspectives of young clinicians and researchers in kidney disease on consuming scientific information. Three focus groups were conducted during the 2017 American Society of Nephrology Kidney Week with a total of 29 nephrologists and researchers (ages 40 years old and younger) purposively sampled through our networks and the American Society of Nephrology registration database. Data were analyzed thematically. Of the 72 participants invited, 29 participated from 28 centers across 13 countries. Five themes were identified: capturing and retaining attention (with subthemes of triggering interest, optimizing readability, and navigation to sustain motivation); having discernible relevance (resonating with clinical and research interests, supporting professional development, action-oriented and readily applicable, able to disseminate, contextualizing the study, and filtering out informational noise); immediacy and efficiency in processing information (requiring instantaneous and easy access, enabling rapid understanding, and facilitating comprehension of complex concepts); trusting legitimate and credible sources (authoritative indicator of importance and quality, reputable experts broadening perspective, certainty and confidence with collegial input, accurate framing and translation of the message, ascertaining methodologic detail and nuances, and integrating the patient perspective); and social dialoguing and debate. Immediate and digitally optimized access motivated young kidney professionals to consume scientific information. Mechanisms that enable them to distil relevant and new evidence, appraise and apply information to clinical practice and research, disseminate studies to colleagues, and engage in discussion and debate may enhance their comprehension, confidence, interpretation, and use of scientific literature.

Noncontrast-Enhanced Magnetic Resonance Versus Computed Tomography Angiography in Preoperative Evaluation of Potential Living Renal Donors

RATIONALE AND OBJECTIVES

Living renal donors undergo an extensive examination program. These examinations should be as safe, gentle, and patient friendly as possible. To compare computed tomography angiography (CTA) and an extensive magnetic resonance imaging (MRI) protocol without contrast agents to observations from nephrectomy in living renal donors and to evaluate whether noncontrast-enhanced MRI can replace CTA for vessel assessment in living renal donors.

MATERIAL AND METHODS

CTA and MRI results were compared to observations from nephrectomy, which served as the reference standard. Fifty-one potential kidney donors underwent imaging, and 31 donated a kidney. Comparisons in sensitivity, specificity, and accuracy were made with respect to the number of arteries, early branching, and the number of veins. Agreement was assessed using Cohen's kappa. The exact McNemar's test was used to test for statistically significant differences.

RESULTS

In the assessment of more than one renal artery, the sensitivity and specificity of MRI and CTA were high and in perfect agreement compared to observations from surgery. The results for both MRI and CTA were as follows: (sensitivity 100%/specificity100%/accuracy 100%/Kappa = 1/P = 1). When comparing the ability to test for early branching we found, MRI: (sensitivity 33%/specificity 100%/accuracy 87%/Kappa = 0.45/P = 1) and CTA: (sensitivity 50%/specificity 100%/accuracy 90%/Kappa = 0.62/P = 1). When used to depict supernumerary veins, we found MRI: (sensitivity60%/specifivity100%/accuracy 93%/Kappa = 0.72/P = 1), whereas CTA showed: (sensitivity 40%/specificity 96%/accuracy 87% Kappa = 0.43/P = 1).

CONCLUSIONS

In conclusion, an optimized MRI protocol that includes noncontrast-enhanced magnetic resonance angiography can be substituted for CTA for preoperative assessment of the renal vessels before living donor nephrectomy.