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Witte C, Schmidt DM, Cimiano P. Comparing generative and extractive approaches to information extraction from abstracts describing randomized clinical trials. J Biomed Semantics 2024; 15:3. [PMID: 38654304 PMCID: PMC11036632 DOI: 10.1186/s13326-024-00305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Systematic reviews of Randomized Controlled Trials (RCTs) are an important part of the evidence-based medicine paradigm. However, the creation of such systematic reviews by clinical experts is costly as well as time-consuming, and results can get quickly outdated after publication. Most RCTs are structured based on the Patient, Intervention, Comparison, Outcomes (PICO) framework and there exist many approaches which aim to extract PICO elements automatically. The automatic extraction of PICO information from RCTs has the potential to significantly speed up the creation process of systematic reviews and this way also benefit the field of evidence-based medicine. RESULTS Previous work has addressed the extraction of PICO elements as the task of identifying relevant text spans or sentences, but without populating a structured representation of a trial. In contrast, in this work, we treat PICO elements as structured templates with slots to do justice to the complex nature of the information they represent. We present two different approaches to extract this structured information from the abstracts of RCTs. The first approach is an extractive approach based on our previous work that is extended to capture full document representations as well as by a clustering step to infer the number of instances of each template type. The second approach is a generative approach based on a seq2seq model that encodes the abstract describing the RCT and uses a decoder to infer a structured representation of a trial including its arms, treatments, endpoints and outcomes. Both approaches are evaluated with different base models on a manually annotated dataset consisting of RCT abstracts on an existing dataset comprising 211 annotated clinical trial abstracts for Type 2 Diabetes and Glaucoma. For both diseases, the extractive approach (with flan-t5-base) reached the best F 1 score, i.e. 0.547 ( ± 0.006 ) for type 2 diabetes and 0.636 ( ± 0.006 ) for glaucoma. Generally, the F 1 scores were higher for glaucoma than for type 2 diabetes and the standard deviation was higher for the generative approach. CONCLUSION In our experiments, both approaches show promising performance extracting structured PICO information from RCTs, especially considering that most related work focuses on the far easier task of predicting less structured objects. In our experimental results, the extractive approach performs best in both cases, although the lead is greater for glaucoma than for type 2 diabetes. For future work, it remains to be investigated how the base model size affects the performance of both approaches in comparison. Although the extractive approach currently leaves more room for direct improvements, the generative approach might benefit from larger models.
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Affiliation(s)
- Christian Witte
- Semantic Computing Group, Center for Cognitive Interaction Technology, Bielefeld University, Inspiration 1, Bielefeld, 33619, NRW, Germany
| | - David M Schmidt
- Semantic Computing Group, Center for Cognitive Interaction Technology, Bielefeld University, Inspiration 1, Bielefeld, 33619, NRW, Germany.
| | - Philipp Cimiano
- Semantic Computing Group, Center for Cognitive Interaction Technology, Bielefeld University, Inspiration 1, Bielefeld, 33619, NRW, Germany
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Hanai A, Ishikawa T, Kawauchi S, Iida Y, Kawakami E. Generative artificial intelligence and non-pharmacological bias: an experimental study on cancer patient sexual health communications. BMJ Health Care Inform 2024; 31:e100924. [PMID: 38575326 PMCID: PMC11002430 DOI: 10.1136/bmjhci-2023-100924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/09/2024] [Indexed: 04/06/2024] Open
Abstract
Objectives The objective of this study was to explore the feature of generative artificial intelligence (AI) in asking sexual health among cancer survivors, which are often challenging for patients to discuss.Methods We employed the Generative Pre-trained Transformer-3.5 (GPT) as the generative AI platform and used DocsBot for citation retrieval (June 2023). A structured prompt was devised to generate 100 questions from the AI, based on epidemiological survey data regarding sexual difficulties among cancer survivors. These questions were submitted to Bot1 (standard GPT) and Bot2 (sourced from two clinical guidelines).Results No censorship of sexual expressions or medical terms occurred. Despite the lack of reflection on guideline recommendations, 'consultation' was significantly more prevalent in both bots' responses compared with pharmacological interventions, with ORs of 47.3 (p<0.001) in Bot1 and 97.2 (p<0.001) in Bot2.Discussion Generative AI can serve to provide health information on sensitive topics such as sexual health, despite the potential for policy-restricted content. Responses were biased towards non-pharmacological interventions, which is probably due to a GPT model designed with the 's prohibition policy on replying to medical topics. This shift warrants attention as it could potentially trigger patients' expectations for non-pharmacological interventions.
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Affiliation(s)
- Akiko Hanai
- Medical Data Mathematical Reasoning Team, Advanced Data Science Project, RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Japan
- Department of Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuo Ishikawa
- Medical Data Mathematical Reasoning Team, Advanced Data Science Project, RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Japan
- Department of Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Extended Intelligence for Medicine, The Ishii-Ishibashi Laboratory, Keio University School of Medicine, Tokyo, Japan
- Collective Intelligence Research Laboratory, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Shoichiro Kawauchi
- Medical Data Mathematical Reasoning Team, Advanced Data Science Project, RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Japan
| | - Yuta Iida
- Medical Data Mathematical Reasoning Team, Advanced Data Science Project, RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Japan
| | - Eiryo Kawakami
- Medical Data Mathematical Reasoning Team, Advanced Data Science Project, RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Japan
- Department of Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
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Dimmer A, Baird R, Puligandla P. Role of practice standardization in outcome optimization for CDH. World J Pediatr Surg 2024; 7:e000783. [PMID: 38532942 PMCID: PMC10961560 DOI: 10.1136/wjps-2024-000783] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Standardization of care seeks to improve patient outcomes and healthcare delivery by reducing unwanted variations in care as well as promoting the efficient and effective use of healthcare resources. There are many types of standardization, with clinical practice guidelines (CPGs), based on a stringent assessment of evidence and expert consensus, being the hallmark of high-quality care. This article outlines the history of CPGs, their benefits and shortcomings, with a specific focus on standardization efforts as it relates to congenital diaphragmatic hernia management.
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Affiliation(s)
- Alexandra Dimmer
- Harvey E. Beardmore Division of Pediatric Surgery, Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Robert Baird
- Division of Pediatric General and Thoracic Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Pramod Puligandla
- Harvey E. Beardmore Department of Pediatric Surgery, McGill University, Montreal, Quebec, Canada
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Borkar N, Tiwari C, Nair A, Mohanty D, Sinha CK, Mahajan JK. Tubularized incised plate urethroplasty and grafted tubularized incised plate urethroplasty: systematic review, meta-analysis and trial sequential analysis. World J Pediatr Surg 2024; 7:e000707. [PMID: 38415100 PMCID: PMC10897843 DOI: 10.1136/wjps-2023-000707] [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: 09/18/2023] [Accepted: 12/26/2023] [Indexed: 02/29/2024] Open
Abstract
Background Hypospadias is one of the most common genital birth defects. There are around 300 various techniques available for the repair of hypospadias. This study aims to compare the reported outcomes of Tubularized incised plate urethroplasty (TIP) and Grafted TIP (GTIP) repair in children undergoing primary hypospadias repair. Methods This meta-analysisadhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and we framed our research question using the population, intervention, control and outcomes format. We conducted comprehensive electronic searches across various databases, employing a Boolean search strategy with predefined search terms. Only randomized controlled trials (RCTs) were included for quantitative analysis. Results Totally, 10 RCTs met our inclusion criteria for quantitative analysis. The results indicated that urethrocutaneous fistula, glans dehiscence, and stricture rates were comparable between the two groups. The incidence of meatal stenosis was found to be significantly lower in the GTIP group with a relative risk (RR) of 0.32 (95% confidence interval (CI) 0.15 to 0.67). Conclusion The coucomes UCF, glans dehiscence, and stricture rates were comparable between the two groups. Notably, the incidence of meatal stenosis was found to be significantly lower in the grafted TIP group. In terms of operative time, our quantitative synthesis demonstrated that the TIP group had a shorter operative time than the GTIP group with significant heterogeneity.
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Affiliation(s)
- Nitinkumar Borkar
- Paediatric Surgery, All India Institute of Medical Sciences-Raipur, Raipur, Chhattisgardh, India
| | - Charu Tiwari
- Paediatric Surgery, All India Institute of Medical Sciences-Raipur, Raipur, Chhattisgardh, India
- Department of Anaesthesiology, Ibra Hospital, Ibra, Oman
| | - Abhijit Nair
- Department of Anaesthesiology, Ibra Hospital, Ibra, Oman
| | - Debajyoti Mohanty
- General Surgery, All India Institute of Medical Sciences-Raipur, Raipur, Chhattisgardh, India
| | - C K Sinha
- Paediatric Surgery, St George's University Hospitals NHS Foundation Trust, London, UK
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Valencia Soto CM, Villacañas Palomares MV, Garcia-Avello Fernández-Cueto A, Barbadillo Villanueva S, Martínez Callejo V, Ochagavía Sufrategui M, Muñoz Cacho P, Valero Domínguez M. Predictive value of immune-related adverse events during pembrolizumab treatment in non-small cell lung cancer. Eur J Hosp Pharm 2023; 31:40-45. [PMID: 35383033 PMCID: PMC10800252 DOI: 10.1136/ejhpharm-2021-003038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/24/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Several studies have reported the role of immune-related adverse events as a predictor of clinical benefit, but few have properly described these findings in advanced or metastatic non-small cell lung cancer treated with pembrolizumab. This study aimed to evaluate the association between immune-related adverse events development and clinical outcomes in the aforementioned group of patients. METHODS We conducted a retrospective study in patients with advanced or metastatic non-small cell lung cancer treated with pembrolizumab. Overall response rate, progression-free survival and overall survival were evaluated according to the appearance, subtype and number of immune-related adverse events developed. We report the results of the immune-related adverse events analysis and the potential correlation between immune-related adverse events and clinical outcomes. Univariate and multivariate analyses were performed to evaluate this relationship. RESULTS A total of 94 patients were analysed; 60 of them developed immune-related adverse events. Patients with immune-related adverse events had a significantly higher overall response rate compared with the non-immune-related adverse events group (34% vs 8.5%, χ2=0.005). Median progression-free survival was statistically significant in favour of patients with at least one immune-related adverse event (p=0.015). Median overall survival was not reached in patients with ≥1 immune-related adverse events, compared with 8 months (95% CI 0.6 to 15.4 months) in those without immune-related adverse events. Patients who developed ≥2 immune-related adverse events had longer median progression-free survival (11 vs 4 months, not statistically significant) and overall survival (not reached vs 11, p=0.022) compared with those with ≤1 immune-related adverse events. CONCLUSIONS Obtained data showed that patients with immune-related adverse events occurrence had significantly better overall response rate and longer progression-free survival and overall survival. This study highlights the role of immune-related adverse events as a predictor of survival in a real-life setting.
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Affiliation(s)
- Carmen Maria Valencia Soto
- Pharmacy, Hospital Universitario Marques de Valdecilla Servicio de Farmacia, Santander, Cantabria, Spain
| | | | | | - Sara Barbadillo Villanueva
- Pharmacy, Hospital Universitario Marques de Valdecilla Servicio de Farmacia, Santander, Cantabria, Spain
| | - Virginia Martínez Callejo
- Pharmacy, Hospital Universitario Marques de Valdecilla Servicio de Farmacia, Santander, Cantabria, Spain
| | - María Ochagavía Sufrategui
- Pharmacy, Hospital Universitario Marques de Valdecilla Servicio de Farmacia, Santander, Cantabria, Spain
| | - Pedro Muñoz Cacho
- Unidad Docente de Medicina familiar y comunitaria, Idival, Santander, Cantabria, Spain
| | - Marta Valero Domínguez
- Pharmacy, Hospital Universitario Marques de Valdecilla Servicio de Farmacia, Santander, Cantabria, Spain
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Boissiere C, Francois E, Vabret E, Le Daré B, Bacle A. Spice-drug interactions: a case report on the use of turmeric, curry and ginger in a renal transplant patient on tacrolimus. Eur J Hosp Pharm 2023; 31:68-69. [PMID: 37586787 PMCID: PMC10800271 DOI: 10.1136/ejhpharm-2023-003871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023] Open
Abstract
Tacrolimus is a widely used immunosuppressant for the prevention of rejection after transplantation. In vitro studies suggest that interactions exist between spices and tacrolimus. We present the case of a renal transplant patient aged around 70 years who was treated with prednisone, mycophenolate-mofetil and tacrolimus. The patient had a pre-transplant dietary habit of consuming foods spiced with turmeric, curry and ginger. The following protocol was implemented in parallel with close monitoring of plasma tacrolimus concentrations: administration of 10 g/day of turmeric for 4 days, then 10 g/day of curry for 4 days and then 10 g/day of ginger for 4 days. No change in tacrolimus plasma concentrations during and after the implementation of the protocol was observed. The impact of turmeric, curry and ginger on plasma tacrolimus concentrations seems negligible in vivo although further studies are needed. A shared decision to test the impact of spice consumption in a patient with dietary habits involving these spices seems reasonable.
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Affiliation(s)
- Camille Boissiere
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, 35000, Rennes, France
| | - Elise Francois
- Service de Néphrologie, CHU Rennes, 35000, Rennes, France
| | - Elsa Vabret
- Service de Néphrologie, CHU Rennes, 35000, Rennes, France
| | - Brendan Le Daré
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, 35000, Rennes, France
- INSERM, INRAE, Institut NuMeCan (Nutrition, Metabolisms and Cancer), Réseau PREVITOX, Université de Rennes 1, 35000, Rennes, France
| | - Astrid Bacle
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, 35000, Rennes, France
- Univ Rennes, CHU Rennes, INSERM, EHESP, Irset-UMR_S 1085, 35000, Rennes, France
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7
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Cave JA. Changing the complexity of therapeutic monitoring. Drug Ther Bull 2023; 61:178. [PMID: 38030153 DOI: 10.1136/dtb.2023.000049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
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Intravenous vitamin injections: where is the evidence? Drug Ther Bull 2023; 61:151-5. [PMID: 37640530 DOI: 10.1136/dtb.2023.000006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
The body needs small daily quantities of vitamins and minerals, which are usually obtained from the diet. Intravenous vitamins are used for a few serious medical conditions (eg, malabsorption syndromes with severe vitamin depletion, Wernicke's encephalopathy or critical illness). Intravenous drips containing high doses of various vitamins and minerals (eg, the so-called 'Myers' cocktail') have been promoted in popular culture to 'reduce stress', 'increase energy' or 'boost immunity', with claims that the intravenous route allows faster absorption of vitamins into the bloodstream than if they are taken orally. There is a lack of high-quality evidence to suggest that high-dose vitamin infusions are necessary or offer any health benefit in the absence of a specific vitamin deficiency or medical condition. There may be harms from taking high (non-physiological) quantities of some vitamins and minerals. Licensed forms of injectable vitamins that are prescription-only medicines should not be advertised to the public and should only be supplied and administered by appropriately qualified healthcare professionals.
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Gonçalves JR, Sleath BL, Cerdeira M, Cavaco AM. Older people, medication usage and long-term care pharmacists: a retrospective cohort study. Eur J Hosp Pharm 2023:ejhpharm-2023-003908. [PMID: 37758319 DOI: 10.1136/ejhpharm-2023-003908] [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: 07/11/2023] [Accepted: 09/12/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE To investigate the impact of the presence of a pharmacist on medication usage in long-term care facilities. METHODS The study followed a retrospective cohort design, with a sample of patients aged ≥65 years admitted to three long-term care facilities over 30 months. Data on age, gender, type of stay, the presence or absence of a pharmacist and pharmacotherapeutic profile at admission and discharge were obtained for study patients. Variations in the number of medicines, anticholinergic burden and potentially inappropriate medications at admission and discharge were assessed as outcome variables. Anticholinergic burden and potentially inappropriate medications were assessed using the Anticholinergic Cognitive Burden scale and the EU(7)-PIM List, respectively. One-sample t-tests were used to compare the mean values of the outcome variables. A four-way ANOVA was used to test the association between background and outcome variables. Partial eta squared (η2) was used to measure the effect size. RESULTS A total of 1366 patients were studied. All outcome variables showed a statistically significant increase at discharge compared with admission. The presence of a pharmacist was statistically significant in improving the number of medicines (p<0.001) and the anticholinergic burden score (p<0.001), while no statistically significant value was reached on potentially inappropriate medications (p=0.642). Small effect size values were obtained for the impact of the pharmacist on the number of medicines and anticholinergic burden scores (η2=0.021 and η2=0.011, respectively). CONCLUSION These findings suggest that the presence of a long-term care pharmacist can positively impact the use of medication associated with poor health outcomes. An integrated interprofessional approach is needed to address potentially inappropriate medications, anticholinergic burden and polypharmacy in long-term care settings, particularly at the time of discharge.
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Affiliation(s)
| | - Betsy L Sleath
- UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Mariana Cerdeira
- Pharmacy Services, Residências Montepio - Serviços de Saúde S.A, Lisbon, Portugal
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Bittar A, Zipperlen C, Gilbert G, Cho L, Valveri J, Kontonicolas F, Joseph C. Comparison of outcomes for fixed and weight-based four-factor prothrombin complex concentrate dosing regimens. Eur J Hosp Pharm 2023:ejhpharm-2023-003892. [PMID: 37726148 DOI: 10.1136/ejhpharm-2023-003892] [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: 06/27/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVES Although fixed dose regimens using four-factor prothrombin complex concentrate (4F-PCC) are more widely accepted, using a 'one size fits all' approach remains an area of uncertainty. The primary objective of this study was to compare percentages of haemostasis between fixed dose and weight-based dose 4F-PCC regimens for multiple bleed types and anticoagulants. Secondary objectives compared differences in the time to administration and in-hospital mortality. METHODS This retrospective, cohort study took place at a community hospital and included patients ≥18 years of age receiving 4F-PCC for major bleeding while on either warfarin or a factor-Xa inhibitor between January 2015 and December 2022. Patients received either fixed dose (treatment) or weight-based dose (comparison). Patients who had been treated for a non-urgent procedure, with unknown haemorrhage source, not on anticoagulation, coagulopathic from hepatic failure, had received dabigatran or were allergic to heparin were excluded. Fisher's exact test and logistic regression were used to analyse primary and secondary outcomes. RESULTS 94 patients met the inclusion criteria; 38 patients were assigned to the treatment group and 56 to the comparator group. There was no statistical evidence of a difference in the achievement of haemostasis between groups (45% vs 46%, p=0.872). The fixed dose patients received the dose on average 13 min faster than weight-based (32 min vs 46 min, p=0.031). There was no difference in mortality (29% vs 29%, p=0.968). CONCLUSION Fixed 4F-PCC regimens may achieve similar outcomes and a faster time to administration compared with weight-based regimens.
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Affiliation(s)
- Amal Bittar
- Pharmacy, Mount Sinai South Nassau, Oceanside, New York, USA
| | - Carl Zipperlen
- Pharmacy, Mount Sinai South Nassau, Oceanside, New York, USA
| | | | - Lance Cho
- Pharmacy, Mount Sinai South Nassau, Oceanside, New York, USA
| | - Joseph Valveri
- Pharmacy, Mount Sinai South Nassau, Oceanside, New York, USA
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Cave JA. Redaction at the heart of NICE appraisals. Drug Ther Bull 2023; 61:130. [PMID: 37524407 DOI: 10.1136/dtb.2023.000035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
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Cohen JR, Stutts M. Interpersonal Well-Being and Suicidal Outcomes in a Nationally Representative Study of Adolescents: A Translational Study. Res Child Adolesc Psychopathol 2023; 51:1327-1341. [PMID: 37222862 DOI: 10.1007/s10802-023-01068-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/25/2023]
Abstract
Adolescent suicide continues to rise despite burgeoning research on interpersonal risk for suicide. This may reflect challenges in applying developmental psychopathology research into clinical settings. In response, the present study used a translational analytic plan to examine indices of social well-being most accurate and statistically fair for indexing adolescent suicide. Data from the National Comorbidity Survey Replication Adolescent Supplement were used. Adolescents aged 13-17 (N = 9,900) completed surveys on traumatic events, current relationships, and suicidal thoughts and attempts. Both frequentist (e.g., receiver operating characteristics) and Bayesian (e.g., Diagnostic Likelihood Ratios; DLRs) techniques provided insight into classification, calibration, and statistical fairness. Final algorithms were compared to a machine learning-informed algorithm. Overall, parental care and family cohesion best classified suicidal ideation, while these indices and school engagement best classified attempts. Multi-indicator algorithms suggested adolescents at high risk across these indices were approximately 3-times more likely to engage in ideation (DLR = 3.26) and 5-times more likely to engage in attempts (DLR = 4.53). Although equitable for attempts, models for ideation underperformed in non-White adolescents. Supplemental, machine learning-informed algorithms performed similarly, suggesting non-linear and interactive effects did not improve model performance. Future directions for interpersonal theories for suicide are discussed and clinical implications for suicide screening are demonstrated.
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Affiliation(s)
- Joseph R Cohen
- Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL, 61820, USA.
| | - Morgan Stutts
- Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL, 61820, USA
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Cosgrove L, Shaughnessy AF. Becoming a Phronimos: Evidence-Based Medicine, Clinical Decision Making, and the Role of Practical Wisdom in Primary Care. J Am Board Fam Med 2023; 36:531-536. [PMID: 37562833 DOI: 10.3122/jabfm.2023.230034r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 08/12/2023] Open
Abstract
There has been much discussion about the overmedicalization of human experience and the problems incurred by overzealous action-oriented medical care. In this paper we describe the Aristotelean virtue of phronesis, or practical wisdom, and discuss how it can be developed by interested clinicians. We argue that becoming a phronimos requires conscious attention to one's practice by using feedback to continually improve. But there must also be judicious adherence to clinical practice guidelines and advocacy for people-as-patients at individual, community, and national levels.
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Affiliation(s)
- Lisa Cosgrove
- From the Department of Counseling and School Psychology, University of Massachusetts-Boston (LC); Department of Family Medicine, Tufts University School of Medicine, Boston, MA (AFS)
| | - Allen F Shaughnessy
- From the Department of Counseling and School Psychology, University of Massachusetts-Boston (LC); Department of Family Medicine, Tufts University School of Medicine, Boston, MA (AFS)
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Affiliation(s)
- David Erskine
- Pharmacy, Guys & St Thomas NHS Foundation Trust, London, UK
| | - John Minshull
- Pharmacy, Guys & St Thomas NHS Foundation Trust, London, UK
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15
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Karagkounis D. Cardiac and renal effects of sodium-glucose co-transporter 2 inhibitors. Drug Ther Bull 2023; 61:103-107. [PMID: 37380347 DOI: 10.1136/dtb.2022.000057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
After initially being licensed as treatment for diabetes, the range of indications for sodium-glucose co-transporter 2 (SGLT2) inhibitors has expanded to include chronic heart failure and chronic kidney disease. This article provides an overview of some of the evidence that supports the use of SGLT2 inhibitors in the management of chronic heart failure and chronic kidney disease, discusses the safety of this group of drugs and considers the practical application of their use.
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Patterson J. Small interfering RNA (siRNA)-based therapeutics. Drug Ther Bull 2023; 61:72-76. [PMID: 37098440 DOI: 10.1136/dtb.2023.000004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
In early studies in simple organisms and mammalian cell lines, small interfering RNA (siRNA) molecules were found to allow experimental cleavage of intracellular messenger RNA (mRNA; the transcription product of a cell gene), reducing the levels of the proteins that would otherwise be formed by the action of the mRNA, thereby 'silencing' a specific gene. Researchers subsequently assessed the effects of this class of molecule in patients with various genetic conditions (eg, hereditary amyloidosis) that could benefit from reductions in the excessive quantities of harmful proteins (eg, amyloid). Due to the hydrophilic (non-fat-soluble) nature of the molecules, they have been formulated as lipid nanoparticles to aid transport into cells or conjugated to molecules with an ability to target certain cells in the body (eg, hepatocytes) to aid specificity of action. Their intracellular effects may last up to several months before they are broken down and inactivated. As they need to be composed of an exact complementary sequence to be able to cleave the target mRNA, they are thought to have few unwanted effects apart from infusion or injection site reactions. Several siRNA medicines have been licensed and many other products are in development for genetic hepatic, cardiovascular and ocular conditions.
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Gulanski BI, Butera NM, Krause-Steinrauf H, Lichtman JH, Harindhanavudhi T, Green JB, Suratt CE, AbouAssi H, Desouza C, Ahmann AJ, Wexler DJ, Aroda VR. Higher burden of cardiometabolic and socioeconomic risk factors in women with type 2 diabetes: an analysis of the Glycemic Reduction Approaches in Diabetes (GRADE) baseline cohort. BMJ Open Diabetes Res Care 2023; 11:e003159. [PMID: 37094945 PMCID: PMC10151943 DOI: 10.1136/bmjdrc-2022-003159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/18/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a powerful risk factor for cardiovascular disease (CVD), conferring a greater relative risk in women than men. We sought to examine sex differences in cardiometabolic risk factors and management in the contemporary cohort represented by the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). RESEARCH DESIGN AND METHODS GRADE enrolled 5047 participants (1837 women, 3210 men) with T2DM on metformin monotherapy at baseline. The current report is a cross-sectional analysis of baseline data collected July 2013 to August 2017. RESULTS Compared with men, women had a higher mean body mass index (BMI), greater prevalence of severe obesity (BMI≥40 kg/m2), higher mean LDL cholesterol, greater prevalence of low HDL cholesterol, and were less likely to receive statin treatment and achieve target LDL, with a generally greater prevalence of these risk factors in younger women. Women with hypertension were equally likely to achieve blood pressure targets as men; however, women were less likely to receive ACE inhibitors or angiotensin receptor blockers. Women were more likely to be divorced, separated or widowed, and had fewer years of education and lower incomes. CONCLUSIONS This contemporary cohort demonstrates that women with T2DM continue to have a greater burden of cardiometabolic and socioeconomic risk factors than men, particularly younger women. Attention to these persisting disparities is needed to reduce the burden of CVD in women. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT01794143).
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Affiliation(s)
- Barbara I Gulanski
- Department of Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Section of Endocrinology, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Nicole M Butera
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland, USA
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland, USA
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Tasma Harindhanavudhi
- Division of Diabetes, Endocrinology and Metabolism, University of Minnesota Health, Minneapolis, Minnesota, USA
| | - Jennifer B Green
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina, USA
| | - Colleen E Suratt
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland, USA
| | - Hiba AbouAssi
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina, USA
| | - Cyrus Desouza
- Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andrew J Ahmann
- Division of Endocrinology Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon, USA
| | - Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vanita R Aroda
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA
- MedStar Health Research Institute, Hyattsville, Maryland, USA
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18
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De Caux D, Mariappa G, Perera G, Girling J. Prescribing for pregnancy: chronic skin diseases. Drug Ther Bull 2023; 61:55-60. [PMID: 36990470 DOI: 10.1136/dtb.2022.000036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Chronic skin disease is common in women of reproductive age. Although skin can improve or remain stable during pregnancy, it is also common for existing conditions to flare and for new conditions to develop. A small number of medications used to control chronic skin disease can potentially have adverse effects on the outcome of the pregnancy. This article forms part of a series on prescribing for pregnancy and highlights the importance of achieving good control of the skin disease prior to conception and during pregnancy. It emphasises the need for patient-centred, open and informed discussions around medication options to achieve good control. During pregnancy and breastfeeding each patient should be treated as an individual in accordance with the medications that are appropriate for them, their preferences, and the severity of their skin disease. This should be done through collaborative working across primary care, dermatology and obstetric services.
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Affiliation(s)
- Deborah De Caux
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Gayathri Perera
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Joanna Girling
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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19
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Hunt DW, Dhairyawan R, Sowemimo A, Nadarzynski T, Nwaosu U, Briscoe-Palmer S, Heskin J, Lander F, Rashid T. Sexual health in the UK: the experience of racially minoritised communities and the need for stakeholder input. Sex Transm Infect 2023; 99:211-212. [PMID: 36813565 DOI: 10.1136/sextrans-2022-055605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 02/24/2023] Open
Affiliation(s)
- Dwayne-Wilson Hunt
- HIV/GUM, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Annabel Sowemimo
- Integrated Sexual Health, Midlands Partnership NHS Foundation Trust, Leicester, UK
| | | | - Uzochi Nwaosu
- HIV/GUM, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | - Joseph Heskin
- HIV/GUM, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Frances Lander
- HIV/GUM, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Lhermitte R, Le Daré B, Laval F, Lemaitre F, Troussier B, Morin MP, Vigneau C, Chemouny JM, Bacle A. A pharmacist-led intervention to improve kidney transplant recipient outcomes and identify patients at risk of highly variable trough tacrolimus levels: a cohort study. Eur J Hosp Pharm 2023:ejhpharm-2022-003625. [PMID: 36737230 DOI: 10.1136/ejhpharm-2022-003625] [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: 11/18/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Given the positive impact of appropriate medication management on graft outcome and therefore of patient survival and graft function, the pharmacist's role in the kidney transplantation team has evolved over recent decades. The primary objective of this study was to determine whether pharmacist-led intervention after kidney transplantation is associated with a lower graft rejection rate and intra-patient variation in tacrolimus trough concentrations (Cmin). The study's secondary objective was to develop a questionnaire to identify patients at risk for highly variable Cmin. METHODS We retrospectively analysed kidney transplant recipients at Rennes University Hospital (France) between January 2013 and December 2020. Patients who received pharmacist-led education (intervention group, n=139) were compared with patients who did not (control group, n=131), according to graft survival at 1 year post-transplant, coefficient of variation (%CV) for the tacrolimus Cmin, age, sex, length of hospital stay post-transplantation, body mass index, and Charlson Comorbidity Index. In the intervention group, a questionnaire assessing patient knowledge was introduced to compare scores with the %CV. RESULTS In the intervention group, 1 year post-transplant graft survival was higher (95.7% vs 88.5%, p=0.0289) and patients had fewer variabilities in Cmin. The %CV was correlated with questionnaire scores (r=-0.9758, p<0.0001). CONCLUSIONS Pharmacist-led interventions may have contributed to improved graft survival and patient management of immunosuppressants. Because %CV correlates with the patient questionnaire score, its introduction could be useful in identifying kidney transplant patients who would benefit most from a pharmacist-led patient education.
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Affiliation(s)
| | - Brendan Le Daré
- Service Hospitalo-Universitaire de Pharmacie, Rennes, France
- NuMeCan, Rennes, France
| | - Florian Laval
- Service Hospitalo-Universitaire de Pharmacie, Rennes, France
| | - Florian Lemaitre
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Clinical Investigation Center CIC-P 1414, Rennes, France
| | | | | | - Cécile Vigneau
- Univ Rennes, CHU Rennes, INSERM, EHESP, Irset-UMR_S 1085, 35000, Rennes, France, Rennes, France
| | - Jonathan M Chemouny
- Univ Rennes, CHU Rennes, INSERM, EHESP, Irset-UMR_S 1085, 35000, Rennes, France, Rennes, France
| | - Astrid Bacle
- Service Hospitalo-Universitaire de Pharmacie, Rennes, France
- Univ Rennes, CHU Rennes, INSERM, EHESP, Irset-UMR_S 1085, 35000, Rennes, France, Rennes, France
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21
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Mintzes B, Vitry A. Australia to lose agency dedicated to better quality medicine use. Drug Ther Bull 2023; 61:2. [PMID: 36456031 DOI: 10.1136/dtb.2022.000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Barbara Mintzes
- School of Pharmacy and Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia .,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Agnes Vitry
- Clinical and Health Sciences, University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
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22
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Cai X, Ebell MH, Russo G. A Quantitative Study of the Decision Threshold for the Diagnosis of Infectious Mononucleosis. J Am Board Fam Med 2022; 35:1065-71. [PMID: 36526329 DOI: 10.3122/jabfm.2022.210185R1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Ordering a serologic test for infectious mononucleosis (IM) in all young patients with sore throat is costly and impractical. The test threshold to determine when to order a diagnostic test for IM based on the patient's symptoms has not been previously studied. OBJECTIVE To determine the test threshold for IM in the management of patients with sore throat. DESIGN AND SETTING Online surveys were sent to a convenience sample of US primary care clinicians regarding their decision making about whether or not to order a test for IM in a patient with sore throat. METHOD 7 clinical vignettes were created, each with a different combinations of symptoms and signs. The probability of IM for each vignette was estimated by the investigator based on the number of symptoms present to generate a plausible range of disease probabilities. Clinicians were then asked to decide whether to test or not test for IM, and mixed-effect logistic regression was used to determine the test threshold for IM where half of physicians chose to test and half chose not to test. RESULTS A total of 117 clinicians provided responses for a total of 819 clinical vignettes. The overall test threshold for IM as estimated using the logistic regression was 9.5% (95% CI: 8.2% to 10.9%). The test threshold for clinicians practicing greater than 10 years was significantly higher than for those practicing less or equal to 10 years (10.5% vs 7.3%, P = .02). No significant differences between specialties and practice sites were found with respect to the test threshold. CONCLUSION This study identified a test threshold for IM of approximately 10% based on realistic clinical vignettes. This threshold was stable regarding the clinician's specialty and practice sites and could be used in the development of a clinical prediction rule to determine the cutoff for low- versus high-risk groups.
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23
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Jensen CJ, Honsey T, Thielen MK, Spitale MS, Marlette BJ, Kennedy E, Olson RL, O’Laughlin DJ. Clicks away from reduced healthcare expenditures: leveraging the electronic health record to reinforce education efforts. BMJ Health Care Inform 2022; 29:bmjhci-2022-100669. [PMID: 36593683 PMCID: PMC9772626 DOI: 10.1136/bmjhci-2022-100669] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/28/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Lupron 11.25 mg has both a narrow indication and a high cost compared to other Lupron presentations. Prior to our study initiation there was no clear distinction between presentations when ordering within the health-system's Electronic Health Record (EHR). This resulted in inappropriate product selection, payment and billing errors that negatively impact our healthcare system. To reinforce prior education efforts, a new approach was considered leveraging the EHR with information to steer prescribers to the proper Lupron presentation based on indication. This study aimed to reduce off-label prescribing for Lupron 11.25 mg (NDC 00074-3663-03) by 25% by 02/28/2022 without negatively impacting the insurance collection rate. METHODS Baseline Lupron 11.25 mg adult kit administrations one year prior to intervention and off-label prescribing was found to account for 22.7% of administrations. In December 2021 intervention order questions were added to Lupron 11.25 mg in the EHR. One and two-month data was obtained after implementing order questions within the EHR. Lupron 11.25 mg administrations were classified into one of four categories to determine impact on off-label prescribing. RESULTS In the one- and two-month post-implementation periods off-label prescribing was 0% and 15.3% respectively, a reduction of 22.7% to and 7.4% respectively from the baseline assessment. There were no clinical denials found in either post-implementation reporting period. CONCLUSION This report adds to the body of evidence that leveraging the EHR can lead to healthcare savings and illustrates how patient and healthcare system burden can be reduced by prompting thought and direction when a medication has indication specific dose requirements.
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Affiliation(s)
- Chelsee Jo Jensen
- Finance Division of Supply Chain Management, Mayo Clinic, Rochester, Minnesota, USA
| | - Theresa Honsey
- Revenue Integrity, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mari S Spitale
- Physician Assistant Program, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Erika Kennedy
- Physician Assistant Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel L Olson
- University of Minnesota Rochester, Rochester, Minnesota, USA
| | - Danielle J O’Laughlin
- Physician Assistant Program, Mayo Clinic, Rochester, Minnesota, USA,Community Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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24
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Bouri S, Johnston E. Vedolizumab: what is the benefit from increasing the dose frequency? Drug Ther Bull 2022; 60:183-187. [PMID: 36442991 DOI: 10.1136/dtb.2022.000012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Vedolizumab was introduced in 2014 as a therapy for Inflammatory Bowel Disease (IBD). Although recommendations from the National Institute for Health and Care Excellence were based on a maintenance dose of 300 mg administered intravenously every 8 weeks, the Summary of Product Characteristics includes an option of increasing the frequency of dosing for patients who initially respond but later experience a decrease in response. In this literature review of the evidence for a shorter duration between doses we identified seven studies which report that dose interval shortening recaptures response in around 50% of cases with remission rates of 11% to 34% between 4 and 52 weeks. A sustained response was seen in the majority of patients for up to 1 year, however, patients continued to receive escalated dosing for up to 100 weeks, which does not reflect clinical practice where short-term escalation is usually prescribed. There is a lack of randomised controlled trials and a lack of trials reporting endoscopic remission, which is the goal of care in IBD. The use of therapeutic drug monitoring (TDM) to guide dose escalation is uncertain and further studies are required to help clarify the role of TDM.
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Affiliation(s)
- Sonia Bouri
- Gastroenterology, West Middlesex University Hospital NHS Trust, London, UK
| | - Emma Johnston
- Gastroenterology, West Middlesex University Hospital NHS Trust, London, UK
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25
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Kim SY. Recent Advance in Clinical Practice Guideline Development Methodology. Korean J Fam Med 2022; 43:347-352. [PMID: 36444118 PMCID: PMC9708852 DOI: 10.4082/kjfm.22.0178] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/08/2022] [Accepted: 11/15/2022] [Indexed: 01/14/2024] Open
Abstract
Clinical practice guidelines (CPG) can be defined as systematically developed recommendations and related content obtained by reviewing scientific evidence, which help healthcare providers make decisions. CPG is one of the most powerful tools that helps clinicians make evidence-based decisions in practice. Methodologies in areas essential for CPG development, such as for systematic review, risk of bias (ROB) assessment, adaptation, and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations, are rapidly developing. Therefore, they must be well-understood and applied to evidence-based CPG development. In this regard, it is necessary to learn about the updates and changed in the methodologies for CPG development. This manuscript covers the following CPG development methodologies: (1) main principles of CPG, (2) managing conflict of interest, (3) considering patient value and preference, (4) determination of key questions, (5) ROB assessment, (6) adaptation, (7) rapid guideline development, (8) living guideline development, and (9) GIN-McMaster Guideline Development Checklist.
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Affiliation(s)
- Soo Young Kim
- Department of Family Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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26
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Komenaka IK, Nodora J, Martinez ME, Hsu CH, Wong T, Shah A, Caruso DM. Mastalgia is Not An Indication for Mammogram. J Am Board Fam Med 2022:jabfm.2022.AP.210476. [PMID: 36096656 DOI: 10.3122/jabfm.2022.ap.210476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Mastalgia is a common breast complaint that is worrisome to patients. This study was performed to determine if mastalgia is a sign of breast cancer and to evaluate the benefit of its work up. METHODS: Retrospective review of prospectively collected data on 8960 consecutive patients at a safety net institution from June 1, 2006 to December 31, 2020. Data on patient reported mastalgia and diagnosis of breast cancer were collected. RESULTS: 8960 patients had a mean age of 45 years. The population was predominantly underinsured, 70% Hispanic, and 16% had adequate health literacy. Approximately 31% (2820 of 8960) of patients presented with a complaint of breast pain. Of 2820 patients with breast pain, 20 (0.7%) were found to have breast cancer. The average age of patients with breast cancer was 49 years. Physical examination identified a mass in 6 patients and only 3 patients had pain limited to the side of the cancer (10 bilateral, 7 contralateral). Of 1280 patients who were under age 40 years, 88% underwent breast imaging. The Cancer Detection Rate (CDR) was 0.9 per 1000 examinations. For 950 patients age 40 to 49 years and 590 patients age 50 years and older, 98% and 99% underwent breast imaging, respectively. The CDR was 10 per 1000 examinations for age 40 to 49 and 14 per 1000 examinations for age 50 years and older. CONCLUSIONS: Mastalgia is rarely associated with breast cancer. In the absence of other findings, imaging of patients less than age 40 is not recommended. Any workup beyond routine screening mammography in age-appropriate patients, to identify the "cause" of breast pain, does not seem warranted.
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Affiliation(s)
- Ian K Komenaka
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Jesse Nodora
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Maria Elena Martinez
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Chiu-Hsieh Hsu
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Tina Wong
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Anushi Shah
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Daniel M Caruso
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
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Day A, Barclay P, Page L. Is there a role for carbetocin in the prophylaxis of postpartum obstetric haemorrhage? Drug Ther Bull 2022; 60:136-140. [PMID: 36002156 DOI: 10.1136/dtb.2021.000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Postpartum haemorrhage is a common complication of pregnancy, most commonly due to uterine atony. Uterotonics have a vital role in preventing postpartum haemorrhage but the choice of the most effective agent with the fewest adverse effects is a subject of debate. Carbetocin, a synthetic analogue of oxytocin has been available in the UK since 2007 but is not currently widely used. It has a longer duration of action than oxytocin, which avoids the need for an infusion and as it is heat-stable it can be stored at room temperature. Current UK clinical guidelines, based on the results of older meta-analyses, do not recommend carbetocin as a first-line agent. A Cochrane review, published in 2018, ranked carbetocin in the top three drug regimens for preventing postpartum haemorrhage and an international consensus statement on uterotonic use for caesarean birth concluded that carbetocin may become the preferred drug for caesarean birth, by reducing the need for additional uterotonics. The higher cost of carbetocin when compared with oxytocin is a limiting factor, but the significant healthcare costs of a postpartum haemorrhage and the physiological impact of this event suggests it a reasonable alternative to consider, especially if ergometrine is contraindicated or in those who are undergoing a caesarean birth or are at high risk of bleeding.
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Affiliation(s)
- Andrea Day
- Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, London, UK
| | - Philip Barclay
- Department of Anaesthesia, Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, London, UK
| | - Louise Page
- Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, London, UK
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Lerner BH, Curtiss-Rowlands G. What Constitutes Evidence? Colorectal Cancer Screening and the U.S. Preventive Services Task Force. J Gen Intern Med 2022; 37:2855-2860. [PMID: 35428902 PMCID: PMC9411348 DOI: 10.1007/s11606-022-07555-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/31/2022] [Indexed: 01/07/2023]
Abstract
The United States Preventive Services Task Force is perhaps America's best-known source of evidence-based medicine (EBM) recommendations. This paper reviews aspects of the history of one such recommendation-screening for colorectal cancer (CRC)-to explore how the Task Force evaluates the best available evidence to reach its conclusions.Although the Task Force initially believed there was inadequate evidence to recommend CRC screening in the 1980s, it later changed its mind. Indeed, by 2002, it was recommending screening colonoscopy for those aged 50 and older, "extrapolating" from the existing evidence as there were no randomized controlled trials of the procedure. By 2016, due in part to the use of an emerging analytic modality known as modeling, the Task Force supported four additional CRC screening tests that lacked randomized data. Among the reasons the Task Force gave for these decisions was the desire to improve adherence for a strategy-screening healthy, asymptomatic individuals-that it believed saved lives.During these same years, the Task Force diverged from other organizations by declining to advocate screening otherwise healthy Black patients earlier than age 50-despite the fact that such individuals had higher rates of CRC than the general population, higher mortality from the disease and earlier onset of the disease. In declining to extrapolate in this instance, the Task Force underscored the lack of reliable data that proved that the benefits of such testing would outweigh the harms.The history of CRC screening reminds us that scientific evaluation relies not only on methodological sophistication but also on a combination of intellectual, cognitive and social processes. General internists-and their patients-should realize that EBM recommendations are often not definitive but rather thoughtful data-based advice.
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Affiliation(s)
- Barron H Lerner
- New York University Grossman School of Medicine, Desk 2D, 462 First Avenue, New York, NY, 10016, USA.
| | - Graham Curtiss-Rowlands
- New York University Grossman School of Medicine, Desk 2D, 462 First Avenue, New York, NY, 10016, USA
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Darrow JJ, Borisova E. Communication of Drug Efficacy Information via a Popular Online Platform. J Am Board Fam Med 2022; 35:833-5. [PMID: 35896451 DOI: 10.3122/jabfm.2022.04.210539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/16/2022] [Accepted: 03/25/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Open-source online information channels have become increasingly important to the dissemination of medical information, including information about pharmaceuticals. We sought to determine the extent to which one prominent source of online information, Wikipedia, presented quantitative efficacy data about drugs. METHODS Using the Drugs@FDA website, we identified all new drugs approved by the Food and Drug Administration (FDA) from 1982 to 2020 and their associated Wikipedia pages, and used dummy variables to code for the presence of efficacy data, safety data, and usage data. RESULTS Approximately 98% of 1201 drugs approved from 1982 to 2020 had Wikipedia pages. While most pages provided indirect indicia of efficacy, such as indication (98%) or mechanism of action (86%), fewer (21%) quantified evidence of benefit. Wikipedia drug pages were associated with indicia of high impact, including a median of more than 23,000 annual page views. CONCLUSION Wikipedia is an important source of information that has the potential to shape public views about drug efficacy, but the absence of quantitative efficacy information in most pages limits public understanding of the benefits that drugs actually offer.
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Gasparyan AY, Kumar AB, Yessirkepov M, Zimba O, Nurmashev B, Kitas GD. Global Health Strategies in the Face of the COVID-19 Pandemic and Other Unprecedented Threats. J Korean Med Sci 2022; 37:e174. [PMID: 35668684 PMCID: PMC9171346 DOI: 10.3346/jkms.2022.37.e174] [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] [Received: 04/20/2022] [Accepted: 05/05/2022] [Indexed: 11/20/2022] Open
Abstract
Global health is evolving as a discipline aiming at exploring needs and offering equitable health services for all people. Over the past four decades, several global initiatives have been introduced to improve the accessibility of primary health care (PHC) and solve most health issues at this level. Historically, the 1978 Alma-Ata and 2018 Astana Declarations were perhaps the most important documents for a comprehensive approach to PHC services across the world. With the introduction of the United Nations Sustainable Development Goals in 2015, developments in all spheres of human life and multi-sectoral cooperation became the essential action targets that could contribute to improved health, well-being, and safety of all people. Other global initiatives such as the Riyadh Declaration on Digital Health and São Paulo Declaration on Planetary Health called to urgent action to employ advanced digital technologies, improve health data processing, and invest more in research management. All these initiatives are put to the test in the face of the coronavirus disease 2019 (COVID-19) pandemic and other unprecedented threats to humanity.
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Affiliation(s)
- Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, UK.
| | - Ainur B Kumar
- Department of Health Policy and Management, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Olena Zimba
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | | | - George D Kitas
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, UK
- Centre for Epidemiology versus Arthritis, University of Manchester, Manchester, UK
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Varan AK, Winkel K, McKenzie R. Your Quest Begins Now! EBMQuest, a Digital Interactive Fiction Module for Medical Student Engagement in Evidence-Based Practice. Stud Health Technol Inform 2022; 290:917-918. [PMID: 35673152 DOI: 10.3233/shti220213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although evidence-based medicine (EBM) has gained increasing focus in medical education, there remains considerable need for innovative approaches to engage learners. We developed a novel online interactive fiction module "EBMQuest", where students navigate three clinical scenarios requiring use of EBM resources for successful progression. Student feedback was strongly positive, with an overall program rating of 4.64 (Good-Very Good). Online interactive fiction should be further explored as a means of delivering innovative medical education.
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Affiliation(s)
- Aiden K Varan
- Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, VIC 3052, Australia
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Carlton, VIC 3053, Australia
| | - Kenneth Winkel
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Carlton, VIC 3053, Australia
| | - Rosemary McKenzie
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Carlton, VIC 3053, Australia
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Peterson S, Weible K, Halpert B, Rhon DI. Continuing Education Courses for Orthopedic and Sports Physical Therapists in the United States Often Lack Supporting Evidence: A Review of Available Intervention Courses. Phys Ther 2022; 102:6556164. [PMID: 35358320 DOI: 10.1093/ptj/pzac031] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/08/2021] [Accepted: 02/06/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to characterize the extent to which orthopedic and sports-related continuing education course descriptions approved for physical therapists in the United States taught interventions supported by evidence. METHODS A review was conducted of courses available on CEU Locker from January through December 2020, estimated to represent most courses nationally available to physical therapists. This review focused specifically on courses teaching interventions for musculoskeletal conditions in adults. Specifically, courses for orthopedic and sports populations were identified. All course information was extracted, including the intervention name, course description, and target audience. Finally, clinical practice guidelines (CPGs) and systematic reviews with at least moderate-level evidence published through May 1, 2021, were searched to determine if treatments were recommended or not recommended, or if no evidence existed. RESULTS The review identified 2406 available courses extracted from the database. After excluding courses that did not meet inclusion criteria, duplicates, and those with incomplete or inadequate information, the final number was 319. Most courses (52.7%, n = 168) taught interventions not supported by a CPG or systematic review. Approximately one-third of courses (34.2%, n = 109) taught interventions that were recommended by a CPG. Many courses were targeted to multiple disciplines (38.9%, n = 124), whereas 89 (27.9%) were specifically for physical therapists, physical therapist assistants, or both. The specific target was unclear for 106 (33.2%) courses. Courses usually focused on multiple body regions, and exercise was the most included intervention. Soft-skill courses were the most supported by evidence (82.9%, n = 29), whereas those teaching modalities were the least supported (30.5%, n = 29). CONCLUSION Fewer than one-half of courses that focused on management of musculoskeletal disorders taught interventions supported by a CPG or systematic review, and course descriptions often misrepresented the current state of evidence. Courses required for licensure renewal might not be meeting the intended goal of keeping clinicians current with new and emerging research. IMPACT Relatively few continuing education courses on orthopedic and sports-related physical therapist interventions are based on evidence provided by CPGs or systematic reviews, and some continuing education options required for physical therapists to meet annual licensure renewal requirements might not be keeping therapists current with the latest evidence. This study provides data that can facilitate candid dialog within the profession about potential solutions.
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Affiliation(s)
- Seth Peterson
- Department of Physical Therapy, Arizona School of Health Sciences, A.T. Still University, Mesa, Arizona, USA.,The Motive Physical Therapy Specialists, Oro Valley, Arizona, USA
| | - Kirstin Weible
- The Motive Physical Therapy Specialists, Oro Valley, Arizona, USA
| | - Brett Halpert
- Sparks Physical Therapy, Sparks Glencoe, Maryland, USA
| | - Daniel I Rhon
- Department of Physical Therapy, Bellin College, Green Bay, Wisconsin, USA.,Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, Texas, USA
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Congleton J. Urgent! A call to put the 'O' back in COPD. Drug Ther Bull 2022; 60:82. [PMID: 35414593 DOI: 10.1136/dtb.2021.000068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Jo Congleton
- Respiratory, University Hospitals Sussex NHS Foundation Trust (East), Worthing, Brighton, UK
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Mushero N, Demers LB, Chippendale R. An Interactive Workshop on Managing Dysphagia in Older Adults With Dementia. MedEdPORTAL 2022; 18:11223. [PMID: 35309254 PMCID: PMC8888763 DOI: 10.15766/mep_2374-8265.11223] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/24/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Nearly six million American adults live with dementia, and dysphagia is a common comorbidity impacting their nutrition and quality of life. There is a shortfall in the number of geriatricians available to care for older adults. Thus, primary care physicians should be equipped with the knowledge to adequately care for the geriatric population. Modified diets are routinely prescribed for patients with dementia despite limited evidence that they protect patients from the sequelae of dysphagia and some suggestion of poor side-effect profiles. METHODS We created a onetime, interactive, case-based session to educate medical residents on how to evaluate and treat dementia-associated dysphagia and address the discrepancy between the limited evidence for dietary modifications and their routine use. The session had a mixture of small-group discussion and didactic learning as well as a participatory component during which learners were able to sample thickened liquids. RESULTS The session was implemented in an established primary care curriculum. Based on survey responses, which were obtained from 15 out of 17 participants, the session significantly improved participants' knowledge of dysphagia-associated dementia and increased their comfort with caring for patients with dysphagia. DISCUSSION Dementia-associated dysphagia, although an increasingly common clinical problem, remains an underexamined area of medicine. We successfully implemented a session on this topic for internal medicine residents on the primary care track. Limitations included generalizability due to the small number of residents in the course and inability to gather sufficient data to see if knowledge learned was sustained over time.
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Affiliation(s)
- Nicole Mushero
- Assistant Professor, Section of Geriatrics, Department of Medicine, Boston University School of Medicine; Physician, Department of Geriatrics, Boston Medical Center
| | - Lindsay B. Demers
- Assistant Professor, Section of Geriatrics, Department of Medicine, Boston University School of Medicine
| | - Ryan Chippendale
- Assistant Professor, Section of Geriatrics, Department of Medicine, Boston University School of Medicine; Physician, Department of Geriatrics, Boston Medical Center
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Murdock ME, Brennan T, Murphy E, Sherrier W. Restructuring of an evidence-based practice curriculum and assessment with structural mapping by course outcome verb. J Chiropr Educ 2022; 36:50-57. [PMID: 34424957 PMCID: PMC8895848 DOI: 10.7899/jce-20-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/24/2021] [Accepted: 04/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE An evidence-based clinical practice (EBCP) subcurriculum within a chiropractic curriculum was restructured to distribute EBCP topics to courses throughout the curriculum. We posited that this would enhance student learning through early exposure, repetition, and the use of progressively more difficult levels of learning. In this paper we describe how we determined if Bloom's verb level trended upward from the beginning of the curriculum to the end and if there were any gaps in presentation of topics periodically in the curriculum. We describe how we determined if the restructured subcurriculum provided adequate integration of topics. METHODS EBCP committee chairs created templates of the new structure, solicited feedback from the faculty, and faculty members volunteered to assimilate topics into courses. Support for the faculty included comprehensive PowerPoint production and in-service training. Assessment for trends and gaps was performed of the resultant learning outcomes by mapping 13 quarters against 6 Bloom's verb levels for 19 topics. RESULTS Fourteen of the topics had increasing linear model trends indicating verb progression. Decreased attention to EBCP topics was identified in some quarters. CONCLUSION The graphical mapping process seemed useful to find EBCP topics that did not show progression of Bloom's verb difficulty and gaps in topics in the restructured subcurriculum.
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Affiliation(s)
- Mark E Murdock
- Mark Murdock is an associate professor at Palmer College of Chiropractic (4777 City Center Pkwy, Port Orange, FL 32129; )
| | - Teresa Brennan
- Teresa Brennan is a retired associate professor from Palmer College of Chiropractic (4777 City Center Pkwy, Port Orange, FL 32129)
| | - Edward Murphy
- Edward Murphy is the campus librarian and library manager at Palmer College of Chiropractic (4777 City Center Pkwy, Port Orange, FL 32129; )
| | - William Sherrier
- William Sherrier is the associate dean of academics at Palmer College of Chiropractic (4777 City Center Pkwy, Port Orange, FL 32129; )
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Tanner D, Minley K, Snider K, Hartwell M, Torgerson T, Ottwell R, Beaman J, Vassar M. Alcohol use disorder: An analysis of the evidence underpinning clinical practice guidelines. Drug Alcohol Depend 2022; 232:109287. [PMID: 35063840 DOI: 10.1016/j.drugalcdep.2022.109287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/22/2021] [Accepted: 01/02/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND As Clinical Practice Guidelines (CPGs) provide effective guidance for providing medical care for individuals with alcohol use disorder (AUD), the evidence behind them should be robust. OBJECTIVE Our primary objective was to critically appraise the methodological and reporting quality of systematic reviews cited within CPGs regarding the treatment of AUD. Our secondary objective was to determine how frequently Cochrane Reviews were cited as justification and to evaluate appraisals between Cochrane and non-Cochrane reviews. METHODS We searched PubMed to identify CPGs for the treatment of AUD published between 2015 and 2021. Systematic reviews included in each CPG were evaluated using the Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses (PRISMA) and a validated quality assessment tool (AMSTAR-2). Additional study characteristics were recorded. RESULTS From the screening process, 98 systematic reviews from 6 CPGs met inclusion criteria. PRISMA adherence ranged from 72% to 85% (mean of 79%). AMSTAR-2 adherence ranged from 52% to 73% (mean of 68%). AMSTAR appraisal ratings found 32 (35.6%) critically low, 10 (11.1%) low, 35 (38.9%) moderate, and only 13 (14.4%) high systematic reviews. Cochrane systematic reviews displayed greater PRISMA (0.92 vs. 0.75: p < 0.001) and AMSTAR-2 (0.90 vs. 0.61.; p < 0.001) scores compared to the non-Cochrane studies. CONCLUSION Systematic reviews included in CPGs for AUD treatment showed variable adherence to PRISMA and AMSTAR-2 guidelines, with almost half of the systematic reviews being critically low to low methodological quality. Given the prevalence of alcohol use disorder, methodological and reporting quality recommendations are important to strengthening evidence informing CPGs.
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Garvey A, Lynch G, Mansour M, Coyle A, Gard S, Truglio J. From Race to Racism: Teaching a Tool to Critically Appraise the Use of Race in Medical Research. MedEdPORTAL 2022; 18:11210. [PMID: 35128047 PMCID: PMC8784584 DOI: 10.15766/mep_2374-8265.11210] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 10/05/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Despite the ubiquitous use of race within scientific literature, medical trainees are not taught how to critically appraise the use of racial categories. We developed a tool to appraise the use of race in medical literature and a workshop to teach this approach. METHODS Third-year medical students and second- and third-year residents participated in workshops between 2015 and 2018. We evaluated our UME workshop with a postworkshop survey. We evaluated our GME workshop with a pretest, immediate posttest, and 6-month posttest on self-assessed knowledge, skills, and use of the Critical Appraisal of Race in Medical Literature (CARMeL) tool in subsequent journal clubs. RESULTS We delivered this workshop to 560 students and 82 residents. Of the initial 140-student cohort evaluating the workshop, 99 (71% response rate) highly rated clarity of presentation, quality of teaching, and quality of slides. Of PGY 2 and PGY 3 residents, 67 (82% response rate) rated the workshop greater than 4.5 out of 5 on quality, clarity, and appropriateness of content. Residents had significant improvements in self-assessed knowledge and skills immediately after the session and 6 months later. Of residents, 74% reported using the CARMeL tool in subsequent presentations. DISCUSSION We designed the CARMeL tool and a workshop to teach it. Trainees rated this workshop as useful, with the majority of residents later applying the tool. Limitations included a lack of objective assessment of knowledge acquisition. We recommend that institutions invest time in faculty development and pair new faculty with those experienced in anti-oppressive facilitation.
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Affiliation(s)
- Amy Garvey
- Third-Year Resident, Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Giselle Lynch
- Third-Year Resident, Department of Ophthalmology, Icahn School of Medicine at Mount Sinai
| | - Mayce Mansour
- Assistant Professor, Department of Medicine and Department of Medical Education, Icahn School of Medicine at Mount Sinai
| | - Andrew Coyle
- Associate Professor, Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health
| | - Sabrina Gard
- Assistant Professor, Department of Medicine, Icahn School of Medicine at Mount Sinai
| | - Joseph Truglio
- Assistant Professor, Department of Medicine, Department of Pediatrics, and Department of Medical Education, Icahn School of Medicine at Mount Sinai
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McCoy LG, Brenna CTA, Chen S, Vold K, Das S. Believing in Black Boxes: Machine Learning for Healthcare Does Not Need Explainability to be Evidence-Based. J Clin Epidemiol 2021; 142:252-257. [PMID: 34748907 DOI: 10.1016/j.jclinepi.2021.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 07/08/2021] [Revised: 10/25/2021] [Accepted: 11/01/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine the role of explainability in machine learning for healthcare (MLHC), and its necessity and significance with respect to effective and ethical MLHC application. STUDY DESIGN AND SETTING This commentary engages with the growing and dynamic corpus of literature on the use of MLHC and artificial intelligence (AI) in medicine, which provide the context for a focused narrative review of arguments presented in favour of and opposition to explainability in MLHC. RESULTS We find that concerns regarding explainability are not limited to MLHC, but rather extend to numerous well-validated treatment interventions as well as to human clinical judgment itself. We examine the role of evidence-based medicine in evaluating inexplicable treatments and technologies, and highlight the analogy between the concept of explainability in MLHC and the related concept of mechanistic reasoning in evidence-based medicine. CONCLUSION Ultimately, we conclude that the value of explainability in MLHC is not intrinsic, but is instead instrumental to achieving greater imperatives such as performance and trust. We caution against the uncompromising pursuit of explainability, and advocate instead for the development of robust empirical methods to successfully evaluate increasingly inexplicable algorithmic systems.
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Affiliation(s)
- Liam G McCoy
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Connor T A Brenna
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Philosophy, University of Toronto, Toronto, Ontario, Canada
| | - Stacy Chen
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Karina Vold
- Institute for the History and Philosophy of Science and Technology, University of Toronto, Toronto, Ontario, Canada; Schwartz Reisman Institute for Technology and Society, University of Toronto, Toronto, Ontario, Canada; Centre for Ethics, University of Toronto, Toronto, Ontario, Canada; Leverhulme Centre for the Future of Intelligence, University of Cambridge, Cambridge, United Kingdom
| | - Sunit Das
- Centre for Ethics, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
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Cai X, Ebell MH, Haines L. Accuracy of Signs, Symptoms, and Hematologic Parameters for the Diagnosis of Infectious Mononucleosis: A Systematic Review and Meta-Analysis. J Am Board Fam Med 2021; 34:1141-56. [PMID: 34772769 DOI: 10.3122/jabfm.2021.06.210217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The accuracy of individual symptoms, signs, and several easily obtainable hematologic parameters for diagnosing infectious mononucleosis (IM) still needs to be confirmed. Improving the diagnosis of IM based on the clinical findings could prompt physicians to identify better which patients need a diagnostic test for IM. This study performed a systematic review to determine the accuracy of symptoms, signs, and hematologic parameters in patients with suspected IM that used heterophile antibody test or viral capsid antigen tests as the reference standard. METHODS The PubMed database was searched for all relevant articles. Two reviewers reviewed all studies in parallel and assessed the quality of the selected studies using the quality assessment of diagnostic accuracy studies 2 (QUADAS-2) criteria. The pooled measures of diagnostic performance were calculated by bivariate meta-analysis for each clinical finding, which included sensitivity, specificity, likelihood ratios, the diagnostic odds ratios, and the area under the receiver operating characteristic curve. RESULTS Seventeen studies were included in our final analysis. The prevalence of IM ranged from 2.1% to 80% among prospective cohort studies. The presence of splenomegaly (positive likelihood ratio [LR+], 2.39; 95% confidence interval [CI], 1.11-5.51), palatal petechiae (LR+, 1.32-11.40), posterior cervical lymphadenopathy (LR+, 3.16; 95% CI, 1.45-5.20), and axillary or inguinal cervical lymphadenopathy (LR+, 3.05; 95 CI, 1.85-4.70) were moderately useful for ruling in IM. The most helpful hematologic parameters for ruling in IM include lymphocytes greater than 4 × 109/L and greater than 40% to 50%, or atypical lymphocytes greater than 40%. A combination of lymphocytes greater than 50% and atypical lymphocytes greater than 10% (LR+, 50.40; 95% CI, 8.43-162) was also found to be helpful to rule in disease. Most of the clinical findings have limited diagnostic value in ruling out the disease when absent. CONCLUSIONS Although most symptoms and signs were unhelpful, the likelihood of IM is appreciably increased by several examination findings. Hematologic parameters were more accurate than symptoms and signs. Since most clinical findings have limited diagnostic value in ruling out the disease, physicians should not rely on the absence of any individual symptom or clinical sign for ruling out IM.
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Pandrangi VC, Scott BL, Pailet J, Mace JC, Farrell NF, Geltzeiler M, Smith TL, Detwiller KY. Patterns of opioid use after endoscopic sinus surgery among patients with anxiety and depression. Int Forum Allergy Rhinol 2021; 12:788-790. [PMID: 34708586 DOI: 10.1002/alr.22919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/27/2021] [Accepted: 10/19/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Vivek C Pandrangi
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Brian L Scott
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Jasmina Pailet
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Nyssa F Farrell
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, MO
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Kara Y Detwiller
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
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Çakmakkaya ÖS. Formal evidence-based medicine instruction in Turkish undergraduate medical education: an initial evaluation. BMC Med Educ 2021; 21:437. [PMID: 34407804 PMCID: PMC8375051 DOI: 10.1186/s12909-021-02876-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Global and national undergraduate medical education accreditation organizations recommend the inclusion of Evidence-Based Medicine (EBM) instructions into the medical schools' curricula. Accordingly, some Turkish medical schools have individually developed and implemented EBM training programs, but there is no data of current programs' effectiveness and students' learning achievements due to the lack of a validated Turkish language EBM assessment tool. This study evaluates the effect of a newly introduced formal EBM instruction to the curriculum on students' knowledge and skills by using the recently published Turkish adaptation of the Fresno Test. METHODS The study is an experimental investigation using pre- and post-test evaluations. A five-week EBM course was developed according to Kern's six-step curriculum development approach. A total of 78 students from the third (n = 30), fourth (n = 19) and fifth (n = 29) year of medical school voluntarily consented and were enrolled into the course. Overall, the Cerrahpaşa Medical Faculty had a total of 555, 461, and 400 students enrolled in the third, fourth, and fifth year, respectively. The program has been evaluated based on students' learning achievements and survey responses. RESULTS The students' mean pre-test Fresno Test score improved from 49.9 ± 18.2 to 118.9 ± 26.3 post-training. The Cohen's effect size was 3.04 (95% CI, 2.6-3.5). The overall students' satisfaction score was 8.66 ± 1.09 on a 1 to 10 scale. CONCLUSIONS The program was effective in improving students' knowledge and skills on EBM. We propose to offer the program as an elective course during the third year of the medical school curriculum based on all data obtained during the program evaluation.
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Affiliation(s)
- Özlem Serpil Çakmakkaya
- Department of Medical Education, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, 34098 Fatih, Istanbul, Turkey.
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Li B, Yan Y, Lv M, Zhao G, Li Z, Feng S, Hu J, Zhang Y, Yu X, Zhang J, Ma B, Yang K, Chen Y. Clinical Epidemiology in China series. Paper 1: Evidence-based medicine in China: An oral history study. J Clin Epidemiol 2021; 140:165-171. [PMID: 34416324 DOI: 10.1016/j.jclinepi.2021.08.012] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/02/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe and record the evolution of EBM in China. STUDY DESIGN AND SETTING We conducted the study following the general methodology of oral history. The interviews were done at Lanzhou University, between 18th and 22nd April 2019 using pre-defined questions. All interviews were videorecorded. Two investigators extracted and analyzed the information from the interviews independently. RESULTS One international expert and ten Chinese experts participated in the interviews. After the introduction of EBM in China in the mid-1990s, more than 20 EBM centres have been established. According to the interviewees, Gordon Guyatt, David Sackett and Iain Chalmers are the international experts who played the most important role in the development of EBM in China. China has contributed to EBM on the international level by conducting systematic reviews, developing reporting checklists, and introducing the principles of EBM into Traditional Medicine. The Chinese Cochrane Centre and the EBM Centre of Lanzhou University were ranked the top two EBM Centres in China by the interviewees. CONCLUSION EBM has been developing in China for nearly a quarter of a century. Many achievements have been reached, however, EBM is still facing many challenges in China, including shortages of funding support and personnel, as well as limited local high-quality evidence.
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Affiliation(s)
- Bo Li
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China; Beijing Institute of Traditional Chinese Medicine, Beijing 100010, China; Beijing Evidence-based Chinese Medicine Centre, Beijing, 100010, China
| | - Yumeng Yan
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China; Beijing Institute of Traditional Chinese Medicine, Beijing 100010, China; Beijing Evidence-based Chinese Medicine Centre, Beijing, 100010, China; Capital Medical University, Beijing 100010, China
| | - Meng Lv
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China; Lanzhou University Institute of Health Data Science, Lanzhou 730000, China
| | - Guozhen Zhao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China; Beijing Institute of Traditional Chinese Medicine, Beijing 100010, China; Beijing Evidence-based Chinese Medicine Centre, Beijing, 100010, China
| | - Zeyu Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China; Beijing Institute of Traditional Chinese Medicine, Beijing 100010, China; Beijing Evidence-based Chinese Medicine Centre, Beijing, 100010, China
| | - Shuo Feng
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China; Beijing Institute of Traditional Chinese Medicine, Beijing 100010, China; Beijing Evidence-based Chinese Medicine Centre, Beijing, 100010, China
| | - Jing Hu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China; Beijing Institute of Traditional Chinese Medicine, Beijing 100010, China; Beijing Evidence-based Chinese Medicine Centre, Beijing, 100010, China
| | - Yuqing Zhang
- Ningbo GRADE Centre, Nottingham Health China Centre, University of Nottingham Ningbo, China
| | - Xuan Yu
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Lanzhou University Institute of Health Data Science, Lanzhou 730000, China
| | - Jingyi Zhang
- Lanzhou University Institute of Health Data Science, Lanzhou 730000, China; School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Bin Ma
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Kehu Yang
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China; Lanzhou University GRADE Centre, Lanzhou 730000, China.
| | - Yaolong Chen
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Lanzhou University Institute of Health Data Science, Lanzhou 730000, China; Lanzhou University GRADE Centre, Lanzhou 730000, China; World Health Organization (WHO) Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou 730000, China.
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Xun Y, Zhou Q, Yang N, Du L, Zhai S, Li H, Zhao Y, Yang K, Chen Y. Clinical Epidemiology in China series. Paper 2: Promoting GRADE at the national level: The experience from China. J Clin Epidemiol 2021; 140:172-177. [PMID: 34411696 DOI: 10.1016/j.jclinepi.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To share the experience of promoting GRADE in China. STUDY DESIGN AND SETTING We designed the study and collected data on the following three aspects of the GRADE in China: the key activities related to GRADE, the main achievements of the GRADE, and potential challenges and future opportunities. RESULTS Three GRADE centres have been established in China since 2011. Seventeen articles of the GRADE working group have been translated and published in Chinese, and 31 articles have been written by Chinese scientists in Chinese to introduce and interpret the GRADE approach so far. More than 50 GRADE workshops and meetings have been held by GRADE centres in China, covering two-thirds of all provinces and autonomous regions of China. The percentages of societies from the Chinese Medical Association (CMA) and the Chinese Medical Doctor Association (CMDA) that used the GRADE system to develop guidelines were 30% and 18%, respectively. CONCLUSION Over the past decade, China has made progress in promoting the GRADE system and Chinese GRADE centres have made a significant contribution.
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Affiliation(s)
- Yangqin Xun
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University GRADE Centre, Lanzhou, China
| | - Qi Zhou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University GRADE Centre, Lanzhou, China
| | - Nan Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University GRADE Centre, Lanzhou, China
| | - Liang Du
- Chinese Evidence-Bassed Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Hui Li
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Yingren Zhao
- Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University GRADE Centre, Lanzhou, China; WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China.
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Manchikanti L, Knezevic E, Knezevic NN, Sanapati MR, Kaye AD, Thota S, Hirsch JA. The role of percutaneous neurolysis in lumbar disc herniation: systematic review and meta-analysis. Korean J Pain 2021; 34:346-368. [PMID: 34193641 PMCID: PMC8255147 DOI: 10.3344/kjp.2021.34.3.346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/30/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 01/03/2023] Open
Abstract
Background Recalcitrant disc herniation may result in chronic lumbar radiculopathy or sciatica. Fluoroscopically directed epidural injections and other conservative modalities may provide inadequate improvement in some patients. In these cases, percutaneous neurolysis with targeted delivery of medications is often the next step in pain management. Methods An evidence-based system of methodologic assessment, namely, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used. Multiple databases were searched from 1966 to January 2021. Principles of the best evidence synthesis were incorporated into qualitative evidence synthesis. The primary outcome measure was the proportion of patients with significant pain relief and functional improvement (≥ 50%). Duration of relief was categorized as short-term (< 6 months) and long-term (≥ 6 months). Results This assessment identified one high-quality randomized controlled trial (RCT) and 5 moderate-quality non-randomized studies with an application of percutaneous neurolysis in disc herniation. Overall, the results were positive, with level II evidence. Conclusions Based on the present systematic review, with one RCT and 5 nonrandomized studies, the evidence level is II for percutaneous neurolysis in managing lumbar disc herniation.
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Affiliation(s)
| | - Emilija Knezevic
- University of Illinois at Urbana-Champaign, College of Liberal Arts and Sciences, Champaign, IL, USA
| | - Nebojsa Nick Knezevic
- Advocate Illinois Masonic Medical Center and College of Medicine, University of Illinois, Chicago, IL, USA
| | | | - Alan D Kaye
- LSU Health Sciences Center, Shreveport, Ochsner Shreveport Hospital and Pain Clinic Feist-Wieller Cancer Center, Shreveport, LA, USA
| | - Srinivasa Thota
- Pain Management Centers of America, Paducah, KY & Evansville, IN, USA
| | - Joshua A Hirsch
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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You D, Qin L, Li K, Li D, Zhao G, Li L. A meta-analysis on advantages of peripheral nerve block post-total knee arthroplasty. Korean J Pain 2021; 34:271-287. [PMID: 34193634 PMCID: PMC8255149 DOI: 10.3344/kjp.2021.34.3.271] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 11/05/2022] Open
Abstract
Background Postoperative pain management is crucial for patients undergoing total knee arthroplasty (TKA). There have been many recent clinical trials on post-TKA peripheral nerve block; however, they have reported inconsistent findings. In this meta-analysis, we aimed to comprehensively analyze studies on post-TKA analgesia to provide evidence-based clinical suggestions. Methods We performed a computer-based query of PubMed, Embase, the Cochrane Library, and the Web of Science to retrieve related articles using neurothe following search terms: nerve block, nerve blockade, chemodenervation, chemical neurolysis, peridural block, epidural anesthesia, extradural anesthesia, total knee arthroplasty, total knee replacement, partial knee replacement, and others. After quality evaluation and data extraction, we analyzed the complications, visual analogue scale (VAS) score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices. Evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results We included 16 randomized controlled trials involving 981 patients (511 receiving peripheral nerve block and 470 receiving epidural block) in the final analysis. Compared with an epidural block, a peripheral nerve block significantly reduced complications. There were no significant between-group differences in the postoperative VAS score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices. Conclusions Our findings demonstrate that the peripheral nerve block is superior to the epidural block in reducing complications without compromising the analgesic effect and patient satisfaction. Therefore, a peripheral nerve block is a safe and effective postoperative analgesic method with encouraging clinical prospects.
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Affiliation(s)
- Di You
- China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Lu Qin
- Center for Applied Statistical Research and College of Mathematics, Jilin University, Changchun, Jinlin, China
| | - Kai Li
- China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Di Li
- China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Guoqing Zhao
- China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.,Jilin University, Changchun, China
| | - Longyun Li
- China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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Costa JRB, Alves LA, Alberto AVP, de Souza CAM. Use of an evidence-based health portal to improve teaching and learning in primary care: a mixed methods evaluation. BMC Med Educ 2021; 21:296. [PMID: 34030697 PMCID: PMC8142472 DOI: 10.1186/s12909-021-02686-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Worldwide, primary care is for most people the gateway into many health systems. Offering solutions to the demands of the communities served requires the constant preparation of professionals, especially doctors and medical undergraduate students. We analyze and propose ways to improve the teaching and learning processes facilitated by the Basic Family Health Units (BFHUs) based on the use of electronic portals with evidence-based medicine criteria. METHOD First phase: The authors conducted a qualitative-quantitative study on students and instructors of primary care (PC) medicine by administering a survey of open- and closed-ended questions at medical schools. The closed-ended questions were studied with descriptive statistics, and open-ended questions were analyzed via the creation of categories. Perceptions of major teaching and learning problems were then identified. Second phase: Meetings were held with students and their instructors for 6 months and involved the use of electronic portals and the application of new questionnaires using a Likert scale for pre- and postevaluation. RESULTS In the first phase, 40% of the students considered local instructor training levels a problem. A similar result was found regarding teachers' lectures, revealing a lack of adequate PC training and performance. Building on our results, we focused on BFHUs to apply new strategies for teaching and learning, such as the use of the Evidence-Based Health (SBE) Portal, which includes several databases with clinical evidence criteria. In the second phase, the authors identified an improvement in the quality of learning among instructors and students. This outcome improved safety in daily clinical practice in PC, possibly with better results for its users. CONCLUSIONS The use of electronic portals can facilitate BFHU teaching and learning and promote the health of users.
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Affiliation(s)
- José Roberto Bittencourt Costa
- Undergraduate Course in Medicine, University Center Serra dos Órgãos (UNIFESO), Cellular Communication Laboratory Postgraduate Program in Teaching in Biosciences and Health, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Cellular Communication Laboratory, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (FIOCRUZ), Rua Leopoldo Bulhões 1480, Pavilhão 108, sala 28B, Rio de Janeiro, Brazil
| | - Luiz Anastacio Alves
- Cellular Communication Laboratory, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (FIOCRUZ), Rua Leopoldo Bulhões 1480, Pavilhão 108, sala 28B, Rio de Janeiro, Brazil
| | - Anael Viana Pinto Alberto
- Cellular Communication Laboratory, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (FIOCRUZ), Rua Leopoldo Bulhões 1480, Pavilhão 108, sala 28B, Rio de Janeiro, Brazil.
| | - Cristina Alves Magalhães de Souza
- Cellular Communication Laboratory, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (FIOCRUZ), Rua Leopoldo Bulhões 1480, Pavilhão 108, sala 28B, Rio de Janeiro, Brazil.
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Phillips WR, Sturgiss E, Yang A, Glasziou P, Olde Hartman T, Orkin A, Russell GM, van Weel C. Clinician Use of Primary Care Research Reports. J Am Board Fam Med 2021; 34:648-60. [PMID: 34088824 DOI: 10.3122/jabfm.2021.03.200436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess how primary care practitioners use reports of general health care (GHC) and primary care (PC) research and how well reports deliver what they need to inform clinical practice. METHODS International, interprofessional online survey, 2019, of primary care clinicians who see patients at least half time. Respondents used frequency scales to report how often they access both GHC and PC research and how frequently reports meet needs. Free-text short comments recorded comments and suggestions. RESULTS Survey yielded 252 respondents across 29 nations, 55% (121) women, including 88% (195) physicians, nurses 5% (11), and physician assistants 3% (7). Practitioners read research reports frequently but find they usually fail to meet their needs. For PC research, 33% (77) accessed original reports in academic journals weekly or daily, and 36% found reports meet needs "frequently" or "always." They access reports of GHC research slightly more often but find them somewhat less useful. CONCLUSIONS PC practitioners access original research in academic journals frequently but find reports meet information needs less than half the time. PC research reflects the unique PC setting and so reporting has distinct focus, needs, and challenges. Practitioners desire improved reporting of study context, interventions, relationships, generalizability, and implementation.
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Svoboda M, Kamal Y, Pinto-Powell R. Science Scholars: Integrating Scientific Research Into Undergraduate Medical Education Through a Comprehensive Student-Led Preclinical Elective. MedEdPORTAL 2021; 17:11144. [PMID: 33889723 PMCID: PMC8056777 DOI: 10.15766/mep_2374-8265.11144] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION One of the goals of evidence-based medical education is to familiarize future health care practitioners with the scientific method so they can interpret scholarly literature and communicate appropriately with patients. However, many students lack the skills necessary to conduct research themselves. We describe a preclinical elective course designed to equip students with these skills through workshops, mentorship, and research experience. METHODS Through an application process, we selected first-year medical (M1) students who expressed interest in conducting basic, translational, or clinical research. Throughout the yearlong curriculum, students attended a series of 10 1-hour workshops to learn the skills necessary to engage in research. Additionally, each student was paired with a peer mentor. As their final project, students completed a specific aims page based on their projected research study. RESULTS Over the course of 3 years, 96% of students secured a research position for the summer following M1, and 36% secured positions at external institutions with nationally competitive funding, compared to 10% of their peers who did not participate in the elective. Of students, 80% indicated that this elective helped them find and secure these research positions, and 75% of students reported that they learned valuable skills not taught in their medical curriculum. DISCUSSION Participation in a preclinical research elective can provide immediate value in the form of research skills with the prospect of stimulating a lifelong interest in scientific inquiry. Our curriculum was delivered in a medical school setting, however it is applicable to any health care professional school.
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Affiliation(s)
- Marek Svoboda
- MD-PhD Student, Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth
| | - Yasmin Kamal
- MD-PhD Student, Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth
| | - Roshini Pinto-Powell
- Professor of Medical Education, Department of Medical Education, Geisel School of Medicine at Dartmouth
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Salas Apaza JA, Franco JVA, Meza N, Madrid E, Loézar C, Garegnani L. Minimal clinically important difference: The basics. Medwave 2021; 21:e8149. [PMID: 35380557 DOI: 10.5867/medwave.2021.03.8149] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 12/30/2020] [Accepted: 03/22/2021] [Indexed: 11/27/2022] Open
Abstract
This article is part of a collaborative methodological series of narrative reviews on biostatistics and clinical epidemiology. This review aims to present basic concepts about the minimal clinically important difference and its use in the field of clinical research and evidence synthesis. The minimal clinically important difference is defined as the smallest difference in score in any domain or outcome of interest that patients can perceive as beneficial. It is a useful concept in several aspects since it links the magnitude of change with treatment decisions in clinical practice and emphasizes the primacy of the patients perception, affected by endless variables such as time, place, and current state of health, all of which can cause significant variability in results.
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Affiliation(s)
| | - Juan Víctor Ariel Franco
- Instituto Universitario Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina. ORCID: 0000-0003-0411-899X
| | - Nicolás Meza
- Centro Interdisciplinario de Estudios en Salud (CIESAL), Universidad de Valparaíso, Centro Asociado Cochrane Chile, Viña del Mar, Chile. ORCID: 0000-0001-9505-0358
| | - Eva Madrid
- Centro Interdisciplinario de Estudios en Salud (CIESAL), Universidad de Valparaíso, Centro Asociado Cochrane Chile, Viña del Mar, Chile. ORCID: 0000-0002-8095-5549
| | - Cristobal Loézar
- Centro Interdisciplinario de Estudios en Salud (CIESAL), Universidad de Valparaíso, Centro Asociado Cochrane Chile, Viña del Mar, Chile. ORCID: 0000-0001-9967-1928
| | - Luis Garegnani
- Instituto Universitario Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina. Dirección: Potosí 4265, C1199, Ciudad Autónoma de Buenos Aires, Argentina. . ORCID: 0000-0003-4605-9473
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Anderson H, Studer AC, Holm KN, Suzuki A. A Case-Based Active Learning Session for Medical Genetics Resources. MedEdPORTAL 2021; 17:11135. [PMID: 33816796 PMCID: PMC8015619 DOI: 10.15766/mep_2374-8265.11135] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
Introduction As the clinical applications of medical genetics and genomics continue to expand, nongenetics professionals increasingly find themselves in the position of managing patients with genetic conditions. To prepare medical students to handle this future practice demand, it is imperative that they obtain skills and confidence in utilizing credible medical genetics resources to care for patients with genetic conditions. To this end, we developed active learning materials to introduce first-year medical students to these resources. Methods This approximately 2-hour session targeted first-year medical students (123 students) and combined flipped classroom and small-group collaborative case-based learning models. Students first completed a hands-on preclass exercise, which guided them in navigating the Online Mendelian Inheritance in Man website, and then attended an in-person small-group classroom activity, which provided the opportunity to apply information obtained from credible medical genetics resources to a patient case. At the conclusion of the classroom activity, students voluntarily completed an anonymous survey. Results Results of student postsession surveys showed that, regardless of previous exposure to medical genetics resources, this session increased both confidence in skills and future intention to use medical genetics resources. Discussion Since the majority of students were unfamiliar with using specialized medical genetics resources prior to this educational intervention, the session functioned as a practical introduction to these essential resources. We propose that equipping medical students with skills that support inquiry-oriented learning, particularly in the early stage of training, can cultivate the practice of lifelong learning in medical genetics.
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Affiliation(s)
- Hana Anderson
- Associate Professor, Department of Internal Medicine and Department of Cell Biology and Human Anatomy, University of California Davis School of Medicine
| | - Amy C. Studer
- Health Science Librarian, Blaisdell Medical Library, University of California Davis School of Medicine
| | - Katharine N. Holm
- Research Associate, Department of Biochemistry and Molecular Medicine, University of California Davis
| | - Ayaka Suzuki
- Licensed and Certified Genetics Counselor, Division of Genomic Medicine, Department of Pediatrics, University of California Davis
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