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Koivunen K, Kaakinen P, Päätalo K, Mattila O, Oikarinen A, Jansson M, Mikkonen K, Pölkki T, Meriläinen M, Kääriäinen M, Holopainen A, Tuomikoski AM, Kanste O. Frontline nurse leaders' competences in evidence-based healthcare: A scoping review. J Adv Nurs 2024; 80:1314-1334. [PMID: 38041585 DOI: 10.1111/jan.15920] [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: 12/21/2022] [Revised: 09/11/2023] [Accepted: 10/17/2023] [Indexed: 12/03/2023]
Abstract
AIM To identify evidence on frontline nurse leaders' competences in evidence-based healthcare (EBHC) and the instruments measuring these competences. DESIGN A scoping review. DATA SOURCES The search was conducted in June 2021 and complemented in June 2022. The CINAHL, ProQuest, Medline (Ovid), Scopus, Web of Science databases and MedNar along with the Finnish database Medic were searched. REVIEW METHOD The scoping review was conducted in accordance with the Joanna Briggs institute methodology for scoping reviews. Titles, abstracts and full-text versions were screened independently by two reviewers according to the inclusion criteria. Deductive-inductive content analysis was used to synthesize data. RESULTS A total of 3211 articles published between 1997 and 2022 were screened, which resulted in the inclusion of 16 articles. Although frontline nurse leaders had a positive attitude towards EBHC, they had a lack of implementing EBHC competence into practice. Part of the instruments were used in the studies, and only one focused especially on leaders. None of instruments systematically covered all segments of EBHC. CONCLUSION There is a limited understanding of frontline nurse leaders' competence in EBHC. It is important to understand the importance of EBHC in healthcare and invest in the development of its competence at all levels of leaders. Frontline nurse leaders' support is essential for direct care nurses to use EBHC to ensure the quality of care and benefits to patients. Leaders must enhance their own EBHC competence to become role models for direct care nurses. It is also essential to develop valid and reliable instruments to measure leaders' competence covering all EBHC segments. The results can be utilized in the assessment and development of frontline nurse leaders' EBHC competence by planning and producing education and other competence development methods.
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Affiliation(s)
- Kirsi Koivunen
- University of Applied Sciences, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
| | - Pirjo Kaakinen
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Kati Päätalo
- University of Applied Sciences, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
| | - Outi Mattila
- Lapland University of Applied Sciences, Rovaniemi, Finland
| | - Anne Oikarinen
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Miia Jansson
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Kristina Mikkonen
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tarja Pölkki
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Merja Meriläinen
- Wellbeing Services County of North Ostrobothnia, Oulu University Hospital, Medical Research Centre (MRC), Oulu, Finland
| | - Maria Kääriäinen
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Arja Holopainen
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Nursing Research Foundation, Helsinki, Finland
| | - Anna-Maria Tuomikoski
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Wellbeing Services County of North Ostrobothnia, Oulu University Hospital, Medical Research Centre (MRC), Oulu, Finland
| | - Outi Kanste
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Bourgault AM, Davis JW, LaManna J, Conner NE, Turnage D. Trends in publication impact of evidence-based healthcare terminology (2013-2022). J Adv Nurs 2024. [PMID: 38504441 DOI: 10.1111/jan.16128] [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: 09/07/2023] [Revised: 01/07/2024] [Accepted: 02/15/2024] [Indexed: 03/21/2024]
Abstract
AIMS This article explored the publication impact of evidence-based healthcare terminology to determine usage and discuss options for low usage terms. BACKGROUND A plethora of terms describe the scholarship of evidence-based healthcare. Several terms are synonyms, creating redundancy and confusion. The abundance and overlap of terms may impede the discovery of evidence. DESIGN This discursive article explored and discussed publication impact of evidence-based healthcare terms. METHODS Evidence-based healthcare terms were identified, and their 10-year (2013-2022) publication impact was assessed in the CINAHL and Medline databases. A card sort method was also used to identify terms with low usage. RESULTS A total of 18/32 terms were included in the review. The terms evidence-based practice, quality improvement, research and translational research were the most highly published terms. Publication data were presented yearly over a 10-year period. Most terms increased in publication use over time, except for three terms whose use decreased. Several terms related to translational research have multiple synonyms. It remains unknown whether these terms are interchangeable and possibly redundant, or if there are nuanced differences between terms. CONCLUSION We suggest a follow-up review in 3-5 years to identify publication trends to assess context and terms with continued low publication usage. Terms with persistent low usage should be considered for retirement in the reporting of scholarly activities. Additionally, terms with increasing publication trends should be treated as emerging terms that contribute to evidence-based healthcare terminology. IMPLICATIONS FOR NURSING Confusion about the use of appropriate terminology may hinder progress in the scholarship of evidence-based healthcare. We encourage scholars to be aware of publication impact as it relates to the use of specific terminology and be purposeful in the selection of terms used in scholarly projects and publications.
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Affiliation(s)
| | - Jean W Davis
- College of Nursing, University of Central Florida, Orlando, Florida, USA
| | - Jacqueline LaManna
- College of Nursing, University of Central Florida, Orlando, Florida, USA
| | - Norma E Conner
- College of Nursing, University of Central Florida, Orlando, Florida, USA
| | - Dawn Turnage
- College of Nursing, University of Central Florida, Orlando, Florida, USA
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Watkins KE, Levack WMM, Rathore FA, C Hay-Smith EJ. Challenges in applying evidence-based practice in stroke rehabilitation: a qualitative description of health professional experience in low, middle, and high-income countries. Disabil Rehabil 2023:1-9. [PMID: 37665337 DOI: 10.1080/09638288.2023.2251396] [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: 06/30/2020] [Revised: 08/13/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023]
Abstract
Purpose: Evidence-based practice (EBP) is considered central to ethical, effective service delivery in rehabilitation, and the implementation of the World Health Organisation's Rehabilitation Strategy 2030. This study aimed to explore and compare the experiences of health professionals regarding the application of EBP for stroke rehabilitation in each participant's region and country, which provided perspectives from low, middle, and high-income countries.Methods and materials: Interviews were conducted with 12 experienced rehabilitation professionals from 12 different countries (5 high-income, 2 upper-middle income, 3 lower-middle income, and 2 low-income countries) and interpreted using qualitative descriptive analysis.Results: Nine factors influencing evidence-based stroke rehabilitation were: 1) the complexity of rehabilitation research; 2) the (ir)relevance of research to local context; 3) lack of time for EBP; 4) minimal training in EBP; 5) changing health professional behaviours; 6) poor access to resources for developing EBP; 7) influence of culture, patients, and families; 8) language barriers; and 9) lack of access to research evidence. Economic constraints contributed to many challenges; but not all challenges related to the country's economic classification.Conclusion: A global approach is needed to share knowledge about EBP, especially scientific evidence and innovative thinking about its application to clinical practice. Implications for rehabilitationRehabilitation professional groups should contribute to a global network to improve informal knowledge sharing and training around evidence-based practice.Support for training in evidence-based practice and its application needs to be developed and accessible in all countries, including low and middle-income countries.It is imperative that policymakers prioritise practical, evidence-based solutions for rehabilitation research in low and middle-income countries that can be effectively implemented within local settings.There must be solutions and increased accessibility of journal articles for those working in low and middle-income countries including those whose first language is not English.
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Affiliation(s)
- Kimberley E Watkins
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - William M M Levack
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Farooq A Rathore
- Department of Rehabilitation Medicine, PNS Shifa Hospital, DHA-II, Karachi, Pakistan
| | - E Jean C Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
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He AH, Manouchehrinia A, Glaser A, Ciccarelli O, Butzkueven H, Hillert J, McKay KA. Association between clinic-level quality of care and patient-level outcomes in multiple sclerosis. Mult Scler 2023; 29:1126-1135. [PMID: 37392018 PMCID: PMC10413789 DOI: 10.1177/13524585231181578] [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: 02/19/2023] [Revised: 04/27/2023] [Accepted: 05/21/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) quality of care guidelines are consensus-based. The effectiveness of the recommendations is unknown. OBJECTIVE To determine whether clinic-level quality of care affects clinical and patient-reported outcomes. METHODS This nationwide observational cohort study included patients with adult-onset MS in the Swedish MS registry with disease onset 2005-2015. Clinic-level quality of care was measured by four indicators: visit density, magnetic resonance imaging (MRI) density, mean time to commencement of disease-modifying therapy, and data completeness. Outcomes were Expanded Disability Status Scale (EDSS) and patient-reported symptoms measured by the Multiple Sclerosis Impact Scale (MSIS-29). Analyses were adjusted for individual patient characteristics and disease-modifying therapy exposure. RESULTS In relapsing MS, all quality indicators benefitted EDSS and physical symptoms. Faster treatment, frequent visits, and higher data completeness benefitted psychological symptoms. After controlling for all indicators and individual treatment exposures, faster treatment remained independently associated with lower EDSS (-0.06, 95% confidence interval (CI): -0.01, -0.10) and more frequent visits were associated with milder physical symptoms (MSIS-29 physical score: -16.2%, 95% CI: -1.8%, -29.5%). Clinic-level quality of care did not affect any outcomes in progressive-onset disease. CONCLUSION Certain quality of care indicators correlated to disability and patient-reported outcomes in relapse-onset but not progressive-onset disease. Future guidelines should consider recommendations specific to disease course.
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Affiliation(s)
- Anna H He
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Glaser
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Olga Ciccarelli
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Kyla Anne McKay
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
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Haavisto E, Siltanen H, Tolvanen A, Holopainen A. Instruments for assessing healthcare professionals' knowledge and skills of evidence-based practice: A scoping review. J Clin Nurs 2022. [PMID: 36229896 DOI: 10.1111/jocn.16506] [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: 05/06/2022] [Revised: 06/27/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this scoping review was to describe the instruments used to assess the knowledge and skills of evidence-based practice (EBP) in healthcare settings. METHODS A scoping review was undertaken. Three electronic databases (CINAHL, PubMed and Cochrane) were searched in January 2022. The search phrases consisted of the following terms: healthcare professionals, EBP, competence and instrument and their synonyms, keywords and MeSH terms. The database search was run without any limitations. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to support reporting. RESULTS Ultimately, 39 studies were included; most of them (35) were cross-sectional studies. The studies were conducted in 17 countries. A total of 17 evidence-based knowledge and skills instruments were identified. The Upton and Upton instrument was used in 19 studies. Twelve self-reported instruments were used only once. The psychometric properties of the instruments varied. The reliability was typically reported with Cronbach's alpha coefficient. The content of the EBP knowledge/skills instruments consists of five main categories: EBP, evaluation of current practice, preparation for the implementation of EBP, implementation of evidence and active participation in the development of EBP. CONCLUSION Almost all instruments are self-assessment instruments. Validated knowledge tests should be further developed. The instruments emphasise the preparation for the implementation of EBP. Further research is needed to develop instruments for healthcare professionals to assess the knowledge and skills of the implementation of evidence.
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Affiliation(s)
- Elina Haavisto
- Department of Health Sciences, Nursing, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Hospital District of Satakunta, Pori, Finland.,Tampere University Hospital, Tampere, Finland
| | - Hannele Siltanen
- Nursing Research Foundation, Helsinki, Finland.,The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
| | | | - Arja Holopainen
- Nursing Research Foundation, Helsinki, Finland.,The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
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Dickson NR, Beauchamp KD, Perry TS, Roush A, Goldschmidt D, Edwards ML, Blakely LJ. Impact of clinical pathways on treatment patterns and outcomes for patients with non-small-cell lung cancer: real-world evidence from a community oncology practice. J Comp Eff Res 2022; 11:609-619. [PMID: 35546311 DOI: 10.2217/cer-2021-0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: The evolving treatment landscape for non-small-cell lung cancer (NSCLC) and complexities of regulations and reimbursement present challenges to community oncologists. Clinical pathways are tools to optimize care, but information on their value in the real world is limited. This retrospective study assessed treatment patterns and clinical outcomes in patients with Stage I-III NSCLC pre- and post-pathways implementation at Tennessee Oncology, a large, community-based oncology practice in the USA. Methods & Materials: Chart data were abstracted for adults diagnosed with Stage I-III NSCLC who received systemic treatment. Patients were divided into pre-pathways (treatment initiation 2014-2015) and post-pathways (treatment initiation 2016-2018) cohorts. Patient characteristics, treatment patterns and outcomes were summarized descriptively. Kaplan-Meier curves were used to assess time-dependent outcomes, and log-rank test was used to compare the cohorts. Results: 291 patients were included (Stage I-II: 38 pre-pathways, 55 post-pathways; Stage III: 105 pre-pathways, 93 post-pathways). Duration on first-line (1L) therapy was similar for Stage I-II patients pre- and post-pathways (median 1.9 months vs 2.1 months; p = 0.75), but increased for Stage III patients post-pathways (2.1 months vs 1.4 months pre-pathways; p < 0.01). Achievement of a complete or partial response with 1L therapy was similar post-pathways among Stage I-Stage -IIII patients (60.0% vs 55.2% pre-pathways), but increased for Stage III patients (56.0% vs 35.2% pre-pathways). Conclusion: Given that improvements in rates of treatment response post-pathways occurred only for patients diagnosed with Stage III NSCLC, among whom immunotherapy uptake increased post-pathways, such improvements may be attributable to evolving practices in cancer care, including advances in treatment and care delivery, rather than clinical pathways implementation. Further research is warranted to assess the impact of clinical pathways in the current treatment era, given that immunotherapy has now become the standard of care in NSCLC.
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Martimbianco ALC, Pacheco RL, Latorraca CDOC, Ferreira RES, Riera R. Systematic reviews on interventions for COVID-19 have rarely graded the certainty of the evidence. SAO PAULO MED J 2021; 139:511-513. [PMID: 34378740 PMCID: PMC9632526 DOI: 10.1590/1516-3180.2021.0107.27052021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/27/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Numerous systematic reviews on coronavirus disease-19 (COVID-19) treatment have been developed to provide syntheses of the large volume of primary studies. However, the methodological quality of most of these reviews is questionable and the results provided may therefore present bias. OBJECTIVE To investigate how many systematic reviews on the therapeutic or preventive options for COVID-19 assessed the certainty of the evidence through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. METHODS We conducted a sensitive search in MEDLINE (via PubMed) and included all systematic reviews that assessed any intervention for COVID-19. The systematic reviews included were examined to identify any planned and/or actual assessment using the GRADE approach (or absence thereof) regarding the certainty of the evidence. RESULTS We included 177 systematic reviews and found that only 37 (21%; 37/177) assessed and reported the certainty of the evidence using the GRADE approach. This number reduced to 27 (16.2%; 27/167) when Cochrane reviews (n = 10), in which an evaluation using GRADE is mandatory, were excluded. CONCLUSION Most of the systematic reviews on interventions relating to COVID-19 omitted assessment of the certainty of the evidence. This is a critical methodological omission that must not be overlooked in further research, so as to improve the impact and usefulness of syntheses relating to COVID-19.
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Affiliation(s)
- Ana Luiza Cabrera Martimbianco
- PhD. Professor, Centro Universitário São Camilo, São Paulo (SP), Brazil; and Professor, Universidade Metropolitana de Santos (UNIMES), Santos (SP), Brazil.
| | - Rafael Leite Pacheco
- MSc. Professor, Centro Universitário São Camilo, São Paulo (SP), Brazil; and Researcher, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil.
| | | | | | - Rachel Riera
- PhD. Adjunct Professor, Discipline of Evidence-Based Health, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil; and Coordinator, Health Technology Assessment Center, Hospital Sírio-Libanês, São Paulo (SP), Brazil.
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Titi MA, Alotair HA, Fayed A, Baksh M, Alsaif FAA, Almomani Z, Atallah M, Alsharif AF, Jamal AA, Amer YS. Effects of Computerised Clinical Decision Support on Adherence to VTE Prophylaxis Clinical Practice Guidelines among Hospitalised Patients. Int J Qual Health Care 2021; 33:6153904. [PMID: 33647102 DOI: 10.1093/intqhc/mzab034] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/27/2021] [Accepted: 02/26/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Venous thromboembolism (VTE) is an important patient safety concern. VTE leads to significant mortality and morbidity and a burden on healthcare resources. Despite the widespread availability of evidence-based clinical practice guidelines on VTE prophylaxis, we found that only 50.9% of our patients were receiving appropriate prophylaxis. The purpose of this study was to evaluate the impact of automation of an adapted VTE prophylaxis CPG using a clinical decision support system (the VTE-CDSS) on VTE prevention among hospitalised adult patients. DESIGN AND SETTING A quasi-experimental study (pre- and post-implementation) was conducted at a large 900-bed tertiary teaching multi-specialty hospital in Riyadh, Saudi Arabia. PARTICIPANTS The 1809 adult patients in the study included 871 enrolled during the pre-implementation stage and 938 enrolled during the post-implementation stage. INTERVENTION Multi-faceted implementation interventions were utilised, including leadership engagement and support, quality and clinical champions, staff training and education and regular audit and feedback. MAIN OUTCOME MEASURE Two rate-based process measures were calculated for each admission cohort (i.e. pre- and post-implementation): the percentage of inpatients who were assessed for VTE risk on admission and the percentage of inpatients who received appropriate VTE prophylaxis. Two outcome measures were calculated: the prevalence of hospital-acquired VTE (HA-VTE) events and the in-hospital all-cause mortality. RESULTS The percentage of inpatients risk assessed for VTE on admission increased from 77.4% to 93.3% (P < 0.01). The percentage of patients who received appropriate VTE prophylaxis increased from 50.9% to 81.4% (P < 0.01). The HA-VTE events decreased by 50% from 0.33% to 0.15% (P < 0.01).All-cause in-hospital mortality did not significantly change after implementation of the VTE-CDSS compared with pre-implementation mortality (P > 0.05). CONCLUSION The VTE-CDSS improved patient safety by enhancing adherence to the VTE prophylaxis best practice and adapted CPG. The multi-faceted implementation strategies approach improved the compliance rate of risk assessment and the adherence to prophylaxis recommendations and substantially reduced the HA-VTE prevalence. A successful CDSS requires a set of critical components to ensure better user compliance and positive patient outcomes.
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Affiliation(s)
- Maher A Titi
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Scientific Research, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia.,Quality Management Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Hadil A Alotair
- Division of Pulmonary and Critical Care, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Amel Fayed
- College of Medicine, Clinical Department, Princess Nora Bint Abdulrahman University, Riyadh 11671, Saudi Arabia.,High Institute of Public Health, Alexandria University, 165 El-Horeya Road, El-Ibrahimia Qebli wa El-Hadarah Bahari, Qism Bab Sharqi, Alexandria Governorate, Alexandria 165, Egypt
| | - Maram Baksh
- Quality Management Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Faisal Abdullah Abdulaziz Alsaif
- Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Ziad Almomani
- Quality Management Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Mohammad Atallah
- Nursing Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Asrar F Alsharif
- Information Technology Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Amr A Jamal
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Scientific Research, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia.,Department of Family and Community Medicine, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia
| | - Yasser S Amer
- Research Chair of Evidence-Based Healthcare and Knowledge Translation, Deanship of Scientific Research, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia.,Quality Management Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, King Khalid Road, Riyadh 11472, Saudi Arabia.,Alexandria Center for Evidence-Based Clinical Practice Guidelines, New University Hospital, Alexandria University, Alexandria 21131, Egypt
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Hahn EG. Integrative medicine and health in undergraduate and postgraduate medical education. GMS J Med Educ 2021; 38:Doc46. [PMID: 33763531 PMCID: PMC7958908 DOI: 10.3205/zma001442] [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] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/09/2020] [Accepted: 10/19/2020] [Indexed: 06/12/2023]
Abstract
Background and objective: Integrative Medicine and Health (IMH) is a theory-based paradigm shift for health, disease and health care, which can probably only be achieved by supplementing medical roles and competences. Definition of IMH: The definitions of the Academic Consortium for Integrative Medicineand Health 2015 and the so-called Berlin Agreement: Self-Responsibility and Social Action in Practicing and Fostering Integrative Medicine and Health Globally are used. The basic features of evidence-based Integrative Medicine and Health (EB-IMH) are based on the recommendations on EBM by David L. Sackett. Global State of Undergraduate and Postgraduate Medical Education (UG-PGME) for IMH: The USA and Canada are most advanced in the development of IMH regarding practice, teaching and research worldwide. Despite socio-cultural peculiarities, they can provide guidance for Europe and especially for Germany. Of interest here are competences for UG-PGME in IMH in primary care and in some specialist disciplines (e.g. internal medicine, gynecology, pediatrics, geriatrics, oncology, palliative care). For these specialties, the need for an interprofessional UG-PGME for IMH was shown in the early stages of development. UG-PGME for IMH in Germany: In the course of the development of the new Medical Licensure Act in Germany (ÄApprO), based on a revision of the National Competence-based Catalogue of Learning Objectives for Medicine (NKLM 2.0) and new regulations for Postgraduate Medical Education in Germany, suggestions for an extension of UG-PGME are particularly topical. To some extent there are already approaches to IMH. Old and new regulations are set out and are partly compared. As a result, some essential elements of IMH are mapped in the new ÄApprO. The new regulations for Postgraduate Medical Education do not mention IMH. Conclusion: The development of medical competences for IMH in the continuum of the UG-PGME could be supported by the coordinated introduction of appropriate entrustable professional activities (EPA) and IMH sub-competences combined with appropriate assessment.
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Affiliation(s)
- Eckhart Georg Hahn
- Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Department of Medicine 1, Erlangen, Germany
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Zhang SX, Chen J. Scientific evidence on mental health in key regions under the COVID-19 pandemic - meta-analytical evidence from Africa, Asia, China, Eastern Europe, Latin America, South Asia, Southeast Asia, and Spain. Eur J Psychotraumatol 2021; 12:2001192. [PMID: 34900123 PMCID: PMC8654399 DOI: 10.1080/20008198.2021.2001192] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This systematic review aims to summarize the prevalence of anxiety, depression, and insomnia in the general adult population and healthcare workers (HCWs) in several key regions worldwide during the first year of the COVID pandemic. Several literature databases were systemically searched for meta-analyses published by 22 September 2021 on the prevalence rates of mental health symptoms worldwide. The prevalence rates of mental health symptoms were summarized based on 388 empirical studies with a total of 1,067,021 participants from six regions and four countries. Comparatively, Africa and South Asia had the worse overall mental health symptoms, followed by Latin America. The research effort on mental health during COVID-19 has been highly skewed in terms of the scope of countries and mental health outcomes. The mental health symptoms are highly prevalent yet differ across regions, and such evidence helps to enable prioritization of mental health assistance efforts to allocate attention and resources based on the regional differences in mental health.
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Affiliation(s)
- Stephen X Zhang
- Faculty of Professions, University of Adelaide, Adelaide, Australia
| | - Jiyao Chen
- College of Business, Oregon State University, Corvallis, OR, USA
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11
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Miller CJ, Wiltsey-Stirman S, Baumann AA. Iterative Decision-making for Evaluation of Adaptations (IDEA): A decision tree for balancing adaptation, fidelity, and intervention impact. J Community Psychol 2020; 48:1163-1177. [PMID: 31970812 PMCID: PMC7261620 DOI: 10.1002/jcop.22279] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/23/2019] [Accepted: 10/26/2019] [Indexed: 05/17/2023]
Abstract
BACKGROUND Evidence-based practices (EBPs) are frequently adapted to maximize outcomes while maintaining fidelity to core EBP elements. Many step-by-step frameworks for adapting EBPs have been developed, but these models may not account for common complexities in the adaptation process. In this paper, we introduce the Iterative Decision-making for Evaluation of Adaptations (IDEA), a tool to guide adaptations that addresses these issues. FRAMEWORK DESIGN AND USE Adapting EBPs requires attending to key contingencies incorporated into the IDEA, including: the need for adaptations; fidelity to core EBP elements; the timeframe in which to make adaptations; the potential to collect pilot data; key clinical and implementation outcomes; and stakeholder viewpoints. We use two examples to illustrate application of the IDEA. CONCLUSIONS The IDEA is a practical tool to guide EBP adaptation that incorporates important decision points and the dynamism of ongoing adaptation. Its use may help implementation scientists, clinicians, and administrators maximize EBP impact.
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Affiliation(s)
- Christopher J Miller
- Department of Psychiatry, VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Harvard Medical School, Boston, Massachusetts
| | - Shannon Wiltsey-Stirman
- Department of Psychiatry and Behavioral Sciences, VA Palo Alto Healthcare System, National Center for PTSD Dissemination and Training Division, Stanford University, Stanford, California
| | - Ana A Baumann
- Brown School, Washington University in St. Louis, St. Louis, Missouri
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Nasser M, Peres N, Knight J, Haines A, Young C, Maranan D, Wright J, Carvil P, Robinson K, Westmore M, Griffin J, Halkes M. Designing clinical trials for future space missions as a pathway to changing how clinical trials are conducted on Earth. J Evid Based Med 2020; 13:153-160. [PMID: 32449984 DOI: 10.1111/jebm.12391] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The project aims to build a framework for conducting clinical trials for long-term interplanetary missions to contribute to innovation in clinical trials on Earth, especially around patient involvement and ownership. METHODS We conducted two workshops in which participants were immersed in the speculative scenario of an interplanetary mission in which health problems emerged that required medical trials to resolve. The workshops used virtual reality and live simulation to mimic a zero-gravity environment and visual perception shifts and were followed by group discussion. RESULTS Some key aspects for the framework that emerged from the workshops included: (a) approaches to be inclusive in the management of the trial, (b) approaches to be inclusive in designing the research project (patient preference trials, n-of-1 trials, designing clinical trials to be part of a future prospective meta-analysis, etc), (c) balancing the research needs and the community needs (eg, allocation of the participants based on both research and community need), (d) ethics and partnerships (ethics and consent issues and how they relate to partnerships and relationships). CONCLUSION In identifying some key areas that need to be incorporated in future planning of clinical trials for interplanetary missions, we also identified areas that are relevant to engaging patients in clinical trials on Earth. We will suggest using the same methodology to facilitate more in-depth discussions on specific aspects of clinical trials in aerospace medicine. The methodology can be more widely used in other areas to open new inclusive conversations around innovating research methodology.
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Affiliation(s)
- Mona Nasser
- Peninsula Dental School, University of Plymouth, Plymouth, England
| | - Nicholas Peres
- Transtechnology Research, School of Art, Design and Architecture, University of Plymouth, Plymouth, England
- Torbay and South Devon NHS Foundation Trust, Torbay, UK
| | - Jacqui Knight
- Transtechnology Research, School of Art, Design and Architecture, University of Plymouth, Plymouth, England
- Torbay and South Devon NHS Foundation Trust, Torbay, UK
| | - Agatha Haines
- Transtechnology Research, School of Art, Design and Architecture, University of Plymouth, Plymouth, England
| | | | - Diego Maranan
- Faculty of Information and Communication Studies, University of the Philippines-Open University, Los Baños, Philippines
| | - Julian Wright
- Torbay and South Devon NHS Foundation Trust, Torbay, UK
| | - Philip Carvil
- The Health Tech Cluster, Science and Technology Facilities Council-UK Research and Innovation, Wiltshire, UK
| | - Karen Robinson
- JHU Evidence based Practice Center, Johns Hopkins University Bloomberg School of Public Health, Maryland, Baltimore
| | | | - Joanna Griffin
- Transtechnology Research, School of Art, Design and Architecture, University of Plymouth, Plymouth, England
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Panzer AD, Margaretos NM, Lai RC, Enright DE, Chambers JD. What types of real-world evidence studies do U.S. commercial health plans cite in their specialty drug coverage decisions? Pharmacoepidemiol Drug Saf 2020; 29:1307-1311. [PMID: 32212282 DOI: 10.1002/pds.4992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/21/2020] [Accepted: 03/04/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE To examine the RWE U.S. commercial health plans cite in their specialty drug coverage decisions. METHODS We used the Tufts Medical Center Specialty Drug Evidence and Coverage Database to identify specialty drug coverage decisions (n = 7267) issued by 17 large commercial health plans. We categorized the clinical evidence plans cited in these coverage decisions (n = 5227) as randomized controlled trials (RCTs), RWE studies, and other clinical studies (studies other than RCT or RWE study). We categorized RWE studies with respect to study type, for example, case series, studies based on medical records, and so on. We compared the frequency that plans cited different categories of RWE, cited RWE for different diseases, and cited RWE for drugs on the market for different time periods. RESULTS RWE comprised 16% of cited clinical studies. Health plans cited RWE with different frequencies (5%-31% of the cited clinical evidence). Overall, plans cited RWE categorized as medical records most often (26% of cited RWE studies). Plans varied in the frequency they cited different RWE categories. Plans most frequently cited RWE for gastroenterological diseases (35% of clinical study citations) and least frequently for respiratory diseases (11% of clinical study citations). Plans cited RWE more for drugs that have long been on the market. CONCLUSIONS Health plans varied with respect to the number and types of RWE studies they cited in their specialty drug coverage decisions. Plans cited RWE more often for some diseases than others, and cited more RWE for older drugs.
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Affiliation(s)
- Ari D Panzer
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Nikoletta M Margaretos
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Rachel C Lai
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Daniel E Enright
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - James D Chambers
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
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Herbrand AK, Schmitt AM, Briel M, Diem S, Ewald H, Hoogkamer A, Joerger M, Mc Cord KA, Novak U, Sricharoenchai S, Hemkens LG, Kasenda B. Contrasting evidence to reimbursement reality for off-label use (OLU) of drug treatments in cancer care: rationale and design of the CEIT-OLU project. ESMO Open 2019; 4:e000596. [PMID: 31803503 PMCID: PMC6890379 DOI: 10.1136/esmoopen-2019-000596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background Off-label use (OLU) of a drug reflects a perceived unmet medical need, which is common in oncology. Cancer drugs are often highly expensive and their reimbursement is a challenge for many healthcare systems. OLU is frequently regulated by reimbursement restrictions. For evidence-based healthcare, treatment ought to be reimbursed if there is sufficient clinical evidence for treatment benefit independently of patient factors not related to the treatment indication. However, little is known about the reality of OLU reimbursement and its association with the underlying clinical evidence. Here, we aim to investigate the relationship of reimbursement decisions with the underlying clinical evidence. Methods/ design We will extract patient characteristics and details on treatment and reimbursement of cancer drugs from over 3000 patients treated in three Swiss hospitals. We will systematically search for clinical trial evidence on benefits associated with OLU in the most common indications. We will describe the prevalence of OLU in Switzerland and its reimbursement in cancer care, and use multivariable logistic regression techniques to investigate the association of approval/rejection of a reimbursement requests to the evidence on treatment effects and to further factors, including type of drug, molecular predictive markers and the health insurer. Discussion Our study will provide a systematic overview and assessment of OLU and its reimbursement reality in Switzerland. We may provide a better understanding of the access to cancer care that is regulated by health insurers and we hope to identify factors that determine the level of evidence-based cancer care in a highly diverse western healthcare system.
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Affiliation(s)
| | | | - Matthias Briel
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Stefan Diem
- Department of Oncology and Hematology, Kantonales Spital Grabs, Grabs, Switzerland.,Department of Oncology and Hematology, Kantonsspital St. Gallen, Sankt Gallen, Switzerland
| | - Hannah Ewald
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,University Medical Library, University of Basel, Basel, Switzerland
| | - Anouk Hoogkamer
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Markus Joerger
- Department of Oncology and Hematology, Kantonsspital St. Gallen, Sankt Gallen, Switzerland
| | - Kimberly Alba Mc Cord
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Urban Novak
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sirintip Sricharoenchai
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lars G Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Benjamin Kasenda
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland.,Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Hematology/Oncology and Palliative Care, Klinikum Stuttgart Katharinenhospital, Stuttgart, Germany
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Kassa MD, Grace JM. A mixed-method study of quality, availability and timeliness of non-communicable disease (NCD) related data and its link to NCD prevention: Perceptions of health care workers in Ethiopia. Health Inf Manag 2018; 48:135-143. [PMID: 30126291 DOI: 10.1177/1833358318786313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Three-quarters of non-communicable disease (NCD) mortality occurs in low- and middle-income countries. However, in most developing countries, quality and reliable data on morbidity, mortality and risk factors for NCD to predict its burden and prevalence are less well understood and availability of these data is limited. To better inform policymakers and improve healthcare systems in developing countries, it is also important that these factors be understood within the context of the particular country in question. Objective: The aim of this study is to further inform practitioners in Ethiopia about the availability and status of NCD information within the Ethiopian healthcare system. METHOD A mixed method research design was used with data collected from 13 public referral hospitals in Ethiopia. In phase 1 quantitative data were collected from 312 health professionals (99 physicians; 213 nurses) using a cross-sectional survey. In phase 2, qualitative data were collected using: interviews (n = 13 physician hospital managers); and one focus group (n = 6 national health bureau officers). RESULTS Results highlighted the lack of NCD morbidity, mortality and risk factor data, periodic evaluation of NCD data and standardised protocols for NCD data collection in hospitals. The study also identified similar discrepancies in the availability of NCD data and standardised protocols for NCD data collection among the regions of Ethiopia. CONCLUSION This study highlighted important deficiencies in NCD data and standardised protocols for data collection in the Ethiopian healthcare system. These deficiencies were also observed among regions of Ethiopia, indicating the need to strengthen both the healthcare system and health information systems to improve evidence-based decision-making. IMPLICATIONS Identifying the status of NCD data in the Ethiopian healthcare system could assist policymakers, healthcare organisations, healthcare providers and health beneficiaries to reform and strengthen the existing healthcare system.
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Chen KH, Kao CC, Chen C. [Evidence-Based Knowledge Translation: From Scientific Evidence to Clinical Nursing Practice]. Hu Li Za Zhi 2016; 63:5-11. [PMID: 27900739 DOI: 10.6224/jn.63.6.5] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In 1992, Gordon Guyatt coined the term "evidence-based medicine", which has since attracted worldwide attention. In 2007, the Institute of Medicine's Roundtable on Evidence-Based Medicine set the goal that 90% of clinical decisions would be supported by accurate, timely, and up-to-date clinical information and would reflect the best available evidence by 2020. However, the chasm between knowing and doing remains palpable. In 2000, the Canadian Institute of Health Research applied the term "knowledge translation" to describe the bridge that is necessary to cross the gap between research knowledge and clinical practice. The present paper outlines the conceptual framework, barriers, and promotion strategies for evidence-based knowledge translation and shares clinical experience related to overcoming the seven layers of leakage (aware, accepted, applicable, able, acted on, agreed, and adhered to). We hope that this paper can enhance the public well-being and strengthen the future health care system.
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Affiliation(s)
- Kee-Hsin Chen
- PhD, RN, Deputy Director, Department of Nursing, and Director, Evidence-Based Knowledge Translation Center, Wan Fang Hospital, Taipei Medical University, and Adjunct Lecturer, School of Nursing, Taipei Medical University; and Researcher, Cochrane Taiwan, Taiwan, ROC
| | - Ching-Chiu Kao
- MSN, RN, Deputy Superintendent, Department of Community, and Consultant, Evidence-Based Knowledge Translation Center, Wan Fang Hospital, Taipei Medical University, and Adjunct Assistant Professor, School of Nursing, Taipei Medical University, Taiwan, ROC
| | - Chiehfeng Chen
- PhD, MD, Director, Department of Plastic Surgery, and Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, and Adjunct Associate Professor, School of Medicine, Taipei Medical University, and Chief Executive Officer, Cochrane Taiwan, Taiwan, ROC.
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Sharma T, Choudhury M, Kaur B, Naidoo B, Garner S, Littlejohns P, Staniszewska S. Evidence informed decision making: the use of "colloquial evidence" at nice. Int J Technol Assess Health Care 2015; 31:138-46. [PMID: 25991028 DOI: 10.1017/S0266462314000749] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Colloquial evidence (CE) has been described as the informal evidence that helps provide context to other forms of evidence in guidance development. Despite challenges around quality, and the potential biases, the use of CE is becoming increasingly important in assessments where scientific literature is sparse and to also capture the experience of all stakeholders in discussions, including that of experts and patients. We aimed to ascertain how CE was being used at the National Institute for Health and Care Excellence (NICE). METHODS Relevant data corresponding to the use of CE was extracted from all NICE technical and process manuals by two reviewers and quality assured and analyzed by a third reviewer. This was considered in light of the results of a focused literature review and a combined checklist for quality assessment was developed. RESULTS At NICE, CE is utilised across all guidance producing programmes and at all stages of development. CE could range from information from experts and patient/carers, grey literature (including evidence from websites and policy reports) and testimony from stakeholders through consultation. Six tools for critical appraisal of CE were available from the literature and a combined best practice checklist has been proposed. CONCLUSIONS As decisions often need to be made in areas where there is a lack of published scientific evidence, CE is employed. Therefore to ensure its appropriateness the development of a validated CE data quality check-list to assist decision makers is essential and further research in this area is a priority.
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Tsai JM. [The historical background and present development of evidence-based healthcare and clinical nursing]. Hu Li Za Zhi 2014; 61:17-22. [PMID: 25464952 DOI: 10.6224/jn.61.6.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Evidence-based healthcare (EBHC) emphasizes the integration of the best research evidence with patient values, specialist suggestions, and clinical circumstances during the process of clinical decision-making. EBHC is a recognized core competency in modern healthcare. Nursing is a professional discipline of empirical science that thrives in an environment marked by advances in knowledge and technology in medicine as well as in nursing. Clinical nurses must elevate their skills and professional qualifications, provide efficient and quality health services, and promote their proficiency in EBHC. The Institute of Medicine in the United States indicates that evidence-based research results often fail to disseminate efficiently to clinical decision makers. This problem highlights the importance of better promoting the evidence-based healthcare fundamentals and competencies to frontline clinical nurses. This article describes the historical background and present development of evidence-based healthcare from the perspective of modern clinical nursing in light of the importance of evidence-based healthcare in clinical nursing; describes the factors associated with evidence-based healthcare promotion; and suggests strategies and policies that may improve the promotion and application of EBHC in clinical settings. The authors hope that this paper provides a reference for efforts to improve clinical nursing in the realms of EBHC training, promotion, and application.
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Affiliation(s)
- Jung-Mei Tsai
- Department of Nursing, Mackay Memorial Hospital, Taiwan, ROC.
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Gorenoi V, Hagen A. [SR/PS-method for using data of primary studies from systematic reviews in the evaluation of health technologies]. Z Evid Fortbild Qual Gesundhwes 2014; 108:325-32. [PMID: 25066352 DOI: 10.1016/j.zefq.2014.03.017] [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: 10/07/2013] [Revised: 03/28/2014] [Accepted: 03/31/2014] [Indexed: 11/29/2022]
Abstract
In general, the evaluation of health technologies is a time-consuming process being performed on the basis of systematic reviews of clinical (primary) studies. In order to save time, health technologies may be assessed based on previously published systematic reviews. However, this assessment method can be associated with a high risk of bias of the obtained results. We developed, therefore, the "Systematic Reviews for assessment based on Primary Studies" (SR/PS) method to enable a transparent, valid and time-saving evaluation of the technologies. Using the SR/PS method the evaluation of the hits that were identified through the literature search for systematic reviews and, if appropriate, through additional search for primary studies is being performed in three stages, namely identification, quality assessment and information synthesis. This process results in the ascertainment of the three most important sets of information: the pool of identified studies, the pool of methodologically sound studies and the results of the information synthesis. Each stage of the evaluation comprises the comprehensive use of relevant data on primary studies from the systematic reviews. At each stage, the corresponding systematic reviews will be selected from the identified hits using certain quality criteria. If information obtained from the systematic reviews is insufficient it will be completed by additionally incorporating the primary studies. The SR/PS method can be especially helpful in performing projects with many primary studies (e. g., guidelines development).
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Affiliation(s)
- Vitali Gorenoi
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung Medizinische Hochschule Hannover.
| | - Anja Hagen
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung Medizinische Hochschule Hannover
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Dörr J, Valipour A, Strametz R, Meyer G, Lühmann D, Steurer J, Horvath K, Donner-Banzhoff N, Forster J, Sauder K, Ollenschläger G, Ochsendorf F, Weberschock T. [Survey on evidence-based medicine teaching activities in the German-speaking area: a target-group specific analysis]. Z Evid Fortbild Qual Gesundhwes 2014; 108:166-174. [PMID: 24780716 DOI: 10.1016/j.zefq.2013.12.003] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/03/2013] [Accepted: 12/09/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION A survey conducted in 2011/12 on evidence-based medicine teaching activities in Germany, Austria and Switzerland shows an apparent increase of undergraduate and postgraduate teaching activities addressing different target groups. The potential target-group specific or generalised nature of teaching activities in EbM were explored by comparing the contents and structures of educational offers in order to detect differences and commonalities. METHODS First, several large institutions of the healthcare system were contacted. In addition, the participants of the EbM Academy were consulted as key informants, and the members of the German-speaking colleges of general practitioners and the German Network for EBM were asked to identify potential providers of EbM teaching activities. In the second step pretested detailed questionnaires were sent out that allowed a target-group specific analysis of contents, structures and didactic methods. RESULTS Altogether, 185 teaching activities in EbM are described; 117 (6.8%) of these address students, 70 (37.8%) physicians and 55 (29.7%) caregivers and members of other healthcare professions. Further target groups include people interested in the healthcare system with a total of 38 (i.e., 20.5%) and patients with 18 (9.7%) teaching activities (multiple responses allowed). Students are mainly taught in obligatory seminars, courses or lectures with a high number of participants, whereas teaching activities addressing other target groups are mostly offered to small groups of participants in the form of optional seminars, courses or workshops lasting a similar length of time. As regards the content, attendees from all target groups with only little previous knowledge are taught the first three steps of EbM according to Sackett. Specialised contents are not distributed evenly and reveal some adaptation to the respective target groups. DISCUSSION Structural differences between the target groups are most likely attributed to distinct framework conditions in education and career. Parallels in content demonstrate high rates of conformity concerning the teaching of basic knowledge, though, while individually selecting particular focus areas of special expertise.
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Affiliation(s)
- Joshua Dörr
- Arbeitsgruppe Evidenzbasierte Medizin, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt.
| | - Arash Valipour
- Arbeitsgruppe Evidenzbasierte Medizin, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt
| | - Reinhard Strametz
- Arbeitsgruppe Evidenzbasierte Medizin, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt; Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt
| | - Gabriele Meyer
- Institut für Gesundheits- und Pflegewissenschaften, Martin-Luther-Universität Halle-Wittenberg
| | - Dagmar Lühmann
- Institut für Sozialmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck
| | | | - Karl Horvath
- EBM Review Center, Universitätsklinik für Innere Medizin, Graz, Österreich
| | - Norbert Donner-Banzhoff
- Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps-Universität Marburg
| | - Johannes Forster
- Abteilung für Kinder- und Jugendmedizin St. Hedwig, St. Josefskrankenhaus, Freiburg
| | - Karsta Sauder
- Deutsches Netzwerk Evidenzbasierte Medizin DNEbM e.V., Ärztliches Zentrum für Qualität in der Medizin, Berlin
| | | | - Falk Ochsendorf
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt
| | - Tobias Weberschock
- Arbeitsgruppe Evidenzbasierte Medizin, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt; Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt
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Siebert U, Rochau U, Claxton K. When is enough evidence enough? - Using systematic decision analysis and value-of-information analysis to determine the need for further evidence. Z Evid Fortbild Qual Gesundhwes 2013; 107:575-84. [PMID: 24315327 DOI: 10.1016/j.zefq.2013.10.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [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: 10/01/2013] [Revised: 10/18/2013] [Accepted: 10/18/2013] [Indexed: 11/18/2022]
Abstract
Decision analysis (DA) and value-of-information (VOI) analysis provide a systematic, quantitative methodological framework that explicitly considers the uncertainty surrounding the currently available evidence to guide healthcare decisions. In medical decision making under uncertainty, there are two fundamental questions: 1) What decision should be made now given the best available evidence (and its uncertainty)?; 2) Subsequent to the current decision and given the magnitude of the remaining uncertainty, should we gather further evidence (i.e., perform additional studies), and if yes, which studies should be undertaken (e.g., efficacy, side effects, quality of life, costs), and what sample sizes are needed? Using the currently best available evidence, VoI analysis focuses on the likelihood of making a wrong decision if the new intervention is adopted. The value of performing further studies and gathering additional evidence is based on the extent to which the additional information will reduce this uncertainty. A quantitative framework allows for the valuation of the additional information that is generated by further research, and considers the decision maker's objectives and resource constraints. Claxton et al. summarise: "Value of information analysis can be used to inform a range of policy questions including whether a new technology should be approved based on existing evidence, whether it should be approved but additional research conducted or whether approval should be withheld until the additional evidence becomes available." [Claxton K. Value of information entry in Encyclopaedia of Health Economics, Elsevier, forthcoming 2014.] The purpose of this tutorial is to introduce the framework of systematic VoI analysis to guide further research. In our tutorial article, we explain the theoretical foundations and practical methods of decision analysis and value-of-information analysis. To illustrate, we use a simple case example of a foot ulcer (e.g., with diabetes) as well as key references from the literature, including examples for the use of the decision-analytic VoI framework by health technology assessment agencies to guide further research. These concepts may guide stakeholders involved or interested in how to determine whether or not and, if so, which additional evidence is needed to make decisions.
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Affiliation(s)
- Uwe Siebert
- Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Area Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria; Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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22
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Abstract
Evidence-based practice has been demonstrated to improve quality of care, increase patients' satisfaction, and reduce the costs of medical care. Therefore, evidence-based practice is now central to the clinical decision-making process and to achieving better quality of care. Today, it is one of the important indicators of core competences for healthcare providers and accreditation for healthcare and educational systems. Further, evidence-based practice encourages in-school and continuous education programs to integrate evidence-based elements and concepts into curricula. Healthcare facilities and professional organizations proactively host campaigns and encourage healthcare providers to participate in evidence-based related training courses. However, the clinical evidence-based practice progress is slow. The general lack of a model for organizational follow-up may be a key factor associated with the slow adoption phenomenon. The authors provide a brief introduction to the evidence-based practice model, then described how it may be successfully translated through a staged process into the evidence-based practices of organizational cultures. This article may be used as a reference by healthcare facilities to promote evidence-based nursing practice.
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Affiliation(s)
- Yu-Chih Chen
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taiwan, ROC.
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