Implementation Of Evidence-based Medicine Research Articles

Implementation of evidence-based medicine in dietetic practice: Current status and hurdles in Italy.

Background: Health professionals, including dietitians, should adapt their clinical daily practice to evidence-based practice (EBP), but this does not happen often in daily practice. The aim of this study was to investigate the current status and barriers to evidence-based practice among dietitians. Methods: This was a mixed-method, cross-sectional, national study (questionnaire and focus group) performed on working and registered dietitians, both self-employed and employed by public hospitals. The main outcomes were EBP knowledge, frequency of use, and proficiency scores. Barriers to EBP implementation were also collected, as well as qualitative information from the focus group. Results: Forty-three dietitians were enrolled from August to November 2021 in Italy. Overall, EBP knowledge was moderate/good. Younger dietitians (< 50 years old) obtained better results than their older colleagues. A similar trend was observed in terms of seniority. There was a discrepancy between EBP knowledge and perception of EBP implementation: the worst scores were obtained by participants who claimed an already complete integration of EBP. The average frequency of EBP use was moderate, with higher scores in dietitians ≥ 50 years old and with seniority ≥ 20 years. EBP proficiency instead was poor. The focus group revealed a lack of time and resistance to change as the main barriers. Conclusion: The importance of EBP is well-acknowledged, but it is not correctly implemented yet, because of identified barriers that need to be fixed. These barriers include a lack of dedicated time, inadequate EBP training, and resistance to change, especially in hierarchical environments.

Translation and cross-cultural adaptation of Persian version of Evidence Based Medicine Questionnaire (EBMQ) in postgraduate medical students in Iran.

Evidence Based Medicine Questionnaire (EBMQ) was developed to assess the knowledge, practice and barriers towards the implementation of Evidence-Based Medicine (EBM). This study aimed to translate, cross-culturally adapt and psychometrically validate the Persian version of EBMQ. This was an analytical cross sectional study. The EBMQ underwent translation and cross-cultural adaptation following best practices. Face validity was assessed by a panel of five experts. The content validity index (CVI) and content validity ratio (CVR) were evaluated by 15 experts who were familiar with EBM. The tool's internal consistency and test-retest reliability over a 2-week period were evaluated using Cronbach's α and intra-class correlation (ICC), respectively. To assess construct validity, the questionnaire was completed by 400 medical students. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used for construct validity assessment. All analyses were carried out using IBM SPSS v.24 and AMOS v.24. A significance level of 5% was considered. The CVR for 40 items was higher than 0.62, and their CVI score was 1.0, indicating good content validity. The scale demonstrated acceptable internal consistency and test-retest reliability (n = 30) with an ICC of 0.909 (95% CI: 0.866 to 0.941), and an overall alpha coefficient of 0.957. The structural validity was established through exploratory factor analysis (Bartlett's test p<0.001; the Kaiser-Meyer-Olkin index = 0.862), and it was further confirmed by confirmatory factor analysis. A three-factor solution with 40 items, explaining 51.610% of the variance, exhibited the best fit indices Chi-square statistics/df = 4.23; RMSEA = 0.08; CFI = 0.95; NFI = 0.93; TLI = 0.92). The Persian version of the EBMQ was a reliable and valid tool that could be utilized to assess the knowledge, practice and barriers of EBM for physicians in Persian language countries.

Encouraging Students and Trainees to Write.

Publications from Japan have been on the decline, and this tendency is expected to continue as the country's population decreases. During the novel coronavirus disease (COVID-19) pandemic, it was discovered that Japanese medical trainees published much fewer papers than trainees from other nations. This issue must be addressed by the entire Japanese medical community. Trainees have the potential to contribute to the medical community through their publishing process presenting fresh perspectives and communicating accurate information to the public through the use of social media. Furthermore, trainees themselves would benefit as they would become more enhanced by deeply and critically considering the contents and the trends of publications worldwide, which would promote further implementation of evidence-based medicine. Therefore, medical educators and students should be motivated and encouraged to write by offering enough instructional and publication opportunities. Such measures would be to (1) train students in "medical writing" as part of the medical curriculum; (2) encourage medical students and trainees to submit of manuscripts, especially in the section of the letters, opinions, and case reports; (3) guarantee trainees time and resources to write; (4) provide as constructive reviews and comments as possible as an educational opportunity for trainees; and (5) motivate trainees to write. Such hands-on training would necessitate significant efforts of the trainees, instructors, and publishers. However, if we cannot invest in fostering future resources now, we may not be able to hope for increase in the amount of research published from Japan. The future lies in everybody's hands.

Development and validation of the clinical information literacy questionnaire.

Clinical Information Literacy (CIL) seems to be a prerequisite for physicians to implement Evidence-Based Medicine (EBM) effectively. This study endeavors to develop and validate a CIL questionnaire for medical residents of Isfahan University of Medical Sciences. This study employs sequential-exploratory mixed methods in 2019. The participants were 200 medical residents in different specialties; they are selected through the convenience sampling method. In the first (qualitative) phase, an early CIL questionnaire was designed by reviewing literature and performing complementary interviews with health professionals. In the second (validation) phase, the questionnaire's face validity and content validity were confirmed. In the third (quantitative) phase, the construct validity was examined via Item-Response Theory (IRT) model, and the factor loading was computed. The gathered data were analyzed using descriptive statistics, t-test, two-way ANOVA, as well as two-parameter IRT model in R software. In the qualitative phase, the concept of CIL is initially described in seven main categories and 22 subcategories, and the items were formulated. An initial 125-item questionnaire was analyzed by the research team, leading to a 43-item. Through the content validity and face validity examination, we removed 11 and 4 items in the Content Validity Ratio (CVR) and Content Validity Index (CVI), respectively. Throughout the face validity analysis, none of the items were removed. According to the construct validity results, difficulty coefficient, discriminant coefficient, and factor loading were confirmed, most of the other questions achieved a proper factor loading value that is higher than 0.30, and a value of 0.66 was achieved for the reliability via the Kuder-Richardson method. Ultimately, the real-assessment 28-item CIL questionnaire was developed with four components. The CIL questionnaire could be employed to examine the actual CIL basic knowledge. Because of using the real-assessment approach rather than self-assessment in the design, it can be claimed that this instrument can provide a more accurate assessment of the information literacy status of medical residents. This valid questionnaire is used to measure and train the skills needed by healthcare professionals in the effective implementation of EBM.

What is confirmed in Kneipp therapy? The perspective of internal medicine

Kneipp therapy comprises the five naturopathic elements of water, exercise, nutrition, medicinal herbs and order of life. As atraditional method, it has been proven in self-treatment at home, but as aholistic therapy concept it is also used in many medical practices both for the prevention and therapy of functional disorders and in the treatment of organic diseases and ailments. While naturopathic and complementary medical procedures are highly accepted by the population and the medical profession, and exercise and nutrition therapy in particular are already largely integrated into conventional medicine, the implementation of evidence-based medicine (EbM) in internal medicine practice represents amajor challenge for Kneipp therapy. This is especially true for Kneipp hydrotherapy. Unlike in the 1980s and 1990s, when Kneipp therapy was scientifically recognized due to numerous preclinical, human physiological and some clinical studies, the change of perspective in medicine towards EbM has resulted in aresearch deficit in the field of clinical trials. The demand for scientific evidence is contrasted by alack of reliable data and an overall heterogeneous study situation or study quality; however, existing studies point to positive or significant effects, so that further research activities are urgently necessary. Some of these studies are presented in this article.

A Survey of Implementation of ABCDE Protocols.

Spontaneous awakening trials (SATs), spontaneous breathing trials (SBTs), delirium assessment/management, early mobility have been termed the ABCDE bundle. The ABCDE bundle has been proven to improve patient outcomes. However, there is often a long gap in dissemination and implementation of evidence-based medicine. To determine the prevalent implementation of and determinants for ABCDE protocol adoption in Pennsylvania. We developed a survey of ABCDE bundle protocols. We surveyed factors around implementation including written protocol presence, standardized assessments to guide protocols, timing of creation of protocols, and estimated adherence to protocols. We also collected data on factors that might be determinants for protocol adoption including ICU staffing models, hospital and ICU level factors. We validated the survey tool using the Michigan Health and Hospital Association Keystone ICU collaborative. We then administered the validated survey to a leader of the medical ICU or mixed medical-surgical ICU of all Pennsylvania Hospitals. Multivariable logistic and ordinal regression were used to determine associations between ICU staffing models and hospital and ICU level factors with the presence of ABCDE bundle protocols. In the study cohort of Pennsylvania ICUs (n = 144), we had 100 respondents (69% response). The median number of hospital beds among the respondents was 185 (IQR 111-355) with a median of 14 ICU beds (IQR 10-20). 86% reported spontaneous awakening trial protocols, 60% reported spontaneous breathing trial protocols, 43% reported delirium assessment/management protocols, and 27% reported early mobility protocols. Being a medical ICU compared to a mixed medical-surgical ICU (OR 3.48, 95% CI 1.19-10.21, P = .02) and presence of multidisciplinary rounds (OR 4.97, 95% CI 2.07-11.94, P < .001) were associated with increasing number of ABCDE bundle protocol components. Variable implementation of ABCDE bundle protocols was present across Pennsylvania. Team communication is important to implementation of these protocols.

Effect of near real-time feedback tool in the electronic medical record on protocol compliance during laparoscopic cholecystectomy: a single-center retrospective analysis.

Implementation of evidence-based medicine has proved difficult across medical fields. Leveraging the electronic medical record may improve clinician compliance to published best practices. Our hypothesis was that the use of a near real-time feedback tool would improve compliance to the protocol steps. In order to test this hypothesis, we performed a retrospective chart review to compare compliance to a proprietary enhanced recovery protocol for patients undergoing laparoscopic cholecystectomy with and without a near real-time feedback tool embedded in the electronic medical record. Deviations to the care pathway were quantified and classified as allowable or as errors of commission, omission, or dose. During the study period, 2625 laparoscopic cholecystectomies were performed. A total of 16,972 protocol steps were evaluated. Complete protocol compliance improved from 10.3 to 61.5% (p < 0.001) with the use of the feedback tool. Individual protocol component compliance increased from 4994/8418 (59.3%) to 7669/8554 (89.7%) (p < 0.001). The near real-time feedback tool reduced the number of cases with every number of deviations (except zero) at p < 0.001. The near real-time feedback tool significantly improved protocol compliance for patients undergoing laparoscopic cholecystectomy.

Letter to the Editor

Dr. Bharathy Kumaravel&#x0D; &#x0D; Journal of Medical Education Research&#x0D; University of Buckingham Press&#x0D; 51 Gower Street&#x0D; London&#x0D; WC1E 6HJ&#x0D; &#x0D; 9th June 2021&#x0D; &#x0D; Dear Editor,&#x0D; &#x0D; Evidence-based medicine (EBM) has become the gold standard for clinical decision-making and customary practice over the last few decades. As recently qualified junior NHS doctors, the COVID-19 pandemic has highlighted the practical relevance and importance of developing the skills of effective literature search and critical appraisal to be able to utilise it in our daily clinical practice.&#x0D; &#x0D; This letter is to bring to your kind attention our own reflection of training opportunities we had in relation to EBM and public health in our undergraduate curriculum. This training has helped us to survive our initial clinical years, made even more challenging by COVID-19 and ever-evolving medical knowledge. As per Meats, Heneghan, Crilly and Glasziou (2009) there is significant variation in EBM undergraduate teaching in medical schools in the UK and although core EBM topics are taught in theory, relatively few medical students gain the opportunity to practice or assess such skills. &#x0D; &#x0D; As medical students at the University of Buckingham Medical School (UBMS), we formed a group called ‘UBMS public health crew’. We were able to go into community lunch clubs and conduct one-to-one interviews with the elderly ethnic minority communities to gain their perceptions and possible barriers they face regarding influenza vaccination uptake. We also had the annual EBM conference conducted by the medical school where we were able to submit our reports of concise and efficient implementation of EBM on clinical questions we formed during our clinical years. These were then showcased as posters, with the best examples also being presented with a prize of EBM champion for the best presentation. To our knowledge, student initiatives surrounding the clinical application of EBM is unique to University of Buckingham.&#x0D; &#x0D; The culmination of this training resulted in us continuing to incorporate EBM into our clinical practice and with the onset of the COVID-19 pandemic, it showed how EBM became almost a necessity in our clinical practice. During the initial wave, many junior doctors were redeployed to COVID specific wards. Clinicians caring for these patients were eager to learn more about the disease. As a result, at our hospital, a journal club was setup to critically analyse recent publications on COVID-19. A topic that was discussed was fluid administration in these patients. An initial management strategy had been to restrict fluid administration to these patients to avoid causing an acute respiratory distress syndrome. However, as more evidence emerged it became clear that this had potentially harmful effects. This led to the advocation of judicious fluid management. Our early exposure to the practical application of EBM has nurtured a dynamic approach to clinical medicine in a profession where what is best for the patient today is not necessarily the case tomorrow.&#x0D; &#x0D; In addition to our clinical application, we have also continued our research on EBM teaching for medical students. By presenting our research with posters and publications we are continuing to expand our research on this field with further opportunities.&#x0D; &#x0D; In conclusion, having formal modules on developing EBM skills as well as having interactive and real-time opportunities for medical students to expand on their EBM interests such as having community-based EBM projects and implementation of EBM in clinical practice are imperative to ensure future clinicians deliver scientifically sound clinical care that is in line with ever evolving medical research and to deal with unprecedented medical challenges.&#x0D; &#x0D; Sincerely,&#x0D; &#x0D; Dr. Fathima Rawther and Dr. Justin Collis&#x0D; Foundation Year 2 Doctors&#x0D; Royal Berkshire Hospital and Epsom &amp; St Helier University Hospitals&#x0D; &#x0D; &#x0D; &#x0D; References&#x0D; Meats, E., Heneghan, C., Crilly, M. and Glasziou, P., 2009. Evidence-based medicine teaching in UK medical schools. Medical Teacher, 31(4), pp.332-337.

Breast Cancer Research to Support Evidence-Based Medicine in Nigeria: A Review of the Literature.

PURPOSEBreast cancer is the most common malignancy in women worldwide. In Nigeria, it accounts for 22.7% of all new cancer cases among women. Evidence-based medicine (EBM) entails using the results from healthcare research to enhance the clinical decision-making process and develop evidence-based treatment guidelines. Level 1 and 2 studies, such as randomized controlled trials, meta-analyses, and systematic reviews of randomized controlled trials, yield more robust types of evidence. This study reviewed the levels of evidence of breast cancer publications in Nigeria.METHODSWe conducted an electronic literature search of all studies published on breast cancer in Nigeria from January 1961 to August 2019. We reviewed all the articles found under the search term “Breast Cancer in Nigeria” on medical databases.RESULTSOur search identified 2,242 publications. One thousand two hundred fifty duplicates were removed, and 520 were excluded. A total of 472 articles were considered eligible for this review. Most of these articles were case series or reports (30.7%), qualitative studies (15.7%), followed by cross-sectional studies (13.3%), laboratory studies (12.9%), case-control studies (6.1%), case reports (7%), and cohort (5.7%).CONCLUSIONBreast cancer research in Nigeria is yet to produce much evidence of the types considered to best support EBM. The scarcity of data hampers the implementation of EBM in Nigeria. Currently, most treatment guidelines are adapted from those developed in other countries, despite genetic differences among populations and different environmental influencing factors.

Current Knowledge of Hypertrophic Cardiomyopathy Among Health Care Providers in Sweden.

IntroductionHypertrophic cardiomyopathy (HCM) is a common disorder with various manifestations, including sudden cardiac death. Patients with suspected or confirmed HCM may be encountered throughout the healthcare system, especially in internal medicine and cardiology. Thus, thorough knowledge of HCM is essential among healthcare providers.MethodsA web-based questionnaire was developed to assess the cross-sectional evaluation of HCM knowledge. It covered aspects such as epidemiology and diagnosis, treatment, lifestyle, risk stratification of sudden cardiac death, and implantable cardioverter-defibrillator knowledge.ResultsIn total, 123 subjects completed the survey. The mean age was 38.5 ±10.7 years and two-thirds (n=82) were females; 43.1% were physicians (non-specialist 24.4%, cardiologists 8.9%, specialist, other than cardiology 9.8%); and the remaining were nurses (nurses within cardiology 37.4%, nurses outside cardiology 19.5%). Almost all subjects had heard about the disease (95.9%) and the vast majority (77.2%) had taken part in the management of a patient with HCM. The total mean score was 15.9 ±3.9 credits and the 25th, 50th, and 75th percentiles were 14, 15, and 18 credits, respectively. The predefined arbitrary pass score of ≥60% was reached by 61.8%, and 20.3% were considered to pass with distinction. Physicians scored higher than nurses (70.7 ±17.0% vs 58.1 ±11.8; p<0.001). Within each professional category, there was a similar score with regard to gender.ConclusionsThere is a considerable lack of knowledge of HCM among healthcare professionals working within the field of internal medicine/cardiology. This insufficient knowledge may contribute to less implementation of evidence-based medicine and current guidelines, although further studies are needed to confirm this.

The emerging specialty of perioperative medicine: a UK survey of the attitudes and behaviours of anaesthetists

BackgroundIn 2014, the Royal College of Anaesthetists (RCoA) launched the Perioperative Medicine Programme to facilitate the delivery of best preoperative, intraoperative and postoperative care through implementation of evidence-based medicine to reduce variation and improve postoperative outcomes. However, variation exists in the establishment of perioperative medicine services in the UK. This survey explored attitudes and behaviours of anaesthetists towards perioperative medicine, described current anaesthetic-led perioperative medicine services across the UK and explored barriers to anaesthetic involvement in perioperative medicine.MethodsSurvey content based on the RCoA vision document was refined and validated using an expert panel. An anonymous electronic survey was then sent by email to the members of the RCoA.ResultsSeven hundred fifty-eight UK anaesthetists (4.5% of the RCoA mailing list) responded to the survey. Of these, 64% considered themselves a perioperative doctor, with 65% having changed local services in response to the RCoA vision. Barriers to developing perioperative medicine included insufficient time (75%) and inadequate training (51%). Three quarters of respondents advocate anaesthetists leading the development of perioperative medicine.ConclusionsDespite evidence of emerging services, this survey describes barriers to ongoing development of perioperative medicine. Facilitators may include increased clinical exposure, targeted education and training and collaborative working with other specialties.

Practicing Evidence-Based Medicine

Today, a plethora of resources for evidence-based medicine (EBM) are available via alert services, compendia, and more. In theory, a clinician researching a topic or looking for information regarding a clinical decision should easily find the literature or synopses needed. However, the real challenge lies in recognizing which resources (out of hundreds or possibly thousands) present the best and most reliable evidence. As well, evidence from research is only part of the decision calculus, and the clinician, not the evidence, makes the final decisions. Medical decision analysis attempts to formalize the process and reduce it to algebra, but it is difficult or impossible to represent all the components of a decision mathematically and validly let alone do so in “real time” for individual patients. This review discusses these challenges and more, including how to ask answerable questions, understand the hierarchy for evidence-based information resources, critically appraise evidence, and apply research results to patient care. Figures show the total number of new articles in Medline from 1965 to 2012, a “4S” hierarchy of preappraised medicine, percentage of physician and medical student respondents with a correct or incorrect answer to a question about calculating the positive predictive value of a hypothetical screening test, a nomogram for Bayes’s rule, an example of nomogram use for pulmonary embolism, and a model for evidence-informed clinical decisions. Tables list selected barriers to the implementation of EBM; Patient, Intervention, Comparison, and Outcome (PICO) framework for formulating clinical questions; guides for assessing medical texts for evidence-based features; clinically useful measures of disease frequency and statistical significance and precision; definitions of clinically useful measures of diagnostic test performance and interpretation; definitions of clinically useful measures of treatment effects from clinical trials; summary of results and derived calculations from the North American Symptomatic Carotid Endarterectomy Trial (NASCET); and selected number needed to treat values for common therapies. This review contains 6 highly rendered figures, 9 tables, and 28 references.

A comparison of evidence-based medicine practices between primary care physicians in rural and urban primary care settings in Malaysia: a qualitative study

ObjectiveThis study aimed to compare the evidence-based practices of primary care physicians between those working in rural and in urban primary care settings.Research designData from two previous qualitative studies, the...

Development and validation of the Evidence Based Medicine Questionnaire (EBMQ) to assess doctors\u2019 knowledge, practice and barriers regarding the implementation of evidence-based medicine in primary care

BackgroundEvidence-Based Medicine (EBM) integrates best available evidence from literature and patients’ values, which then informs clinical decision making. However, there is a lack of validated instruments to assess the knowledge, practice and barriers of primary care physicians in the implementation of EBM. This study aimed to develop and validate an Evidence-Based Medicine Questionnaire (EBMQ) in Malaysia.MethodsThe EBMQ was developed based on a qualitative study, literature review and an expert panel. Face and content validity was verified by the expert panel and piloted among 10 participants. Primary care physicians with or without EBM training who could understand English were recruited from December 2015 to January 2016. The EBMQ was administered at baseline and two weeks later. A higher score indicates better knowledge, better practice of EBM and less barriers towards the implementation of EBM. We hypothesized that the EBMQ would have three domains: knowledge, practice and barriers.ResultsThe final version of the EBMQ consists of 80 items: 62 items were measured on a nominal scale, 22 items were measured on a 5 point Likert-scale. Flesch reading ease was 61.2. A total of 343 participants were approached; of whom 320 agreed to participate (response rate = 93.2%). Factor analysis revealed that the EBMQ had eight domains after 13 items were removed: “EBM websites”, “evidence-based journals”, “types of studies”, “terms related to EBM”, “practice”, “access”, “patient preferences” and “support”. Cronbach alpha for the overall EBMQ was 0.909, whilst the Cronbach alpha for the individual domain ranged from 0.657–0.940. The EBMQ was able to discriminate between doctors with and without EBM training for 24 out of 42 items. At test-retest, kappa values ranged from 0.155 to 0.620.ConclusionsThe EBMQ was found to be a valid and reliable instrument to assess the knowledge, practice and barriers towards the implementation of EBM among primary care physicians in Malaysia.

Poor control and management of type 2 diabetes mellitus at an under-resourced South African Hospital: is it a case of clinical inertia?

Evidence shows that even with the implementation of evidence-based medicine, the attainment of optimal glycaemic control is difficult and challenging for both patients and healthcare providers. This study was a one-year retrospective chart review with data collected during the period October 2010 to December 2010 of patients with Type 2 diabetes mellitus (T2DM) who attended the outpatients’ department at the Port Shepstone Regional Hospital (PSRH), South Africa (SA). The total study population was 360 patients with 51% Black African, 32% Indian, 16% White and 1% Coloured. Of the 111 patients’ charts only 78 had two consecutive HbA1c levels recorded. Of the 78/111 patients, only 10 patients had the target HbA1c level of &lt; 7% at visit 1. By visit two, 15.4% (n = 12) had achieved the target HbA1c level. Over the one-year chart review only 3/111 (2.7%) maintained their HbA1c level of &lt; 7% and 5/111 patients whose treatment was revised according to the 2009 SEMDSA guidelines reached HbA1c &lt; 7% by visit 2 whilst 4/111 patients, whose treatment schedule was not modified according to the 2009 SEMDSA guidelines, also reached HbA1c &lt; 7% at visit 2. However, this one-year chart review showed that glycaemia was poorly managed at this hospital, which may be explained by clinical inertia.&#x0D; &#x0D; (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)&#x0D; &#x0D; S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1307909

Effectiveness of the HuCare Quality Improvement Strategy on health-related quality of life in patients with cancer: study protocol of a stepped-wedge cluster randomised controlled trial (HuCare2 study)

IntroductionOur group previously demonstrated the feasibility of the HuCare Quality Improvement Strategy (HQIS), aimed at integrating into practice six psychosocial interventions recommended by international guidelines. This trial will assess whether...

Health care professionals\u2019 attitudes towards evidence-based medicine in the workers\u2019 compensation setting: a cohort study

BackgroundProblems may arise during the approval process of treatment after a compensable work injury, which include excess paperwork, delays in approving services, disputes, and allegations of over-servicing. This is perceived as undesirable for injured people, health care professionals and claims managers, and costly to the health care system, compensation system, workplaces and society. Introducing an Evidence Based Medicine (EBM) decision tool in the workers’ compensation system could provide a partial solution, by reducing uncertainty about effective treatment. The aim of this study was to investigate attitudes of health care professionals (HCP) to the potential implementation of an EBM tool in the workers’ compensation setting.MethodsThe study has a mixed methods design. The quantitative study consisted of an online questionnaire asking about self-reported knowledge, attitudes and behaviour to EBM in general. The qualitative study consisted of interviews about an EBM tool being applied in the workers’ compensation process. Participants were health care practitioners from different clinical specialties. They were recruited through the investigators’ clinical networks and the workers’ compensation government regulator’s website.ResultsParticipants completing the questionnaire (n = 231) indicated they were knowledgeable about the evidence-base in their field, but perceived some difficulties when applying EBM. General practitioners reported having the greatest obstacles to applying EBM. Participants who were interviewed (n = 15) perceived that an EBM tool in the workers’ compensation setting could potentially have some advantages, such as reducing inappropriate treatment, or over-servicing, and providing guidance for clinicians. However, participants expressed substantial concerns that the EBM tool would not adequately reflect the impact of psychosocial factors on recovery. They also highlighted a lack of timeliness in decision making and proper assessment, particularly in pain management.ConclusionsOverall, HCP are supportive of EBM, but have strong concerns about implementation of EBM based decision making in the workers’ compensation setting. The participants felt that an EBM tool should not be applied rigidly and should take into account clinical judgement and patient variability and preferences. In general, the treatment approval process in the workers’ compensation insurance system is a sensitive area, in which the interaction between HCP and claims managers can be improved.

Poor control and management of type 2 diabetes mellitus at an under-resourced South African Hospital: is it a case of clinical inertia?

Evidence shows that even with the implementation of evidence-based medicine, the attainment of optimal glycaemic control is difficult and challenging for both patients and healthcare providers. This study was a one-year retrospective chart review with data collected during the period October 2010 to December 2010 of patients with Type 2 diabetes mellitus (T2DM) who attended the outpatients’ department at the Port Shepstone Regional Hospital (PSRH), South Africa (SA). The total study population was 360 patients with 51% Black African, 32% Indian, 16% White and 1% Coloured. Of the 111 patients’ charts only 78 had two consecutive HbA1c levels recorded. Of the 78/111 patients, only 10 patients had the target HbA1c level of < 7% at visit 1. By visit two, 15.4% (n = 12) had achieved the target HbA1c level. Over the one-year chart review only 3/111 (2.7%) maintained their HbA1c level of < 7% and 5/111 patients whose treatment was revised according to the 2009 SEMDSA guidelines reached HbA1c < 7% by visit 2 whils...

The role and limitations of Cochrane reviews at the bedside: asystematic synopsis of five pediatric subspecialties.

Cochrane meta-analyses provide the physician at the bedside with the most relevant, up-to-date clinical information. However, implementation of evidence-based medicine (EBM) at the bedside may be difficult for avariety of reasons. The aim of this study was to assess relevant issues and obstacles related to implementing EBM in pediatrics in real life at the bedside/cotside. We performed five systematic literature reviews of all published Cochrane reviews in neonatology (1996-2010), pediatric neurology (1996-2010), pediatric gastroenterology (1993-2012), pediatric cardiology (2001-2015), and complementary and alternative medicine (1996-2012; CAM) in children and neonates. In all five analyses, the main outcome variables were percentage of reviews concluding that acertain intervention provides abenefit, percentage of reviews concluding that acertain intervention should not be performed, and percentage of studies concluding that the current level of evidence is inconclusive. In all five areas of pediatrics, asubstantial number of Cochrane reviews yielded inconclusive data (neonatology: 46.6%; neuropediatrics: 26.8%; pediatric gastroenterology: 27.9%; pediatric cardiology: 42.9%; complementary and alternative medicine: 66.9%). Our up-dated systematic synopsis reiterates the need for high-quality, sophisticated research to reduce the number of inconclusive meta-analyses in the field of pediatrics-most importantly in the field of complementary and alternative medicine (CAM), neonatology, and pediatric cardiology. The realization of high-quality, clinically driven research will in turn yield more systematic reviews with aclear conclusion (e. g., in favor or against acertain intervention, or treatment modality), thus, substantively decreasing the proportion of inconclusive reviews.

Evidence-based medicine: A survey among perioperative health care professionals in India.

Background and Aims:Evidence-based medicine (EBM) is defined as the use of scientifically proven evidence for delivering best possible health care to patients. Despite growing emphasis on the need for EBM-based practice, acceptability, and perceptions toward EBM might differ among health professionals. The objective of this study was to assess the attitude, knowledge, and current practices of EBM among perioperative care health professionals in India.Material and Methods:This was a single point paper-based questionnaire survey carried out in February 2014 among delegates registered for an EBM conference on “perioperative care” held at a Tertiary referral Cancer Centre in India. Participation was voluntary and respondents were given the option of remaining anonymous.Results:Out of 190 questionnaires, 123 (65%) were returned. Most respondents (98%) agreed that practicing EBM improved patient care. The need to follow departmental protocols (22%) worries about the cost of implementing new treatments (20%) and inadequate skills to critically appraise articles (16%) accounted for major barriers in implementing EBM in clinical practice, with only 15% of respondents stating reluctance to change set practice. “Randomized controlled trial” and “number needed to treat” were the best and least understood EBM terms. Regarding awareness of 10 commonly used EBM-based guidelines in perioperative medicine, the percentage of correct responses ranged from 20% to 88%.Conclusion:Although most respondents agreed that practicing EBM improved patient care, many of them showed a low level of awareness regarding fundamental aspects of EBM. In addition to encouraging implementation of EBM, there should be increased focus on training in EBM methods.