Controlled before-after study to evaluate change in evidence-based practice of speech and language therapy students.

BACKGROUND: The integration of evidence-based practice (EBP) into speech and language therapy (SLT) curricula has been increasingly encouraged in recent years. OBJECTIVES: The study aimed to evaluate whether an educational module on EBP for undergraduate SLT students can improve their EBP competencies. METHODS: The EBP module, taught by a SLT faculty member and a librarian, was delivered over 2 months. All fourth year SLT students (trained group) and all fourth year psychology students (control group) of the University of Liège (Belgium) were asked to participate in the study. Their performance on an adapted Fresno test was measured before and after the module. In addition, the SLT students took a computer-based searching task. They were also asked to share their perceptions towards the module. RESULTS: All the 47 SLT students and 57/108 psychology students took the pre- and post-tests. Although both groups performed similarly at the baseline, only the trained students gained new skills and knowledge. Furthermore, 36 SLT students shared their perceptions on the module and offered suggestions on ways to improve it. DISCUSSION-CONCLUSION: Trained students improved their EBP competencies. Nevertheless, the module could be strengthened along with better integration of EBP into clinical modules and across the curriculum.

Are blind injections of gleno-humeral joint (GHJ) really less accurate imaging-guided injections? A narrative systematic review considering multiple anatomical approaches.

AIM: To perform a systematic review to establish whether blind injections of the gleno-humeral (GHJ) joint may be an accurate alternative to injections performed imaging guidance, considering multiple anatomical approaches. MATERIALS AND METHODS: Our search strategy yielded 478 articles for Scopus, 815 articles for MEDLINE, 128 articles for Cochrane Central Register of Controlled Trials and 555 articles for Embase until May 2016. One hundred and sixty-seven abstracts were retrieved after duplicates removal. Two readers independently reviewed all the 1067 abstracts. They selected for the full-text analysis only the abstracts in which the accuracy of intra-articular position of the needle was confirmed on imaging (humans) or by a surgical dissection (cadavers). Thirty-eight studies were eventually selected for the full-text reading and data extraction. The selected studies included a total of 2309 patients (2690 shoulders) and 195 cadavers (299 shoulders). To objectively assess the methodological quality of the present systematic review, "Assessment of Multiple Systematic Review" (AMSTAR) tool was used. RESULTS: The overall accuracy of the intra-articular injection in GHJ varied from 42 to 100% in the 38 selected studies. Imaging guidance was used in 65% of articles and the overall accuracy of guided GHJ injections was higher than blind injection. However, five articles in which blind injection the GHJ was used (159 shoulders) reported accuracy as high as 100%. CONCLUSION: A comprehensive review of the literature confirms that guided injections of the GHJ have overall accuracy higher compared to blind injection. Nevertheless, in some studies, including a relatively large number of shoulders, blind injections have been proven to be 100% accurate. Hence, blind injections of GHJ could be proposed a cost-effective alternative to imaging-guided injection. A large prospective randomized study is needed to gauge this hypothesis and compare the cost-effectiveness of these two techniques for the most common anatomical approaches.

Information behaviour of French-speaking speech-language therapists in Belgium: results of a questionnaire survey.

BACKGROUND: Speech-language therapists (SLTs) are encouraged to implement evidence-based practice (EBP). Nevertheless, EBP use by practitioners can be questioned. OBJECTIVES: The objective of this study was to explore Belgian French-speaking SLTs' information behaviour and their awareness of EBP. The collected data allow one to determine how far they have embraced this approach. METHODS: The two Belgian French-speaking SLT professional associations promoted an online questionnaire survey by email. Additionally, clinical supervisors of students were asked to participate. In March 2012, 2068 emails were sent. RESULTS: The participation rate was at least 20% (n = 415). The reported information needs mainly concerned treatment or diagnosis. Most of the time, to attempt to fulfil their information needs, SLTs relied on their own resources (personal experience and libraries) and on colleagues in the workplace. When they searched on the Internet, they preferred to use a general search engine rather than a specialised bibliographic database. Barriers to obtaining scientific information are highlighted. Only 12% of the respondents had already heard about EBP. CONCLUSION: This study provides the first overview of the information behaviour of SLTs working in the French community of Belgium. Several recommendations are suggested for SLTs and librarians.

Systematic qualitative review of randomised trials conducted in nonsmall cell lung cancer with a noninferiority or equivalence design.

The use of noninferiority randomised trials for patients with advanced non-small cell lung cancer has emerged during the past 10-15 years but has raised some issues related to their justification and methodology. The present systematic review aimed to assess trial characteristics and methodological aspects. All randomised clinical trials with a hypothesis of noninferiority/equivalence, published in English, were identified. Several readers extracted a priori defined methodological information. A qualitative analysis was then performed. We identified 20 randomised clinical trials (three phase II and 17 phase III), 11 of them being conducted in strong collaboration with industry. We highlighted some deficiencies in the reports like the lack of justification for both the noninferiority assumption and the definition of the noninferiority margin, as well as inconsistencies between the results and the authors' conclusions. CONSORT guidelines were better followed for general items than for specific items (p<0.001). Improvement in the reporting of the meth"odology of noninferiority/equivalence trials is needed to avoid misleading interpretation and to allow readers to be fully aware of the assumptions underlying the trial designs. They should be restricted to limited specific situations with a strong justification why a noninferiority hypothesis is acceptable.

Health Outcomes of Sarcopenia: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this study was to perform a systematic review to assess the short-, middle- and long-term consequences of sarcopenia. METHODS: Prospective studies assessing the consequences of sarcopenia were searched across different electronic databases (MEDLINE, EMBASE, EBM Reviews, Cochrane Database of Systematic Reviews, EBM Reviews ACP Journal Club, EBM Reviews DARE and AMED). Only studies that used the definition of the European Working Group on Sarcopenia in Older People to diagnose sarcopenia were included. Study selection and data extraction were performed by two independent reviewers. For outcomes reported by three or more studies, a meta-analysis was performed. The study results are expressed as odds ratios (OR) with 95% CI. RESULTS: Of the 772 references identified through the database search, 17 were included in this systematic review. The number of participants in the included studies ranged from 99 to 6658, and the duration of follow-up varied from 3 months to 9.8 years. Eleven out of 12 studies assessed the impact of sarcopenia on mortality. The results showed a higher rate of mortality among sarcopenic subjects (pooled OR of 3.596 (95% CI 2.96-4.37)). The effect was higher in people aged 79 years or older compared with younger subjects (p = 0.02). Sarcopenia is also associated with functional decline (pooled OR of 6 studies 3.03 (95% CI 1.80-5.12)), a higher rate of falls (2/2 studies found a significant association) and a higher incidence of hospitalizations (1/1 study). The impact of sarcopenia on the incidence of fractures and the length of hospital stay was less clear (only 1/2 studies showed an association for both outcomes). CONCLUSION: Sarcopenia is associated with several harmful outcomes, making this geriatric syndrome a real public health burden.

Organising access to Evidence-Based Medicine resources on the Web.

The continuing education is a challenge for health care professionals, considering the growing amount and variable quality of information in this field. In this context, we developed a method allowing clinicians to have a centralised access to the best current medical evidence supporting medical decision-making. Relevant data has been gathered according to the rules stated for Evidence-Based Medicine (EBM) and organised in a free-of-charge Web site, created by using common software applications. The general aim of our study was to encourage individual practice of EBM by providing tutorials as well as a selection of free access tools for searching medical information on the Web. In addition to the education part, we provided clinicians, through a Web interface, with up-to-date, accurate and quality data obtained from heterogeneous sources and presented in a full text format when available. The developed methodology has been applied to human prostate cancer. URL address: http://www.ebm.lib.ulg.ac.be/prostate/index.htm.