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3.
BMC Med Educ ; 21(1): 470, 2021 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-34481485

RESUMO

BACKGROUND: Evidence-based medicine (EBM) is the use of the current best evidence for patient care. Medical students should critically appraise the research evidence to help them during their clinical practice in the future. We conducted this study to assess the skills, terms and attitude toward EBM. METHOD: We conducted a cross-sectional study for medical students from governmental universities. Students completed an online validated questionnaire consisting of several sections to assess skills, attitude and knowledge about terms related to EBM. We used a scale ranging from 1(strongly disagree) to 5(strongly agree) for the 11 questions assessing the attitude and a scale ranging from 1(Poor) to 5(advanced) for EBM skills. RESULTS: A total of 761 medical students with a mean age of 21.97 ± 1.64 participated in the study. 327 (43 %) of them were males. The most commonly used search engines were Google 690 (91 %) and Wikipedia 465 (61 %). Medical books 719 (94 %) and lecture notes 353 (46 %) were the most common sources for health information. The majority of students rated their skills related to EBM as average and below average for all questions (overall = 2.18 ± 0.8). Students rated their skills as poor (31 %) in locating professional literature, as average (34 %) in searching online databases, poor (42 %) in critical appraisal of a scientific publication reporting findings from clinical research and poor (36 %) in Critical appraisal of available scientific literature. Regarding attitude, the overall mean score was 2.83 ± 0.76. There is no significant difference in attitude score between students with or without EBM training (P = 0.2). The terms with the highest understanding were case-control study (45 %) and case report (44 %) for study design. Median (44 %) and sample size (43 %) for statistics. Incidence (46 %) and prevalence (44 %) for epidemiology. CONCLUSIONS: Medical students have a knowledge gap in skills and terms related to EBM and an average attitude towards EBM. The majority of them were using a nonscientific search engine to obtain medical information. There is a need to educate students about the proper steps for getting the scientific literature and EBM skills.


Assuntos
Estudantes de Medicina , Estudos de Casos e Controles , Estudos Transversais , Medicina Baseada em Evidências , Humanos , Masculino , Sudão
4.
JNMA J Nepal Med Assoc ; 59(233): 94-97, 2021 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-34508463

RESUMO

The practice of medicine has started since the existence of humankind on the earth. But the commencement of scientific and evidence-based medicine cannot be traced back so far. The insight we are getting from the current medical science is the output of the laborious effort and contributions made by people before us. The statement stating 'we learn from our past' is in perfect resonant with the practice of clinical medicine. Those past experiences or findings which are scientifically cataloged are crucial in the advancement of modern medicine. The countless researches conducted in various aspects of medical science prove to be strong evidence of our past achievements. Many people's contribution to such research activities in the medical field has taken us this far in modern medicine. In the pool of such people, medical students who are in the early phase of pursuing their career in medicine have also contributed a lot to medical research time and again.


Assuntos
Pesquisa Biomédica , Estudantes de Medicina , Medicina Baseada em Evidências , Humanos
5.
BMJ Open ; 11(9): e051611, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493523

RESUMO

INTRODUCTION: Various evidence-based interventions are available to improve the care of people with dementia in different care settings, many of which are not or are only partially implemented in routine care. Different implementation strategies have been developed to support the implementation of interventions in routine care; however, the implementation of complex interventions remains challenging. The aim of our reviews is to identify promising strategies for, significant facilitators of and barriers to the implementation of evidence-based interventions for very common dementia care phenomena: (A) behaviour that challenges supporting a person with dementia in long-term care, (B) delirium in acute care and (C) the postacute care needs of people with dementia. METHODS AND ANALYSIS: We will conduct one scoping review for each preselected dementia care phenomenon (A, B and C). For this, three literature searches will be carried out in the following electronic databases: MEDLINE (via PubMed), CINAHL (via EBSCO) and PsycINFO (via EBSCO). Additionally, we will perform backward and forward citation tracking via reference lists and Google Scholar. Identified records will be independently screened by two reviewers (title/abstract and full text) using the defined inclusion criteria. We will include all study designs and publications in the German or English language. For the data analyses, we will conduct a deductive content analysis using two different analytical approaches: Expert Recommendations for Implementation Change and the Consolidated Framework for Implementation Research. ETHICS AND DISSEMINATION: Due to the nature of a review, ethical clearing is not required. We will disseminate our results in peer-reviewed journals, workshops with stakeholders, and (inter)national conferences.


Assuntos
Atenção à Saúde , Demência , Demência/terapia , Medicina Baseada em Evidências , Humanos , Assistência de Longa Duração , Projetos de Pesquisa , Literatura de Revisão como Assunto
6.
BMC Med Educ ; 21(1): 492, 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521409

RESUMO

BACKGROUND: Evidence-based medicine (EBM) is a core skillset for enhancing the quality and safety of patients' care. Online EBM education could improve clinicians' skills in EBM, particularly when it is conducted during vocational training. There are limited studies on the impact of online EBM training on clinical practice among general practitioner (GP) registrars (trainees in specialist general practice). We aimed to describe and evaluate the acceptability, utility, satisfaction and applicability of the GP registrars experience with the online course. The course was developed by content-matter experts with educational designers to encompass effective teaching methods (e.g. it was interactive and used multiple teaching methods). METHODS: Mixed-method data collection was conducted after individual registrars' completion of the course. The course comprised six modules that aimed to increase knowledge of research methods and application of EBM skills to everyday practice. GP registrars who completed the online course during 2016-2020 were invited to complete an online survey about their experience and satisfaction with the course. Those who completed the course within the six months prior to data collection were invited to participate in semi-structured phone interviews about their experience with the course and the impact of the course on clinical practice. A thematic analysis approach was used to analyse the data from qualitative interviews. RESULTS: The data showed the registrars were generally positive towards the course and the concept of EBM. They stated that the course improved their confidence, knowledge, and skills and consequently impacted their practice. The students perceived the course increased their understanding of EBM with a Cohen's d of 1.6. Registrars identified factors that influenced the impact of the course. Of those, some were GP-related including their perception of EBM, and being comfortable with what they already learnt; some were work-place related such as time, the influence of supervisors, access to resources; and one was related to patient preferences. CONCLUSIONS: This study showed that GP registrars who attended the online course reported that it improved their knowledge, confidence, skill and practice of EBM over the period of three months. The study highlights the supervisor's role on GP registrars' ability in translating the EBM skills learnt in to practice and suggests exploring the effect of EBM training for supervisors.


Assuntos
Medicina Geral , Medicina Baseada em Evidências , Medicina de Família e Comunidade , Humanos , Médicos de Família , Inquéritos e Questionários
7.
BMC Med Educ ; 21(1): 437, 2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34407804

RESUMO

BACKGROUND: Global and national undergraduate medical education accreditation organizations recommend the inclusion of Evidence-Based Medicine (EBM) instructions into the medical schools' curricula. Accordingly, some Turkish medical schools have individually developed and implemented EBM training programs, but there is no data of current programs' effectiveness and students' learning achievements due to the lack of a validated Turkish language EBM assessment tool. This study evaluates the effect of a newly introduced formal EBM instruction to the curriculum on students' knowledge and skills by using the recently published Turkish adaptation of the Fresno Test. METHODS: The study is an experimental investigation using pre- and post-test evaluations. A five-week EBM course was developed according to Kern's six-step curriculum development approach. A total of 78 students from the third (n = 30), fourth (n = 19) and fifth (n = 29) year of medical school voluntarily consented and were enrolled into the course. Overall, the Cerrahpasa Medical Faculty had a total of 555, 461, and 400 students enrolled in the third, fourth, and fifth year, respectively. The program has been evaluated based on students' learning achievements and survey responses. RESULTS: The students' mean pre-test Fresno Test score improved from 49.9 ± 18.2 to 118.9 ± 26.3 post-training. The Cohen's effect size was 3.04 (95% CI, 2.6-3.5). The overall students' satisfaction score was 8.66 ± 1.09 on a 1 to 10 scale. CONCLUSIONS: The program was effective in improving students' knowledge and skills on EBM. We propose to offer the program as an elective course during the third year of the medical school curriculum based on all data obtained during the program evaluation.


Assuntos
Educação de Graduação em Medicina , Estudantes de Medicina , Currículo , Avaliação Educacional , Medicina Baseada em Evidências/educação , Humanos , Idioma
9.
Transfus Apher Sci ; 60(4): 103207, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34353706

RESUMO

Blood transfusions come with risks and high costs, and should be utilized only when clinically indicated. Decisions to transfuse are however not always well informed, and lack of clinician knowledge and education on good clinical transfusion practices contribute to the inappropriate use of blood. Low and middle-income countries in particular take much strain in their efforts to address blood safety challenges, demand-supply imbalances, high blood costs as well as high disease burdens, all of which impact blood usage and blood collections. Patient blood management (PBM), which is a patient-focused approach aimed at improving patient outcomes by preemptively diagnosing and correcting anaemia and limiting blood loss by cell salvage, coagulation optimization and other measures, has become a major approach to addressing many of the challenges mentioned. The associated decrease in the use of blood and blood products may be perceived as being in competition with blood conservation measures, which is the more traditional, but primarily product-focused approach. In this article, we hope to convey the message that PBM and blood conservation should not be seen as competing concepts, but rather complimentary strategies with the common goal of improving patient care. This offers opportunity to improve the culture of transfusion practices with relief to blood establishments and clinical services, not only in South Africa and LMICs, but everywhere. With the COVID-19 pandemic impacting blood supplies worldwide, this is an ideal time to call for educational interventions and awareness as an active strategy to improve transfusion practices, immediately and beyond.


Assuntos
Bancos de Sangue/organização & administração , Transfusão de Sangue , Procedimentos Médicos e Cirúrgicos sem Sangue , Anemia/terapia , Bancos de Sangue/economia , Perda Sanguínea Cirúrgica , Segurança do Sangue , Transfusão de Sangue/economia , Infecções Transmitidas por Sangue/prevenção & controle , Procedimentos Médicos e Cirúrgicos sem Sangue/economia , COVID-19 , Tomada de Decisão Clínica , Países em Desenvolvimento , Seleção do Doador/economia , Medicina Baseada em Evidências , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pandemias , Hemorragia Pós-Parto/terapia , Guias de Prática Clínica como Assunto , Gravidez , Prevalência , Utilização de Procedimentos e Técnicas , SARS-CoV-2 , África do Sul/epidemiologia , Medicina Transfusional/educação
11.
BMC Med Inform Decis Mak ; 21(1): 240, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372841

RESUMO

BACKGROUND: A clinical librarian is a member of the medical team in many countries. To strengthen this new job, librarians need to acquire professional skills in order to provide information services to medical staff. In this study, we aimed to explor the skills required for the presence of a clinical librarian in the treatment team. METHODS: In this study, we sonducted a qualitative study in which 15 experienced librarians were interviewed in connection with information services. Also, a treatment team was involved in this study using purposive-convenience and snowball sampling methods. The data collection tool was a semi-structured interview that continued until the data was saturated; finally the data analysis was performed using thematic analysis. RESULTS: Out of the total interviews, 158 primary codes and, 107 main codes were extracted in 25 subclasses. After careful evaluation and integration of subclasses and classes, they were finally classified into 13 categories and four main themes, namely clinical librarian's role, professional and specialized skills, communication skills, and training programs. CONCLUSION: The results showed that specialized skills and training programs for the clinical librarian are defined based on his/her duties in the treatment team. We also defined the most important key skills for the clinical librarian in two categories of professional and communication skills such as specialized information search, content production, resource management, familiarity with various sources related to evidence-based medicine, teamwork, and effective communication. To acquire these skills, officials and policy-makers should develop and implement related educational programs at medical universities and colleges.


Assuntos
Bibliotecários , Coleta de Dados , Medicina Baseada em Evidências , Feminino , Humanos , Serviços de Informação , Masculino
12.
Pediatr Emerg Med Pract ; 18(Suppl 8): 1-39, 2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-34423962

RESUMO

Trauma is the leading cause of death in the pediatric population and is among the most common reasons for ED visits by children. Imaging is an important tool for the diagnosis and management of pediatric trauma, but there are risks associated with exposure to ionizing radiation. In pediatric head and neck injuries, clinical findings and clinical decision tools can help inform selection of the most appropriate imaging modalities for the trauma patient, while also reducing unnecessary radiation exposure. This supplement reviews evidence-based recommendations for imaging decisions and interpretations in skull fractures, traumatic brain injuries, abusive head trauma, cervical spine injuries, and facial bone fractures. Examples demonstrating imaging modalities and specific findings for the types of injuries are also provided.


Assuntos
Regras de Decisão Clínica , Traumatismos Craniocerebrais/diagnóstico por imagem , Lesões do Pescoço/diagnóstico por imagem , Variação Anatômica , Criança , Maus-Tratos Infantis , Traumatismos Craniocerebrais/complicações , Medicina Baseada em Evidências , Humanos , Lesões do Pescoço/complicações , Exposição à Radiação
14.
Artif Intell Med ; 118: 102098, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34412851

RESUMO

In the latest years, the healthcare domain has seen an increasing interest in the definition of intelligent systems to support clinicians in their everyday tasks and activities. Among others, also the field of Evidence-Based Medicine is impacted by this twist, with the aim to combine the reasoning frameworks proposed thus far in the field with mining algorithms to extract structured information from clinical trials, clinical guidelines, and Electronic Health Records. In this paper, we go beyond the state of the art by proposing a new end-to-end pipeline to address argumentative outcome analysis on clinical trials. More precisely, our pipeline is composed of (i) an Argument Mining module to extract and classify argumentative components (i.e., evidence and claims of the trial) and their relations (i.e., support, attack), and (ii) an outcome analysis module to identify and classify the effects (i.e., improved, increased, decreased, no difference, no occurrence) of an intervention on the outcome of the trial, based on PICO elements. We annotated a dataset composed of more than 500 abstracts of Randomized Controlled Trials (RCT) from the MEDLINE database, leading to a labeled dataset with 4198 argument components, 2601 argument relations, and 3351 outcomes on five different diseases (i.e., neoplasm, glaucoma, hepatitis, diabetes, hypertension). We experiment with deep bidirectional transformers in combination with different neural architectures (i.e., LSTM, GRU and CRF) and obtain a macro F1-score of.87 for component detection and.68 for relation prediction, outperforming current state-of-the-art end-to-end Argument Mining systems, and a macro F1-score of.80 for outcome classification.


Assuntos
Registros Eletrônicos de Saúde , Idioma , Algoritmos , Bases de Dados Factuais , Medicina Baseada em Evidências , Processamento de Linguagem Natural
15.
Blood Adv ; 5(15): 3032-3046, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34374748

RESUMO

BACKGROUND: Venous thromboembolism (VTE) is a common disease in Latin American settings. Implementing international guidelinn Aes in Latimerican settings requires additional considerations. OBJECTIVE: The purpose of our study was to provide evidence-based guidelines about managing VTE for Latin American patients, clinicians, and decision makers. METHODS: We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE)-ADOLOPMENT method to adapt recommendations from 2 American Society of Hematology (ASH) VTE guidelines (Treatment of VTE and Anticoagulation Therapy). ASH and local hematology societies formed a guideline panel comprised of medical professionals from 10 countries in Latin America. Panelists prioritized 18 questions relevant for the Latin American context. A knowledge synthesis team updated evidence reviews of health effects conducted for the original ASH guidelines and summarized information about factors specific to the Latin American context (ie, values and preferences, resources, accessibility, feasibility, and impact on health equity). RESULTS: The panel agreed on 17 recommendations. Compared with the original guideline, 4 recommendations changed direction and 1 changed strength. CONCLUSIONS: This guideline adolopment project highlighted the importance of contextualization of recommendations suggested by the changes to the original recommendations. The panel also identified 2 implementation priorities for the region: expanding the availability of home treatment and increasing the availability of direct oral anticoagulants (DOACs). The guideline panel made a conditional recommendation in favor of home treatment for individuals with deep venous thrombosis and a conditional recommendation for either home or hospital treatment for individuals with pulmonary embolism. In addition, a conditional recommendation was made in favor of DOACs over vitamin K antagonists for several populations.


Assuntos
Embolia Pulmonar , Tromboembolia Venosa , Anticoagulantes/uso terapêutico , Medicina Baseada em Evidências , Humanos , América Latina/epidemiologia , Embolia Pulmonar/tratamento farmacológico , Tromboembolia Venosa/tratamento farmacológico
16.
Blood Adv ; 5(15): 3047-3052, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34374749

RESUMO

BACKGROUND: From 2017 to 2020, the American Society of Hematology (ASH) collaborated with 12 hematology societies in Latin America to adapt the ASH guidelines on venous thromboembolism (VTE). OBJECTIVE: To describe the methods used to adapt the ASH guidelines on venous thromboembolism. METHODS: Each society nominated 1 individual to serve on the guideline panel. The work of the panel was facilitated by the 2 methodologists. The methods team selected 4 of the original VTE guidelines for a first round. To select the most relevant questions, a 2-step prioritization process was conducted through an on-line survey and then through in-person discussion. During an in-person meeting in Rio de Janeiro, Brazil, from 23 April through 26 April 2018, the panel developed recommendations using the ADOLOPMENT approach. Evidence about health effects from the original guidelines was reused, but important data about resource use, accessibility, feasibility, and impact in health equity were added. RESULTS: In the guideline accompanying this paper, Latin American panelists selected 17 questions from an original pool of 49. Of the 17 questions addressed, substantial changes were introduced for 5 recommendations, and remarks were added or modified for 12 recommendations. CONCLUSIONS: By using the evidence from an international guideline, a significant amount of work and time were saved; by adding regional evidence, the final recommendations were tailored to the Latin American context. This experience offers an alternative to develop guidelines relevant to local contexts through a global collaboration.


Assuntos
Hematologia , Tromboembolia Venosa , Brasil , Medicina Baseada em Evidências , Humanos , América Latina/epidemiologia , Tromboembolia Venosa/tratamento farmacológico
17.
BJS Open ; 5(4)2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34355242

RESUMO

BACKGROUND: Coronavirus (COVID-19) forced surgical evolution worldwide. The extent to which national evidence-based recommendations, produced by the current authors early in 2020, remain valid, is unclear. To inform global surgical management and a model for rapid clinical change, this study aimed to characterize surgical evolution following COVID-19 through a multifaceted systematic review. METHODS: Rapid reviews were conducted targeting intraoperative safety, personal protective equipment and triage, alongside a conventional systematic review identifying evidence-based guidance for surgical management. Targeted searches of PubMed and Embase from 31 December 2019 were repeated weekly until 7 August 2020, and systematic searches repeated monthly until 30 June 2020. Literature was stratified using Evans' hierarchy of evidence. Narrative data were analysed for consistency with earlier recommendations. The systematic review rated quality using the AGREE II and AMSTAR tools, was registered with PROSPERO, CRD42020205845. Meta-analysis was not conducted. RESULTS: From 174 targeted searches and six systematic searches, 1256 studies were identified for the rapid reviews and 21 for the conventional systematic review. Of studies within the rapid reviews, 903 (71.9 per cent) had lower-quality design, with 402 (32.0 per cent) being opinion-based. Quality of studies in the systematic review ranged from low to moderate. Consistency with recommendations made previously by the present authors was observed despite 1017 relevant subsequent publications. CONCLUSION: The evidence-based recommendations produced early in 2020 remained valid despite many subsequent publications. Weaker studies predominated and few guidelines were evidence-based. Extracted clinical solutions were globally implementable. An evidence-based model for rapid clinical change is provided that may benefit surgical management during this pandemic and future times of urgency.


Assuntos
COVID-19/epidemiologia , Procedimentos Cirúrgicos Operatórios/métodos , Medicina Baseada em Evidências , Humanos , Inovação Organizacional , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/normas
18.
Nutrients ; 13(7)2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34371932

RESUMO

BACKGROUND: There are numerous guidelines developed for bone health. Yet, it is unclear whether the differences in guideline development methods explain the variability in the recommendations for vitamin D and calcium intake. The objective of this systematic review was to collate and compare recommendations for vitamin D and calcium across bone health guidelines, assess the methods used to form the recommendations, and explore which methodological factors were associated with these guideline recommendations. METHODS: We searched MEDLINE, EMBASE, CINAHL, and other databases indexing guidelines to identify records in English between 2009 and 2019. Guidelines or policy statements on bone health or osteoporosis prevention for generally healthy adults aged ≥40 years were eligible for inclusion. Two reviewers independently extracted recommendations on daily vitamin D and calcium intake, supplement use, serum 25 hydroxyvitamin D [25(OH)D] level, and sunlight exposure; assessed guideline development methods against 25 recommended criteria in the World Health Organization (WHO) handbook for guideline development; and, identified types identified types of evidence underpinning the recommendations. RESULTS: we included 47 eligible guidelines from 733 records: 74% of the guidelines provided vitamin D (200~600-4000 IU/day) and 70% provided calcium (600-1200 mg/day) recommendations, 96% and 88% recommended vitamin D and calcium supplements, respectively, and 70% recommended a specific 25(OH)D concentration. On average, each guideline met 10 (95% CI: 9-12) of the total of 25 methodological criteria for guideline development recommended by the WHO Handbook. There was uncertainty in the association between the methodological criteria and the proportion of guidelines that provided recommendations on daily vitamin D or calcium. Various types of evidence, including previous bone guidelines, nutrient reference reports, systematic reviews, observational studies, and perspectives/editorials were used to underpin the recommendations. CONCLUSIONS: There is considerable variability in vitamin D and calcium recommendations and in guideline development methods in bone health guidelines. Effort is required to strengthen the methodological rigor of guideline development and utilize the best available evidence to underpin nutrition recommendations in evidence-based guidelines on bone health.


Assuntos
Remodelação Óssea/efeitos dos fármacos , Osso e Ossos/efeitos dos fármacos , Cálcio/administração & dosagem , Suplementos Nutricionais , Guias de Prática Clínica como Assunto/normas , Recomendações Nutricionais , Vitamina D/administração & dosagem , Adulto , Osso e Ossos/fisiopatologia , Cálcio/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Medicina Baseada em Evidências/normas , Feminino , Nível de Saúde , Disparidades em Assistência à Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Osteoporose/fisiopatologia , Osteoporose/prevenção & controle , Vitamina D/efeitos adversos
20.
J Orthop Sports Phys Ther ; 51(8): 380-381, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34338004

RESUMO

Work rehabilitation refers to the process of assisting workers to remain at work or return to work (RTW) in a safe and productive manner, while limiting the negative impact of work restriction, unemployment, and work disability. The clinical practice guideline (CPG) published in the August 2021 issue of JOSPT provides guidance for physical therapy clinicians when evaluating, treating, and managing individuals who experience limitations in the ability to participate in work following injury or illness. J Orthop Sports Phys Ther 2021;51(8):380-381. doi:10.2519/jospt.2021.0505.


Assuntos
Medicina Baseada em Evidências , Doenças Profissionais/terapia , Saúde do Trabalhador , Traumatismos Ocupacionais/terapia , Modalidades de Fisioterapia , Retorno ao Trabalho , Humanos , Guias de Prática Clínica como Assunto , Fatores de Risco
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