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1.
Surg Clin North Am ; 101(4): 667-677, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242608

RESUMO

Residency programs should use a systematic method of recruitment that begins with defining unique desired candidate attributes. Commonly sought-after characteristics may be delineated via the residency application. Scores from standardized examinations taken in medical school predict academic success, and may correlate to overall performance. Strong letters of recommendation and a personal history of prior success outside the medical field both forecast success in residency. Interviews are crucial to determining fit within a program, and remain a valid measure of an applicant's ability to prosper in a particular program, even with many interviews being completed in the virtual realm.


Assuntos
Cirurgia Geral/educação , Internato e Residência/organização & administração , Critérios de Admissão Escolar , Prática Clínica Baseada em Evidências , Humanos , Entrevistas como Assunto , Personalidade , Habilidades Sociais , Estudantes de Medicina/psicologia , Estados Unidos
3.
Artigo em Inglês | PAHO-IRIS | ID: phr-54415

RESUMO

[ABSTRACT]. The Health Sciences Descriptors (DeCS) vocabulary establishes a unique and common language that allows the organization and facilitates the search and retrieval of technical and scientific literature on health avail-able in the information sources of the Virtual Health Library. The DeCS, created by the Latin American and Caribbean Center on Health Sciences Information (BIREME), a specialized center of the Pan American Health Organization/World Health Organization (PAHO/WHO), is the translation and extension of the Medical Subject Headings (MeSH) vocabulary, maintained by the United States National Library of Medicine. BIREME, in coor-dination with experts from Latin America and the Caribbean, has included in the DeCS the topics of equity, gender, ethnicity and human rights—cross-cutting themes in the programmatic framework of PAHO/WHO technical cooperation—to ensure better retrieval and use of scientific information and evidence related to these topics. The objective of this article is to describe the methodology used during the terminology review of the DeCS and to report the results obtained and the impacts of the terminology expansion in the field of equity, which included the inclusion of 35 new descriptors.


[RESUMEN]. El vocabulario Descriptores en Ciencias de la Salud (DeCS) establece un lenguaje único y común que permite la organización y facilita la búsqueda y recuperación de la literatura técnica y científica en salud disponible en las fuentes de información de la Biblioteca Virtual en Salud. El DeCS, creado por el Centro Latinoamericano y del Caribe de Información en Ciencias de la Salud (BIREME), un centro especializado de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS), es la traducción y la extensión del vocabulario Medical Subject Headings (MeSH), mantenido por la National Library of Medicine de los Estados Unidos. BIREME, en coordinación con expertos de América Latina y el Caribe, ha incluido en el DeCS los temas de equidad, género, etnicidad y derechos humanos —temas transversales en el marco programático de la cooperación técnica de la OPS/OMS— para garantizar una mejor recuperación y uso de la información y evidencia científica relacionadas a estos temas. El objetivo de este artículo es describir el método de revisión terminológica del DeCS e informar los resultados obtenidos y los impactos de la ampliación terminológica en el área de equidad, que comprendió la inclusión de 35 nuevos descriptores.


Assuntos
Equidade , Sistemas de Informação , Medical Subject Headings , Prática Clínica Baseada em Evidências , Acesso à Informação , Equidade , Sistemas de Informação , Prática Clínica Baseada em Evidências , Acesso à Informação
4.
N Z Med J ; 134(1536): 12-24, 2021 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-34140710

RESUMO

The last decade (2010-2019) has seen calls to action to improve the prescribing practice of junior doctors. An in-depth investigation into the causes of prescribing errors by foundation trainees in relation to their medical education (the EQUIP study) in the UK reported a prescription error rate of 8.9% for all prescribed medicines, and although that is a UK study, there are similarities with New Zealand prevocational training programmes. The EQUIP study revealed that existing teaching strategies are not working. To believe a single intervention will prevent most prescribing errors is simplistic, and for improvement to occur, new prescribers need to learn from their mistakes. Traditionally, the education of junior doctors has focused on their competence and professional registration requirements. Working in healthcare is collective and multidisciplinary, and errors occur through human and system factors.


Assuntos
Relações Interprofissionais , Corpo Clínico Hospitalar , Padrões de Prática Médica , Prescrições de Medicamentos/estatística & dados numéricos , Prática Clínica Baseada em Evidências , Humanos , Corpo Clínico Hospitalar/educação , Corpo Clínico Hospitalar/normas , Erros de Medicação/prevenção & controle , Erros de Medicação/estatística & dados numéricos , Nova Zelândia
7.
J Orthop Sports Phys Ther ; 51(6): 314-315, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34058836

RESUMO

This article describes the differences between common analyses for randomized controlled trials (RCTs). Intention-to-treat (ITT) and per-protocol (PP) analyses are common approaches, but readers may also encounter complier average causal effects (CACE) analysis, a newer method that is gaining popularity. Because these analyses answer slightly different research questions, the aim of this article is to help readers of RCTs understand why researchers conduct these different types of analyses and how to interpret the findings. J Orthop Sports Phys Ther 2021;51(6):314-315. doi:10.2519/jospt.2021.0701.


Assuntos
Prática Clínica Baseada em Evidências , Análise de Intenção de Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Humanos
8.
Syst Rev ; 10(1): 189, 2021 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-34174962

RESUMO

BACKGROUND: Healthcare and human services increasingly rely on teams of individuals to deliver services. Implementation of evidence-based practices and other innovations in these settings requires teams to work together to change processes and behaviors. Accordingly, team functioning may be a key determinant of implementation outcomes. This systematic review will identify and summarize empirical research examining associations between team functioning and implementation outcomes in healthcare and human service settings. METHODS: We will conduct a comprehensive search of bibliographic databases (e.g., MEDLINE, PsycINFO, CINAHL, ERIC) for articles published from January 2000 or later. We will include peer-reviewed empirical articles and conference abstracts using quantitative, qualitative, or mixed methods. We will include experimental or observational studies that report on the implementation of an innovation in a healthcare or human service setting and examine associations between team functioning and implementation outcomes. Implementation outcomes of interest are acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. Two reviewers will independently screen all titles/abstracts, review full-text articles, and extract data from included articles. We will use the Mixed Methods Appraisal Tool to assess methodological quality/bias and conduct a narrative synthesis without meta-analysis. DISCUSSION: Understanding how team functioning influences implementation outcomes will contribute to our understanding of team-level barriers and facilitators of change. The results of this systematic review will inform efforts to implement evidence-based practices in team-based service settings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020220168.


Assuntos
Atenção à Saúde , Instalações de Saúde , Prática Clínica Baseada em Evidências , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
9.
BMC Public Health ; 21(1): 1116, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112141

RESUMO

BACKGROUND: Youth suicide prevention in high-schools and universities is a public health priority. Our aim was to propose a research agenda to advance evidence-based suicide prevention in high-schools and universities by synthesizing and critically reviewing the research focus and methodologies used in existing intervention studies. METHODS: Fourteen databases were systematically searched to identify studies which evaluate suicide prevention interventions delivered on high-school or university campuses, with before and after measures. Data from included studies (n = 43) were extracted to identify what, where, how and for whom interventions have been tested. Narrative synthesis was used to critically evaluate research focus and methodology. Study quality was assessed. RESULTS: Research has focused primarily on selective interventions, with less attention on indicated and universal interventions. Most evidence comes from North America and high-income countries. The target of interventions has been: non-fatal suicidal behaviour; confidence and ability of staff/students to intervene in a suicidal crisis; suicide-related knowledge and attitudes; and suicide-related stigma. No studies included suicide deaths as an outcome, evaluated eco-systemic interventions, explored how context influences implementation, used multisite study designs, or focused explicitly on LGBTQ+ youth. Two studies evaluated digital interventions. Quality of the majority of studies was compromised by lack of methodological rigour, small samples, and moderate/high risk of bias. Interventions often assume the existence of an external well-functioning referral pathway, which may not be true in low-resource settings. CONCLUSION: To advance evidence-based suicide prevention in educational settings we need to: conduct more high-quality clinical and pragmatic trials; promote research in low- and middle-income countries; test targeted interventions for vulnerable populations (like LGBTQ+ youth), evaluate interventions where death by suicide is the primary outcome; include translational studies and use implementation science to promote intervention uptake; evaluate the potential use of digital and eco-systemic interventions; and conduct multisite studies in diverse cultural settings.


Assuntos
Suicídio , Universidades , Adolescente , Prática Clínica Baseada em Evidências , Humanos , América do Norte , Instituições Acadêmicas , Suicídio/prevenção & controle
12.
Hist Philos Life Sci ; 43(2): 66, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: covidwho-1210756

RESUMO

The COVID-19 pandemic poses extraordinary public health challenges. In order to respond to such challenges, most democracies have relied on so-called 'evidence-based' policies, which supposedly devolve to science the burden of their justification. However, the biomedical sciences can only provide a theory-laden evidential basis, while reliable statistical data for policy support is often scarce. Therefore, scientific evidence alone cannot legitimise COVID-19 public health policies, which are ultimately based on political decisions. Given this inevitable input on policy-making, the risk of arbitrariness is ubiquitous and democratic scrutiny becomes essential to counter it. During the COVID-19 pandemic, the standards of scientific and democratic scrutiny have been, as a matter of fact, substantially lowered. This erosion potentially damages democracy.


Assuntos
COVID-19/epidemiologia , Prática Clínica Baseada em Evidências , Política de Saúde , Formulação de Políticas , COVID-19/prevenção & controle , Democracia , Prática Clínica Baseada em Evidências/normas , Governo , Humanos
14.
NeuroRehabilitation ; 48(4): 505-512, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33967067

RESUMO

BACKGROUND: Independent mobility is the most important determinant of quality of life after stroke and it is vital that training aimed at restoration of gait is based on contemporary evidence. Despite several practice guidelines for gait rehabilitation after stroke existing globally, their feasibility of application in low-resource settings is often questionable. OBJECTIVE: To investigate the current practices in gait training among Indian physiotherapists involved in the rehabilitation of stroke survivors. METHODS: A questionnaire on the various aspects of gait training was developed and the content was validated by experts. The survey was made available online and distributed among Indian physiotherapists working in the field of stroke rehabilitation, using snowball sampling. Frequency distribution was used to summarize responses to each component of the questionnaire. RESULTS: Responses were obtained from 250 practicing physiotherapists. The majority of the respondents (55%) reported that they initiate gait training within seven days after stroke. Gait training sessions ranged from 15-30 minutes (55%), once every day (44%), and the majority (89%) reported use of subjective outcome measures to evaluate gait. Although most respondents agreed on the use of assistive aids, 24% indicated that their use may deter gait, rather than improve it. Nearly 86% of the respondents reported that they do not follow standard guidelines pertaining to gait rehabilitation for stroke survivors. CONCLUSION: The findings of the study point toward a lack of evidence-based practice among Indian physiotherapists while training gait after stroke. This implied the urgent need for development and implementation of country specific guidelines for stroke rehabilitation.


Assuntos
Atitude do Pessoal de Saúde , Custos e Análise de Custo , Prática Clínica Baseada em Evidências/métodos , Terapia por Exercício/métodos , Marcha , Reabilitação do Acidente Vascular Cerebral/métodos , Prática Clínica Baseada em Evidências/economia , Terapia por Exercício/economia , Humanos , Índia , Fisioterapeutas/psicologia , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral/economia , Inquéritos e Questionários
15.
Hist Philos Life Sci ; 43(2): 66, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33939023

RESUMO

The COVID-19 pandemic poses extraordinary public health challenges. In order to respond to such challenges, most democracies have relied on so-called 'evidence-based' policies, which supposedly devolve to science the burden of their justification. However, the biomedical sciences can only provide a theory-laden evidential basis, while reliable statistical data for policy support is often scarce. Therefore, scientific evidence alone cannot legitimise COVID-19 public health policies, which are ultimately based on political decisions. Given this inevitable input on policy-making, the risk of arbitrariness is ubiquitous and democratic scrutiny becomes essential to counter it. During the COVID-19 pandemic, the standards of scientific and democratic scrutiny have been, as a matter of fact, substantially lowered. This erosion potentially damages democracy.


Assuntos
COVID-19/epidemiologia , Prática Clínica Baseada em Evidências , Política de Saúde , Formulação de Políticas , COVID-19/prevenção & controle , Democracia , Prática Clínica Baseada em Evidências/normas , Governo , Humanos
16.
BMC Med Educ ; 21(1): 282, 2021 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-34001073

RESUMO

BACKGROUND: Communities of Practice (CoPs) focus on learning, knowledge sharing, and creation, and research indicates they can improve healthcare performance. This article describes the development of a CoP that focused on synthesizing and adapting evidence in Physical Medicine and Rehabilitation (PM&R). This study aimed to investigate the CoP members' experiences and perceived barriers and enablers of CoP success in the early phase of a CoP. METHODS: Physical therapists and a physician (n = 10) volunteered for a CoP that synthesized literature of PM&R evidence. CoP members participated in education and training on critical appraisal and knowledge synthesis, practiced critical appraisal skills, and summarized literature. Three months after CoP initiation, semi-structured interviews were conducted to understand the CoP members' experiences and reflections. Members also completed an online survey that included the Evidence-Based Practice Confidence scale (EPIC), questions related to CoP activities, and demographics before CoP initiation. We utilized the Capability, Opportunity, and Motivation Model of Behaviour (COM-B) to explore how these experiences related to the behavioral adaptation and participation. RESULTS: Ten themes related to the potential contributors to CoP success and failure were identified. These included project management, technological solutions, efficacy, organizational support, interaction, the bigger picture, self-development, time, and motivation. CONCLUSIONS: Contributors to CoP success may include clearly articulated project goals and participant expectations, education and training, reliable technology solutions, organizational support, face-to-face communication, and good project management. Importantly, CoP members need time to participate in activities.


Assuntos
Prática Clínica Baseada em Evidências , Fisioterapeutas , Atenção à Saúde , Humanos , Aprendizagem , Pesquisa Qualitativa
17.
Nurse Educ Today ; 102: 104927, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33957395

RESUMO

BACKGROUND: Evidence-based practice is considered as the core competency requirement for nursing practice internationally. However, there is limited information regarding the evidence-based practice competency indicators for clinical nurses in China. OBJECTIVE: To establish a set of evidence-based practice competencies specific to nurses in China. DESIGN: A modified Delphi study. SETTING: The study was mainly conducted in a university-affiliated hospital in China. PARTICIPANTS: Twenty experts with evidence-based practice knowledge or practical experience from different regions and organizations in China. METHODS: A literature review was conducted to develop the initial list of competencies which consisted of 35 items in seven domains. A two-round Delphi survey used email to invite experts to rate the importance of each item and provide qualitative comments on their ratings. Consensus was predefined as a mean score is of 4.0 or above and at least 75% agreement among the participants. RESULTS: In round 1, 2 items were excluded, 5 items were added, and 12 items were required to be modified. In round 2, the consensus was achieved on 34 items in seven domains. CONCLUSION: The study established a comprehensive set of evidence-based practice competencies for nurses in China, which provides benchmark standards for the assessment and training of nurses on evidence-based practice.


Assuntos
Prática Clínica Baseada em Evidências , Enfermeiras e Enfermeiros , China , Competência Clínica , Consenso , Técnica Delfos , Humanos
20.
J Prof Nurs ; 37(3): 501-509, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34016306

RESUMO

BACKGROUND: Providing quality and safe nursing care is considered the cornerstone of the healthcare system globally. However, there are no comprehensive evaluation indicators of nursing students' quality and safety competencies in China. AIM: To develop the evaluation indicators and achieve experts' consensus on bachelor nursing students' quality and safety competencies at their graduation. METHODS: Based on the framework of the American Association of Colleges of Nursing's Quality and Safety Education for Nurses, literature review, semi-structured interview, and e-Delphi technique, the evaluation indicators were developed and obtained consensus through the participation of 22 nursing educational experts from August 2016 to May 2017. RESULTS: The evaluation indicators consisted of six domains, including safety care, patient-center care, collaboration and teamwork, continuous quality improvement, informatics, and evidence-based practice competencies, and 88 indicators. These indicators obtained ≥76% consensus on the experts' judgments. CONCLUSIONS: The evaluation indicators achieved the consensus on a panel of nursing experts, which were scientific and practicable. It could provide guidance for establishing a nursing curriculum to prepare bachelor nursing students' quality and safety competencies.


Assuntos
Estudantes de Enfermagem , China , Competência Clínica , Currículo , Técnica Delfos , Prática Clínica Baseada em Evidências , Humanos
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