Evaluation of the impact of the first evidence-based guidelines for congenital toxoplasmosis in Armenia (Quindío) Colombia: An observational retrospective analysis

Abstract Background Fever in infants <90 days old can indicate a serious bacterial infection (SBI) such as urinary tract infection, bacteremia, or meningitis. Clinical management of febrile infants varies widely. Implementing clinical practice guidelines (CPGs) can help standardize care, and electronic clinical decision support (eCDS) tools are a potential means of distributing CPGs. Little is known regarding the individual-level impact of eCDS tool use on medical decision-making. Children’s Mercy Kansas City developed a mobile eCDS tool (CMPeDS: Pediatric Decision Support) that was used internationally in a practice standardization project focused on the management of febrile infants. Methods We conducted a prospective cross-over simulation study amongst pediatric healthcare providers. Attending and resident physicians performed simulated patient scenarios using either CMPeDS or a standard text reference (the Harriet Lane Handbook). Participants’ responses in the simulation were evaluated based on adherence to evidence-based guidelines. Participants’ mental workload was assessed using the NASA Task Load Index survey (NASA-TLX, in which lower scores are optimal) to assesses mental, physical, and temporal demand, as well as performance, effort, and frustration when completing a series of tasks. Paired t-test and ANOVA were used to determine significance for case performance scores and NASA-TLX scores, respectively. A System Usability Scale (SUS) was used to determine usability of the CMPeDS app. Results A total 28 of 32 planned participants have completed trial procedures to date. Mean performance scores on the cases were significantly higher with CMPeDS vs. standard reference, (87.7% vs. 72.4% [t(27) 3.22, P = 0.003]). Participants reported lower scores on the NASA-TLX when using CMPeDS compared with standard reference tool (Figure 1). Mean score on SUS was 88.2 (scale 0–100) indicating excellent tool usability (Figure 2). Conclusion Using the eCDS tool CMPeDS was associated with significantly increased adherence to evidence-based guidelines for febrile infant management and decreased mental workload in simulation. Our findings highlight the potential value of eCDS deployment as part of CPG implementation projects. Disclosures All authors: No reported disclosures.

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Experiences of telehealth in general practice in Australia: research protocol for a mixed methods study

BJGP Open ◽

10.3399/bjgpo.2021.0187 ◽

2021 ◽

pp. BJGPO.2021.0187

Author(s):

Sarah J White ◽

Amy Nguyen ◽

Peter Roger ◽

Tim Tse ◽

John A Cartmill ◽

...

Keyword(s):

General Practice ◽

Conversation Analysis ◽

General Practitioners ◽

Direct Evidence ◽

Mixed Methods Study ◽

Evidence Based ◽

Practice Setting ◽

Australian General Practice ◽

Evidence Based Guidelines ◽

The Impact

BackgroundDue to the COVID-19 pandemic, use of telehealth has expanded rapidly. However, little is known about the impact of delivering care through telehealth on communication between clinicians and patients. At an interactional level, the ways in which clinicians establish rapport and connection with their patients in telehealth consultations is not well understood.AimThis study will explore interactional practices of general practitioners (GPs) and patients in telehealth consultations to develop evidence-based resources to improve communication.Design & settingThe study will be conducted within the Australian general practice setting.MethodConversation analysis and sociolinguistic discourse analysis of recorded telehealth consultations will provide direct evidence of specific elements contributing to successful and less successful instances of telehealth communication. This analysis will be complemented by co-design techniques such as qualitative and reflective interviews and collaborative workshops with telehealth users, including both general practitioners and patients.ConclusionEffective communication is critical for telehealth consultations and is central to achieving optimal clinical outcomes and patient satisfaction. This study will co-develop with end-users, evidence-based guidelines encompassing effective telehealth communication strategies.

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Preventing Ventilator-Associated Pneumonia: Educating Emergency Room Nurses

10.28971/532014fd89 ◽

2014 ◽

Author(s):

Dana Ferrazzano

Keyword(s):

Intensive Care ◽

Emergency Room ◽

Oral Care ◽

Evidence Based ◽

Ventilator Associated Pneumonia ◽

Preventative Measures ◽

Emergency Room Nurses ◽

Evidence Based Guidelines ◽

The Impact ◽

Nurses Knowledge

<p>Ventilator-associated pneumonia (VAP) is the second most common hospital acquired infection and is primarily found in the intensive care units. The presence of an endotracheal tube is the primary risk factor for developing VAP. Many times the process of intubation occurs pre-hospital, in the emergency room (ER) or in the operating room. Ventilator associated pneumonia is associated with increased hospital stay and costs. Evidence-based guidelines have been developed to decrease the occurrence of VAP and decrease patient mortality. Preventative measures are initiated on the intensive care unit once the patient is transferred. The purpose of this study was to evaluate the impact of an educational program on ER nurses knowledge of VAP and preventative measures to decrease VAP.</p> <p>The study took place at Rhode Island Hospital, a level 1 trauma center located in Providence, RI. Participants were ER nurses who worked in the critical care area of the ER. A pre-intervention-posttest design was used to evaluate emergency room nurses knowledge regarding VAP. The intervention consisted of a posterboard and study guide that provided information regarding evidence-based guidelines that could be implemented in the ER such as oral care, and head of bed elevation. The overall results on the pre and posttest demonstrated that ER nurses were unaware that oral care and the use of chlorhexidine were important interventions to reduce the incidence of developing VAP. Recommendations and implications for advanced practice nursing and the need for future research are discussed.</p>

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Characteristics of sleep-conducive music: A narrative evidence review

Advances in Social Sciences Research Journal ◽

10.14738/assrj.73.7968 ◽

2020 ◽

Vol 7 (3) ◽

pp. 430-437

Author(s):

Yuluan Wang ◽

Annette Rivard ◽

Christine Guptill ◽

Carol Boliek ◽

Cary Brown

Keyword(s):

Sleep Disturbances ◽

Meta Analysis ◽

Sleep Onset ◽

Well Being ◽

Future Research ◽

Evidence Based ◽

Negative Consequences ◽

Evidence Review ◽

Evidence Based Guidelines ◽

The Impact

Objectives: Sleep deficiency (SD) is a prevalent problem and has serious negative consequences for physical, cognitive, and psychological well-being. The use of music as a non-pharmacological sleep intervention has been proposed in several studies. A 2014 meta-analysis of 10 randomized trials evaluating the impact of music on sleep concluded that it can decrease sleep onset delay (latency) and sleep disturbances, increases sleep duration, and improves daytime dysfunction. It appears that, to-date, evidence-based guidelines for the selection and/or production of sleep-promoting music do not exist. This review addresses that gap and synthesizes available literature towards the goal of developing guidelines grounded in the evidence-based characteristics of sleep conducive music. Design and Results: A narrative review of research papers relevant to the topic identified evidence-based characteristics of sleep-conducive music related to tempo, rhythm, pitch, volume, and duration. Conclusion: This identification and compilation of evidence-based characteristics of sleep-conducive music can underpin future research that targets development and testing of specific music to promote sleep.

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Influencing antiemetic prescribing practices and funding changes through evidence-based guidelines.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.31 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 31-31

Author(s):

Kathy Vu ◽

Michael Wan ◽

Aliya Pardhan ◽

Erin Redwood ◽

Andrea Crespo ◽

...

Keyword(s):

Public Funding ◽

Drug Benefit ◽

Evidence Based ◽

Drug Formulary ◽

Prescribing Practices ◽

Receptor Antagonists ◽

Line Therapy ◽

Evidence Based Guidelines ◽

The Impact ◽

Made In

31 Background: In 2013 Cancer Care Ontario released updated antiemetic recommendations supporting the use of aprepitant-based combinations as 1st line therapy for highly emetogenic and 2nd line therapy for moderately emetogenic chemotherapy and discouraging the prolonged use of 5-HT3 antagonists. In 2014 changes were made in the Ontario drug formulary to align public funding to those recommendations. The impact of the changes in guidance and public funding on prescribing practices are now being analyzed. Methods: Using the Ontario Drug Benefit (ODB) database, data was extracted to analyze the prescribing practices of aprepitant, granisetron and ondansetron for chemotherapy-induced emesis between the pre-funding period (November 2013 to September 2014) and post-funding period (October 2014 to July 2015). Results: Prior to funding changes, an average of 197 prescriptions/month of aprepitant were billed to the ODB program totaling $22,422. After funding, an average of 1,165 prescriptions/month of aprepitant were billed totaling $132,145. This represented a 490% increase in utilization. The combined 5-HT3 receptor antagonists prescriptions/month billed during the respective time periods were 5,592 ($405,604) and 5,536 ($402,628). This represented a 1% decrease in utilization. Conclusions: There was a significant increase in aprepitant utilization and total expenditure to the ODB program indicating strong uptake of the triple-drug recommendation for highly emetogenic regimens. However, there was minimal change in prescribing practices related to the 5-HT3 receptor antagonists, indicating a reluctance to decrease utilization. Further work is necessary to discourage the prolonged use of 5-HT3 receptor antagonists.

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Pediatric evidence-based imaging guidelines for adult trauma providers significantly reduces radiation exposure to children

Trauma ◽

10.1177/14604086211028452 ◽

2021 ◽

pp. 146040862110284

Author(s):

Anna Wu ◽

Mary J Edwards ◽

Rachel Le ◽

Ashar Ata ◽

Jasmine Adderly ◽

...

Keyword(s):

Radiation Exposure ◽

Guideline Implementation ◽

Skull Fracture ◽

Pediatric Trauma ◽

Evidence Based ◽

Trauma Centers ◽

Trauma Service ◽

Number Of Patients ◽

Evidence Based Guidelines ◽

The Impact

Introduction Evidence suggests that stand-alone pediatric trauma centers outperform adult and combined adult/pediatric trauma centers in limiting radiation exposure to injured children. We sought to determine the impact of implementing evidence-based guidelines for pediatric imaging at a combined adult (level 1) and pediatric (level 2) center. The initiative focused on trauma/critical care surgeons as the pediatric surgeons did not participate in the resuscitation and initial evaluation of injured children. Methods Imaging guidelines were developed from existing clinical studies. After 3 months of education, guidelines were implemented, and regular feedback was given to providers regarding compliance. Data were collected from the trauma registry for all pediatric patients (aged less than 15 years), in calendar years 2017 (pre-guideline) and 2019 (post-guideline). All admissions were analyzed, with subgroup analysis of children with multisystem trauma admitted to the trauma surgery service. Results Following guideline implementation, mean computed tomography (CT) scans per injured child fell by over 50% (.93 vs .45). For patients admitted to the trauma service, the mean fell by 58% (1.82 vs 0.76). The number of patients receiving more than 1 CT significantly decreased for all children (26% vs 10%), and particularly those admitted to the trauma service (52% vs 17%). During this time, there was only one injury missed at the initial admission, which was clinically insignificant (non-displaced skull fracture). Conclusions Implementation of evidence-based guidelines for imaging eliminates disparity in practices between a combined adult/pediatric trauma center and stand-alone pediatric trauma centers.

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Achieving evidence-based prescribing practice in an adult community mental health service

Psychiatric Bulletin ◽

10.1192/pb.30.2.51 ◽

2006 ◽

Vol 30 (2) ◽

pp. 51-55 ◽

Cited By ~ 4

Author(s):

Maria Moran ◽

Bangaru Raju ◽

Jean Saunders ◽

David Meagher

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Community Mental Health ◽

Health Service ◽

Evidence Based ◽

Community Mental Health Service ◽

Prescribing Practice ◽

Evidence Based Guidelines ◽

The Impact

Aims and MethodPrescribing in everyday practice frequently deviates from evidence-based guidelines. Previous work compared practice in a community mental health service with evidence-based guidelines and identified factors related to suboptimal prescribing. This study reports the impact of a multifaceted intervention on prescribing practice. A Prescribing Practice Quality (PPQ) score was generated from six key aspects of prescribing at initial assessment and again 1 year later after an intervention to reduce suboptimal prescribing practices.ResultsA total of 264 patients were attending the service at both the initial and follow-up phase and were thus exposed to the prescribing intervention. In this population, PPQ scores were significantly lower at follow-up (0.96v.0.67,P<0.001). Improved prescribing practice was predicted by receipt of adjunctive supportive inputs, such as anxiety management (P=0.003).Similarly, mean PPQ scores substantially decreased when the total patient population was considered at each time point (0.75 in 2001 and 0.52 in 2002). These results suggest a reduction in both the initiation and continuation of suboptimal practices.Clinical ImplicationsPrescribing in real-world settings can be improved by interventions that target multiple aspects of service activity. The provision of supportive inputs is a key factor in improving practice.

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The Impact of Health Information Technology on the Quality of Medical and Health Care: A Systematic Review

Health Information Management Journal ◽

10.1177/183335830903800305 ◽

2009 ◽

Vol 38 (3) ◽

pp. 26-37 ◽

Cited By ~ 90

Author(s):

Aziz Jamal ◽

Kirsten McKenzie ◽

Michele Clark

Keyword(s):

Health Care ◽

Information Technology ◽

Health Information Technology ◽

Health Information ◽

Patient Outcomes ◽

Evidence Based ◽

Specific Patient ◽

Evidence Based Guidelines ◽

The Impact

The aim of this study was to systematically review the published evidence of the impact of health information technology (HIT) or health information systems (HIS) on the quality of healthcare, focusing on clinicians' adherence to evidence-based guidelines and the corresponding impact this had on patient clinical outcomes. The review covered the use of health information technologies and systems in both medical care (i.e. clinical and surgical) and other areas such as allied health and preventive services. Studies were included in the review if they examined the impact of Electronic Health Record (EHR), Computerised Provider Order-Entry (CPOE), or Decision Support System (DS); and if the primary outcomes of the studies were focused on the level of compliance with evidence-based guidelines among clinicians. Measurements considered relevant to the review were either of changes in clinical processes resulting from a change of the providers' behaviour, or of specific patient outcomes that demonstrated the effectiveness of a particular treatment given by providers. Of 23 studies included in the current review, 17 assessed the impact of HIT/HIS on health care practitioners' performance. A positive improvement, in relation to their compliance with evidence-based guidelines, was seen in 14 studies. Studies that included an assessment of patient outcomes, however, showed insufficient evidence of either clinically or statistically important improvements. Although the number of studies reviewed was relatively small, the findings demonstrated consistency with similar previous reviews of this nature in that wide scale use of HIT has been shown to increase clinician's adherence to guidelines.

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Compliance with pathology testing guidelines in Australian general practice: protocol for a secondary analysis of electronic health record data

BMJ Open ◽

10.1136/bmjopen-2018-024223 ◽

2018 ◽

Vol 8 (11) ◽

pp. e024223 ◽

Cited By ~ 2

Author(s):

Gorkem Sezgin ◽

Andrew Georgiou ◽

Rae-Anne Hardie ◽

Ling Li ◽

Lisa G Pont ◽

...

Keyword(s):

General Practice ◽

General Practitioners ◽

Evidence Based ◽

Department Of Health ◽

General Practices ◽

Electronic Health ◽

Haemoglobin Testing ◽

Evidence Based Guidelines ◽

The Impact ◽

Test Ordering

IntroductionIn Australia, general practitioners usually are the first point of contact for patients with non-urgent medical conditions. Appropriate and efficient utilisation of pathology tests by general practitioners forms a key part of diagnosis and monitoring. However overutilisationand underutilisation of pathology tests have been reported across several tests and conditions, despite evidence-based guidelines outlining best practice in pathology testing. There are a limited number of studies evaluating the impact of these guidelines on pathology testing in general practice. The aim of our quantitative observational study is to define how pathology tests are used in general practice and investigate how test ordering practices align with evidence-based pathology guidelines.Methods and analysisAccess to non-identifiable patient data will be obtained through electronic health records from general practices across three primary health networks in Victoria, Australia. Numbers and characteristics of patients, general practices, encounters, pathology tests and problems managed over time will be described. Overall rates of encounters and tests, alongside more detailed investigation between subcategories (encounter year, patient’s age, gender, and location and general practice size), will also be undertaken. To evaluate how general practitioner test ordering coincides with evidence-based guidelines, five key candidate indicators will be investigated: full blood counts for patients on clozapine medication; international normalised ratio measurements for patients on warfarin medication; glycated haemoglobin testing for monitoring patients with diabetes; vitamin D testing; and thyroid function testing.Ethics and disseminationEthics clearance to collect data from general practice facilities has been obtained by the data provider from the RACGP National Research and Evaluation Ethics Committee (NREEC 17–008). Approval for the research group to use these data has been obtained from Macquarie University (5201700872). This study is funded by the Australian Government Department of Health Quality Use of Pathology Program (Agreement ID: 4-2QFVW4M). Findings will be reported to the Department of Health and disseminated in peer-reviewed academic journals and presentations (national and international conferences, industry forums).

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