The Q**** Study – basic randomised evaluation of attendance at a children's emergency department

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A11.2-A11
Author(s):  
Graham Johnson
Keyword(s):  
Emergency Department ◽  
Health Professionals ◽  
Control Period ◽  
Evidence Based ◽  
Intervention Period ◽  
Time Period ◽  
Significant Difference ◽  
Based Medicine ◽  
And Control ◽  
Published Research

IntroductionHealth Professionals are superstitious; be it a little ritual before sitting a cannula, or wearing a particular item of clothing while on-call, there are many things that we irrationally do day-to-day. One of the most well known superstitions is that uttering the word “quiet” (Q****) will immediately turn what has previously been a pleasant day into an extremely busy one. This belief is strongly at odds with modern Evidence Based Medicine, in fact a thorough literature review revealed no published research in this area. The aim of this study was to establish if there was any evidence that saying the word “Q****” influenced the number of attendances to a Children's Emergency Department.MethodWe measured attendance during three time periods per day for the study duration (A – 00:00 to 07:59; B – 08:00 to 15:59; C – 16:00 to 23:59). At the beginning of each time period a randomised envelope was opened that contained either the word “Q****”, “Busy” or was blank, this prompted the doctor and nurse in charge to utter a sentence containing the word from the envelope, which was also displayed for the rest of the 8 h.Results1454 patients were included in the intervention period and 2818 were included in the 4 week control period to measure typical attendance. Mean attendance for intervention and control were: A 7.29 and 7.71; B 40.86 and 40; C 55.57 and 52.86 respectively. “Q****” and Busy were uttered 12 times each. There was no statistically significant difference in attendance for either word.ConclusionThis study has shown that the long-held belief that saying the word ‘Quiet’ has dire consequences is unfounded. We would recommend further research to explore whether other words could be used to influence Emergency Department attendances.

Será que estamos precisando de uma lava jato científica?

2019 ◽  
Vol 18 (1) ◽  
pp. 1
Author(s):  
Antonio Marcos Andrade
Keyword(s):  
Health Care ◽  
Medical Journal ◽  
British Medical Journal ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Plos Medicine ◽  
De Se ◽  
Research Findings ◽  
Based Medicine ◽  
Published Research

Em 2005, o grego John Loannidis, professor da Universidade de Stanford, publicou um artigo na PLOS Medicine intitulado “Why most published research findings are false” [1]. Ele que é dos pioneiros da chamada “meta-ciência”, disciplina que analisa o trabalho de outros cientistas, avaliou se estão respeitando as regras fundamentais que definem a boa ciência. Esse trabalho foi visto com muito espanto e indignação por parte dos pesquisadores na época, pois colocava em xeque a credibilidade da ciência.Para muitos cientistas, isso acontece porque a forma de se produzir conhecimento ficou diferente, ao ponto que seria quase irreconhecível para os grandes gênios dos séculos passados. Antigamente, se analisavam os dados em estado bruto, os autores iam às academias reproduzir suas experiências diante de todos, mas agora isso se perdeu porque os estudos são baseados em seis milhões de folhas de dados. Outra questão importante que garantia a confiabilidade dos achados era que os cientistas, independentemente de suas titulações e da relevância de suas descobertas anteriores, tinham que demonstrar seus novos achados diante de seus pares que, por sua vez, as replicavam em seus laboratórios antes de dar credibilidade à nova descoberta. Contudo, na atualidade, essas garantias veem sendo esquecidas e com isso colocando em xeque a validade de muitos estudos na área de saúde.Preocupados com a baixa qualidade dos trabalhos atuais, um grupo de pesquisadores se reuniram em 2017 e construíram um documento manifesto que acabou de ser publicado no British Medical Journal “Evidence Based Medicine Manifesto for Better Health Care” [2]. O Documento é uma iniciativa para a melhoria da qualidade das evidências em saúde. Nele se discute as possíveis causas da pouca confiabilidade científica e são apresentadas algumas alternativas para a correção do atual cenário. Segundo seus autores, os problemas estão presentes nas diferentes fases da pesquisa:Fases da elaboração dos objetivos - Objetivos inúteis. Muito do que é produzido não tem impacto científico nem clínico. Isso porque os pesquisadores estão mais interessados em produzir um número grande de artigos do que gerar conhecimento. Quase 85% dos trabalhos não geram nenhum benefício direto a humanidade.Fase do delineamento do estudo - Estudos com amostras subdimensionados, que não previnem erros aleatórios. Métodos que não previnem erros sistemáticos (viés na escolha das amostras, falta de randomização correta, viés de confusão, desfechos muito abertos). Em torno de 35% dos pesquisadores assumem terem construídos seus métodos de maneira enviesada.Fase de análise dos dados - Trinta e cinco por cento dos pesquisadores assumem práticas inadequadas no momento de análise dos dados. Muitos assumem que durante esse processo realizam várias análises simultaneamente, e as que apresentam significância estatística são transformadas em objetivos no trabalho. As revistas também têm sua parcela de culpa nesse processo já que os trabalhos com resultados positivos são mais aceitos (2x mais) que trabalhos com resultados negativos.Fase de revisão do trabalho - Muitos revisores de saúde não foram treinados para reconhecer potenciais erros sistemáticos e aleatórios nos trabalhos.Em suma é necessário que pesquisadores e revistas científicas pensem nisso. Só assim, teremos evidências de maior qualidade, estimativas estatísticas adequadas, pensamento crítico e analítico desenvolvido e prevenção dos mais comuns vieses cognitivos do pensamento.

Clinician education, advice and SMS/text reminders improve test of reinfection rates following diagnosis of Chlamydia trachomatis or Neisseria gonorrhoeae: before and after study in primary care

2019 ◽  
Vol 46 (1) ◽  
pp. 32-37
Author(s):  
Sally B Rose ◽  
Susan M Garrett ◽  
Deborah Hutchings ◽  
Kim Lund ◽  
Jane Kennedy ◽  
...  
Keyword(s):  
Primary Care ◽  
Chlamydia Trachomatis ◽  
Neisseria Gonorrhoeae ◽  
Systematic Approach ◽  
Control Period ◽  
Intervention Period ◽  
Clinician Education ◽  
Significant Difference ◽  
Time Periods

BackgroundEvidence-based guidelines for the management of Chlamydia trachomatis and Neisseria gonorrhoeae recommend testing for reinfection 3–6 months following treatment, but retesting rates are typically low.MethodsParticipants included six primary care clinics taking part in a pilot study of strategies designed to improve partner notification, follow-up and testing for reinfection. Rates of retesting between 6 weeks and 6 months of a positive chlamydia or gonorrhoea diagnosis were compared across two time periods: (1) a historical control period (no systematic approach to retesting) and (2) during an intervention period involving clinician education, patient advice about reinfection risk reduction and retesting, and short messaging service/text reminders sent 2–3 months post-treatment inviting return for retesting. Retesting was calculated for demographic subgroups (reported with 95% CI).ResultsOverall 25.4% (61 of 240, 95% CI 20.0 to 31.4) were retested during the control period and 47.9% (116 of 242, 95% CI 43.2 to 55.1) during the intervention period. Retesting rates increased across most demographic groups, with at least twofold increases observed for men, those aged 20–29 years old, and Māori and Pasifika ethnic groups. No significant difference was observed in repeat positivity rates for the two time periods, 18% (11 of 61) retested positive during the control and 16.4% (19 of 116) during the intervention period (p>0.05).ConclusionsClinician and patient information about retesting and a more systematic approach to follow-up resulted in significant increases in proportions tested for reinfection within 6 months. These simple strategies could readily be implemented into primary healthcare settings to address low rates of retesting for bacterial sexually transmitted infections.Trial registration numberACTRN12616000837426.

scholarly journals “They Just Need to Come Down a Little Bit to Your Level”: A Qualitative Study of Parents’ Views and Experiences of Early Life Interventions to Promote Healthy Growth and Associated Behaviours

2020 ◽  
Vol 17 (10) ◽  
pp. 3605
Author(s):  
Marita Hennessy ◽  
Molly Byrne ◽  
Rachel Laws ◽  
Caroline Heary
Keyword(s):  
Health Professionals ◽  
Early Life ◽  
Critical Time ◽  
Evidence Based ◽  
Structured Interviews ◽  
Critical Window ◽  
Time Period ◽  
Multi Level ◽  
To Come ◽  
Healthy Growth

The first 1000 days is a critical window of opportunity to promote healthy growth and associated behaviours. Health professionals can play an important role, in part due to the large number of routine contacts they have with parents. There is an absence of research on the views of parents towards obesity prevention and the range of associated behaviours during this time period. This study aimed to elicit parents’ views on early life interventions to promote healthy growth/prevent childhood obesity, particularly those delivered by health professionals. Semi-structured interviews were conducted with 29 parents (24 mothers, 5 fathers) who were resident in Ireland and had at least one child aged under 30 months. Data were analysed using reflexive thematic analysis. Two central themes were generated: (1) navigating the uncertainty, stress, worries, and challenges of parenting whilst under scrutiny and (2) accessing support in the broader system. Parents would welcome support during this critical time period; particularly around feeding. Such support, however, needs to be practical, realistic, evidence-based, timely, accessible, multi-level, non-judgemental, and from trusted sources, including both health professionals and peers. Interventions to promote healthy growth and related behaviours need to be developed and implemented in a way that supports parents and their views and circumstances.

Utilizing network quality committees to improve reporting and adherence to evidence-based clinical pathways.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 76-76
Author(s):  
Debra A. Patt ◽  
J. Russell Hoverman ◽  
Gay Lindsey ◽  
Deedra Jastrzembski ◽  
Cynthia Taniguchi ◽  
...  
Keyword(s):  
Clinical Pathways ◽  
Time Interval ◽  
Evidence Based ◽  
Large Network ◽  
Time Period ◽  
Community Oncology ◽  
Improve Compliance ◽  
Value Based Care ◽  
Based Medicine

76 Background: In an era of evidence based medicine, several different evidence based pathways for cancer treatment exist. Few, however, contain decision support, are implemented into an electronic health record (EHR) or have demonstrated their effectiveness to provide value-based care. Providing systems to make a Pathways program operational and improve adherence supports a culture of value-based care. Methods: Physician designed evidence based pathways for a large network of community oncologists was rolled out over a statewide practice. A team of pharmacists and data managers designed a program to support implementation of this pathways initiative. Physician-led quality committees were created at the practice level to troubleshoot and characterize the process of making adherence operational and improving upon other quality metrics, variance reporting, and patient satisfaction. Treatments were charted in the EHR and available for reporting. Documentation of rationale for off-pathway exceptions was also captured. Assessable data, adherence, and exception documentation were measured prior to the onset of the committees and again with follow-up for 1 year after initiation of the committees from March 2011 through February 2012. Results: Within this large practice of 342 physicians, there were 39 quality committees created. During this time assessable data, adherence, and justification of exceptions to evidence-based pathways changed. At the beginning of the time period, assessable data was 84% and improved to 90% after a year. Adherence to pathways was 60% and improved to 68% over the same time interval. Exception documentation also improved from 14% to 25%. Conclusions: Formalizing an internal physician-driven operational procedure to improve upon quality can increase the reporting and adherence to physician created evidence-based pathways across a network of community oncologists and moves to change a culture of value-based excellence within community oncology practices. Continuous and internally driven adherence to value-based metrics improve compliance over time. Internal systems such as these are essential to make evidence-based pathways operational.

An Assessment of the Methodological Quality of Research Published in the American Journal of Sports Medicine

2005 ◽  
Vol 33 (12) ◽  
pp. 1812-1815 ◽  
Author(s):  
Robert H. Brophy ◽  
Michael J. Gardner ◽  
Omar Saleem ◽  
Robert G. Marx
Keyword(s):  
Data Collection ◽  
Sports Medicine ◽  
Methodological Quality ◽  
Case Series ◽  
Evidence Based ◽  
Prospective Data ◽  
Article Type ◽  
Based Medicine ◽  
Published Research

Background Evidence-based medicine has become a popular topic in academic medicine during the past several decades and more recently in orthopaedics and sports medicine. Hypothesis Articles published in The American Journal of Sports Medicine have shown an improvement in methodological quality in 2001-2003, compared with 1991-1993. Study Design Systematic review. Methods All articles published in The American Journal of Sports Medicine during the periods 1991-1993 and 2001-2003 were reviewed and classified by type of study. The use of pertinent methodologies such as prospective data collection, randomization, blinding, and controlled studies was noted for each article. The frequency of each article type and the use of evidence-based techniques were compared across study periods. Results Case series and descriptive studies decreased during the study period, from 27.4% to 15.3% (P=. 00003) and from 11.9% to 5.6% (P=. 001), respectively, of articles published. Prospective cohort studies increased from 4.7% to 14.1% (P=. 000005), and randomized, prospective clinical trials increased from 2.7% to 5.9% of articles (P=. 04). More studies tested an explicit hypothesis (P=. 0000002), used prospective data collection (P=. 000003), and used blinding (P=. 02), and more studies identified a funding source (P=. 004). Conclusions Overall, there was a shift toward more prospective and randomized research designs published in The American Journal of Sports Medicine during 2001-2003 compared to 1991-1993, demonstrating an improvement in the methodological quality of published research.

scholarly journals Early and comprehensive care bundle in elderly for acute heart failure in the emergency department: study protocol of The ELISABETH stepped wedge cluster randomized trial

2018 ◽  
Author(s):  
Yonathan Freund ◽  
Judith Gorlick ◽  
Marine Cachanado ◽  
Sarah Salhi ◽  
Vanessa Lemaitre ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Elderly Patients ◽  
Acute Heart Failure ◽  
Control Period ◽  
Care Bundle ◽  
Stepped Wedge ◽  
Precipitating Factors ◽  
Intervention Period ◽  
Cluster Randomized

Abstract Background: Acute heart failure (AHF) is one of the most common diagnoses for elderly patients in the emergency department (ED), with an admission rate higher than 80% and 1-month mortality around 10%. The European guidelines for the management of AHF are based on moderate levels of evidence, due to the lack of randomized controlled trials and the scarce evidence of any clinical added value of a specific treatment to improve outcomes. Recent reports suggest that the very early administration of full recommended therapy may decrease mortality. However, several studies highlighted that elderly patients often received suboptimal treatment. Our hypothesis is that an early care bundle that comprises early and comprehensive management of symptoms, along with prompt detection and treatment of precipitating factors should improve AHF outcome in elderly patients. Method/design: ELISABETH is a stepped-wedge, controlled cluster randomized, clinical trial in 15 emergency departments in France recruiting all patients aged 75 years and older with a diagnosis of AHF. The tested intervention is a care bundle with a checklist that mandates detection and early treatment of AHF precipitating factors, early and intensive treatment of congestion with intravenous nitrates boluses, and application of other recommended treatment (low dose diuretics, non-invasive ventilation when indicated, and preventive low molecular weight heparin). Each centre are randomized to the order in which they will switch from “control period” to “intervention period”. All centers begin the trials with the control period for two weeks, then after each two-weeks step a new centre will be in the intervention period. At the end of the trial, all clusters will receive the intervention regimen. The primary outcome is the number of days alive and out of the hospital at 30 days. Discussion: If our hypothesis is confirmed, this trial will strengthen the level of evidence of AHF guidelines and stress the importance of the associated early and comprehensive treatment of precipitating factors. This trial could be the first to report a reduction in short term morbidity and mortality in elderly AHF patients. Registration: NCT03683212, prospectively registered on September 25th 2018 Keywords: Elderly, acute heart failure, emergency department

scholarly journals Changes in Emergency Department Performance during Strike of Junior Physicians in Korea

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Jeongyong Sim ◽  
Yuri Choi ◽  
Jinwoo Jeong
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Tertiary Care ◽  
Control Period ◽  
Junior Doctors ◽  
And Performance ◽  
Almost All ◽  
Ed Operations ◽  
And Control

Objective. A nationwide strike that took place from August 21 to September 7, 2020, which was led by young doctors represented by residents and interns, resulted in shortages of manpower at almost all university and training hospitals. This study aimed to identify differences in the process and outcomes of emergency department (ED) patient care by comparing the performance over about 2 weeks of the strike with that during the usual ED operations. Methods. This retrospective observational study evaluated ED flow and performance during the junior doctors’ strike and compared it with the usual period in a single tertiary-care academic hospital. The outcome variables were defined as ED length of stay, crude mortality, and hospital mortality and adjusted for demographic and clinical parameters. The effect of the doctors’ strike on hospital mortality adjusted for demographic and clinical variables was investigated using logistic regression. Results. A total of 1,121 and 1,496 patients visited the ED during the strike and control periods (both 17 days), respectively. The care usually provided by four or six physicians, including one specialist, was replaced with that by one or two specialists at any one time. During the trainee doctors’ strike, EM specialists managed patients with fewer consultations. However, the proportion of patients who underwent laboratory and radiologic tests did not change significantly. The median ED length of stay significantly decreased from 359 minutes (interquartile range, IQR: 147–391) in the control period to 326 minutes (IQR: 123–318) during the strike period P < 0.001 . The doctors’ strike was not found to have a significant effect on mortality after adjustments with other variables. Conclusion. During the junior doctors’ strike in 2020 in Korea, EM specialists efficiently managed the care of emergency patients with higher levels of acuity without compromising the survival rate, through fewer consultations and faster disposition.

scholarly journals EVIDENCE-BASED MEDICINE IN THE TIMES OF COVID-19: A CROSS-SECTIONAL SURVEY TO UNDERSTAND THE INDIAN PERSPECTIVE

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Karan B. Bhanushali ◽  
Nikita Gupta ◽  
Vinayak Mishra ◽  
Heena Asnani
Keyword(s):  
Decision Making ◽  
Clinical Experience ◽  
Evidence Based Medicine ◽  
Online Survey ◽  
Medical Literature ◽  
Evidence Based ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Significant Difference ◽  
Based Medicine

Introduction: During the COVID-19 pandemic, there is a tremendous amount of literature published regularly. In a country like India, historically, where there is a paternalistic approach to practicing medicine, there is a lot of hindrance to evidence-based medicine (EBM). Doctors have always weighed one's clinical experience superior over any other form of decision-making. This system of practice has made decision-making difficult for the physicians during this pandemic as COVID-19 is a reasonably new disease entity and the physicians lack enough 'prior experience' dealing with such a situation. Our survey tries to address the common barriers to evidence-based medical practices especially during the COVID-19 pandemic in India. We also try to explore the various source of information used by the doctors. Methods: It is a descriptive cross-sectional survey. The questions were provided in multiple-choice question format. An online survey comprising of 10 questions entitled “Hurdles faced by physicians to assimilate evidence-based guidelines on COVID-19” was made using Google Forms (Google Inc, California, US) and circulated through email to medical practitioners in the Ghatkopar (Mumbai, India) Medical Association's register from 17th June 2020 to 1st September 2020. Results: Our survey collected 213 responses, out of which 80.3% (n=171) of doctors were involved in care, counseling, or management of COVID-19 patients. The most opted primary sources for evidence-based information during this pandemic were teachings of/discussions with medical colleagues (71.4%, n=152), followed by online webinars (59.6%, n= 127) and social media (41.8%, n=89). When questioned about the main obstacles faced by them to obtain evidence-based information, the responses were as follows: Overload of medical literature (53.5%, n=114), limited access to quality resources (40.8%, n=87), unfamiliarity with the bio-statistics analysis (39%, n= 83), difficulty in locating relevant medical literature (38%, n=81), unfamiliarity with the research methodology (37.1%, n=79), lack of time (30%, n=64).  Our respondents' perspective concerning EBM attributes: 57.3% (n=122) think evidence-based practice takes their clinical experience into account. 93.4% (n=199) of them have shown an interest in broadening their skills. There was no significant difference between doctors' attitudes with less than 10 years and more than 10 years of experience (chi-square value = 0.857, p = 0.65). Conclusion: Our survey results highlight the balance maintained between evidence-based medicine and experience-based medicine by Indian physicians. They identify the importance of EBM while acknowledging its shortcomings. They realize the significance of developing their repertoire to understand, appraise, and practice EBM. Keywords: EBM, COVID-19

scholarly journals Brazilian version of the Fresno test of competence in Evidence-Based Medicine: a validation study

2019 ◽  
Vol 29 (1) ◽  
pp. 32295
Author(s):  
Margareth Rodrigues Salerno ◽  
Fábio Herrmann ◽  
Leticia Manoel Debon ◽  
Matheus Dorigatti Soldatelli ◽  
Gabriele Carra Forte ◽  
...  
Keyword(s):  
Medical Students ◽  
Psychometric Properties ◽  
Internal Consistency ◽  
Validation Study ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Fresno Test ◽  
Brazilian Version ◽  
Significant Difference ◽  
Based Medicine

AIMS: To validate the Brazilian version of the Fresno test of competence in Evidence-Based Medicine.METHODS: This is a cross-sectional, validation study. Phase 1: translation of the Fresno instrument. Phase 2: validation of the translated version, which was tested in 70 undergraduate medical students. The psychometric properties evaluated were validity, internal consistency, and sensitivity to change.RESULTS: Overall, validity was adequate; most items showed a moderate to strong and significant correlation with the total score; there was an important and significant difference between both groups, with and without previous contact with Evidence-Based Medicine (median, 55 [IQ25-75, 45.2-61.7] vs. median, 18.5 [IQ25-75, 6.0-29.7]) (p <0.001). Internal consistency was also adequate (α-C 0.718), and sensitivity to change showed a considerable and significant difference between pre and post-test (median, 18.5 [IQ25-75, 6.0-29.7] vs. median, 44 [IQ25-75, 34.0-60.0]) (p <0.001).CONCLUSIONS: The Brazilian version of the Fresno test showed satisfactory psychometric properties, and it can now be used as a tool to assess the knowledge and skills of Evidence-Based Medicine in Brazilian medical students.

scholarly journals Exercício físico na prevenção de quedas do idoso da comunidade: revisão baseada na evidência

2018 ◽  
Vol 12 (39) ◽  
pp. 1-11 ◽  
Author(s):  
Joana Rita Bento ◽  
Nadina Duarte Sousa
Keyword(s):  
Medical Association ◽  
Evidence Based Medicine ◽  
Accidental Falls ◽  
Prevention And Control ◽  
Falls Prevention ◽  
National Guideline ◽  
Cochrane Library ◽  
Evidence Based ◽  
Based Medicine ◽  
And Control

Introdução: A prevenção de quedas do idoso é um urgente desafio de saúde pública. O exercício físico tem-se comprovado uma intervenção preventiva eficaz. Objetivo: Rever a evidência científica mais recente, relativa à recomendação do exercício físico na prevenção de quedas do idoso da comunidade. Identificar modalidade física e regimes de frequência com maior benefício. Métodos: Efetuou-se uma pesquisa bibliográfica, utilizando os termos MeSH “aged”, “accidental falls/prevention and control” e “exercise”, nas bases de dados PubMed, Cochrane Library, National Guideline Clearinghouse, Canadian Medical Association, Evidence based Medicine e NICE Evidence Search, nos últimos 5 anos. Foram incluídos artigos que avaliassem o exercício como intervenção isolada na prevenção de quedas do indivíduo da comunidade, com ≥60 anos. Resultado avaliado: incidência de quedas. Resultados: De 637 potenciais artigos, 4 cumpriam critérios de inclusão: 2 ensaios clínicos aleatorizados controlados (ECACs), 1 estudo coorte e 1 meta-análise (MA). Globalmente, os resultados demonstram um efeito protetor do exercício físico. A MA obteve uma razão de taxas de incidência (RTI) de 0,79 (p<0,001), com o treino de equilíbrio (RTI=0,85, p=0,04) e maior dose semanal (RTI=0,77, p=0,03) a demonstrarem-se mais efetivos. Contrariamente, um ECAC demonstrou superioridade na marcha. O estudo coorte revelou maior benefício em participações ≥3 anos (RTI=0,90; p=0,03). Conclusão: O exercício físico é efetivo na prevenção de quedas do idoso da comunidade. Treinos de equilíbrio e práticas semanais ≥3 horas demonstraram melhores resultados (SORT A). A sua manutenção deve ser incentivada a longo prazo (SORT B).

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