scholarly journals Barriers and facilitators to answering clinical questions in the Americas: a cross-sectional study of surgical trauma care providers

2021 ◽  
Vol 6 (1) ◽  
pp. e000774
Author(s):  
Helen Elizabeth Noble ◽  
Felipe Vega Rivera ◽  
Lacey LaGrone
Keyword(s):  
Clinical Care ◽  
Income Level ◽  
Barriers And Facilitators ◽  
Dissemination And Implementation ◽  
Surgical Trauma ◽  
Care Providers ◽  
Level Of Evidence ◽  
Trauma Society ◽  
Clinical Scenarios ◽  
Clinical Questions

BackgroundWe aimed to understand how surgical trauma providers in the Americas acquire answers to clinical questions and what barriers and facilitators they face in efforts to practice according to recommendations for common surgical cases. We hypothesized that increased English proficiency and country income improved providers’ acquisition and application of clinical knowledge.MethodsA 23-question survey evaluated reported confidence in interpretation of evidence, perceived language fluency, and access to and application of recommendations on sepsis and appendicitis. Electronic surveys were distributed across the Americas to Pan American Trauma Society members.Results108 participants from 21 countries completed this survey. 59% had ≥21 years of provider experience. 38% reported their English reading comprehension as less than or equal to “limited working proficiency.” 44% endorsed using Google Translate; 35% reported they did not need translation tools to evaluate medical literature. 59% felt uncertainty regarding clinical care at least weekly. 65% reported inability to answer their clinical questions at least once per month. 86% felt confident in their ability to interpret and apply evidence for their practice. To answer clinical questions, participants listed guidelines (76%), full-text peer-reviewed journal articles (61%), and meta-analyses (49%) as their most used resources. 25% answered all five clinical questions correctly, whereas 43% answered three or fewer correctly. 79% felt they had adequate access to resources to answer the five clinical questions. When controlling for individual demographic characteristics, decreased age (p<0.01) and increased country income level (p=0.03) positively impacted correct answers to questions.DiscussionUncertainties in clinical care are unavoidable. Language, age, and country income level impacted provider acquisition and application of knowledge relevant to select clinical scenarios. These findings highlight disparities in access and training and add urgency to the movement for improved dissemination and implementation approaches for evidence-based practice in surgery.Level of evidenceIV.

Introduction and clinical scenarios

2019 ◽  
pp. 1-32
Author(s):  
Paul Atkinson ◽  
Bob Jarman ◽  
Tim Harris ◽  
Rip Gangahar ◽  
David Lewis ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Critical Care ◽  
Clinical Skills ◽  
Point Of Care ◽  
Clinical Care ◽  
Critical Care Medicine ◽  
Everyday Practice ◽  
Point Of Care Ultrasound ◽  
Clinical Scenarios ◽  
Clinical Questions

Point-of-Care Ultrasound in Emergency Medicine and Resuscitation provides a curriculum-based guide to the integration of ultrasound into everyday practice for clinicians in emergency medicine and critical care medicine and for resuscitation. In addition to describing commonly used protocols, we focus on how ultrasound can be used to help to answer specific clinical questions and provide guidance for procedures at the point of care, augmenting traditional clinical skills. This chapter introduces the general concepts of using ultrasound at the bedside, describes how to use point-of-care ultrasound (PoCUS), and provides clinical scenarios as examples of where PoCUS can improve clinical care.

An Evaluation of the Dissemination and Implementation of a Google Apple Exposure Notification System for COVID-19 Risk Mitigation at a National Public University (Preprint)

2021 ◽  
Author(s):  
Cathy Lee Melvin ◽  
Katherine Regan Sterba ◽  
Ronald Gimbel ◽  
Leslie Andrew Lenert ◽  
Kathleen Buford Cartmell
Keyword(s):  
Mixed Methods ◽  
Health Care Providers ◽  
Specific Treatment ◽  
Implementation Strategies ◽  
Public University ◽  
Barriers And Facilitators ◽  
Phase Iii ◽  
Dissemination And Implementation ◽  
University Campus ◽  
Care Providers

BACKGROUND The infectivity characteristics of SARS-Cov-2 require expeditious testing and isolation of cases for pandemic control. The large proportion of very severe or deadly cases, combined with a lack of specific treatment options for SARS-CoV-2, makes it imperative to identify and isolate infected individuals and quickly test their exposed close contacts (ECC) to reduce the odds of continued spread. Compared to conventional contact tracing, cell phone-based exposure notification has potential to inform individuals of exposures more quickly, to identify a more complete set of true contacts, and to better assess extent of exposure. Promptly providing contacts with information about their exposure, allowing them to proactively measure their risks, and take actions that might safeguard their own and the public’s health. OBJECTIVE This paper describes a protocol to evaluate the implementation of a COVID-19 exposure notification application, the SC Safer Together App (Safer Together), on a large, public university campus. The purpose of this mixed methods study is to 1) characterize and evaluate communication, dissemination and implementation strategies used to promote and support the use of Safer Together and 2) examine implementation outcomes (reach, acceptability, adoption and use) as well as barriers and facilitators encountered from the perspective of multiple stakeholders. The study objectives are to: 1. Describe the content, intended audience(s), communication channels, and timing of multi-level communication, dissemination and implementation strategies used to deploy Safer Together. 2. Determine the reach, acceptability, adoption, and use of Safer Together among targeted audiences of university students, employees (University staff, faculty and emeritus faculty), and health care providers. 3. Characterize barriers and facilitators to implementation and use of Safer Together. METHODS A parallel convergent mixed methods design will be used to 1) describe implementation strategies (i.e., marketing, distribution, education) used to launch the program and 2) evaluate program reach, acceptability, adoption and use guided by the Reach, Effectiveness, Adoption, Implementation Maintenance (RE-AIM) framework. The study will focus on three phases of dissemination and implementation that include start-up/planning (phase I), early implementation as students return to University campus in Fall 2020 (phase II), and late implementation as students continue into the Spring 2021 semester (phase III). RESULTS The project was started on October 28, 2020 and is currently enrolling participants. The active implementation plan spans nine months (October 28, 2020 – August 31, 2021). CONCLUSIONS This study proposes a structured approach to evaluate implementation strategies associated with deployment of Safer Together, an exposure notification app, in a university setting from the viewpoint of students, employees, and university leadership. The instruments developed for this study and its results will inform future implementation of apps like Safer Together during pandemic conditions at major state universities and/or statewide. CLINICALTRIAL not applicable

scholarly journals Audiologists and Tinnitus

2019 ◽  
Vol 28 (4) ◽  
pp. 1059-1064 ◽  
Author(s):  
James A. Henry ◽  
Michael Piskosz ◽  
Arnaud Norena ◽  
Philippe Fournier
Keyword(s):  
Health Care Providers ◽  
Graduate Programs ◽  
Clinical Care ◽  
Professional Services ◽  
Current Status ◽  
Care Providers ◽  
Level Of Evidence ◽  
Care Services ◽  
Primary Health Care Providers ◽  
Care Training

Purpose Although tinnitus is highly prevalent among patients receiving audiology services, audiologists are generally untrained in tinnitus management. Audiology graduate programs, as a rule, do not provide comprehensive instruction in tinnitus clinical care. Training programs that do exist are inconsistent in their recommendations. Furthermore, no standards exist to prevent the delivery of unvetted audiologic services, which can be expensive for patients. Patients seeking professional services by an audiologist, therefore, have no basis upon which to be assured they will receive research-based care. The purpose of this article is to describe the current status of tinnitus management services that exist within the general field of audiology and to suggest specific approaches for improving those services. Conclusion Audiologists may be in the best position to serve as the primary health care providers for patients experiencing tinnitus. Tinnitus care services by audiologists, however, must achieve a level of evidence-based standardization.

Future Issues in Dissemination and Implementation Research

2017 ◽  
Author(s):  
Ross C. Brownson ◽  
Graham A. Colditz ◽  
Enola K. Proctor
Keyword(s):  
Public Health ◽  
Health Services ◽  
Implementation Research ◽  
Clinical Care ◽  
Dissemination And Implementation ◽  
Public Health Services ◽  
Middle Income ◽  
Middle Income Countries ◽  
Dissemination And Implementation Research ◽  
The Many

This chapter highlights just a sample of the many rich areas for dissemination and implementation research that will assist us in shortening the gap between discovery and practice, thus beginning to realize the benefits of research for patients, families, and communities. Greater emphasis on implementation in challenging settings, including lower and middle-income countries and underresourced communities in higher income countries will add to the lessons we must learn to fully reap the benefit of our advances in dissemination and implementation research methods. Moreover, collaboration and multidisciplinary approaches to dissemination and implementation research will help to make efforts more consistent and more effective moving forward. Thus, we will be better able to identify knowledge gaps that need to be addressed in future dissemination and implementation research, ultimately informing the practice and policies of clinical care and public health services.

scholarly journals The Value of Real-World Data in Understanding Prostate Cancer Risk and Improving Clinical Care: Examples from Swedish Registries

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 875
Author(s):  
Kerri Beckmann ◽  
Hans Garmo ◽  
Ingela Franck Lissbrant ◽  
Pär Stattin
Keyword(s):  
Prostate Cancer ◽  
Real World ◽  
Clinical Care ◽  
Prostate Cancer Risk ◽  
Real World Data ◽  
Level Of Evidence ◽  
World Data ◽  
Cancer Data ◽  
Using Data ◽  
Randomised Controlled

Real-world data (RWD), that is, data from sources other than controlled clinical trials, play an increasingly important role in medical research. The development of quality clinical registers, increasing access to administrative data sources, growing computing power and data linkage capacities have contributed to greater availability of RWD. Evidence derived from RWD increases our understanding of prostate cancer (PCa) aetiology, natural history and effective management. While randomised controlled trials offer the best level of evidence for establishing the efficacy of medical interventions and making causal inferences, studies using RWD offer complementary evidence about the effectiveness, long-term outcomes and safety of interventions in real-world settings. RWD provide the only means of addressing questions about risk factors and exposures that cannot be “controlled”, or when assessing rare outcomes. This review provides examples of the value of RWD for generating evidence about PCa, focusing on studies using data from a quality clinical register, namely the National Prostate Cancer Register (NPCR) Sweden, with longitudinal data on advanced PCa in Patient-overview Prostate Cancer (PPC) and data linkages to other sources in Prostate Cancer data Base Sweden (PCBaSe).

Communication and psychological safety in veterans health administration work environments

2014 ◽  
Vol 28 (6) ◽  
pp. 754-776 ◽  
Author(s):  
Nancy J. Yanchus ◽  
Ryan Derickson ◽  
Scott C. Moore ◽  
Daniele Bologna ◽  
Katerine Osatuke
Keyword(s):  
Health Care Providers ◽  
Care Delivery ◽  
Clinical Care ◽  
Psychological Safety ◽  
Veterans Health Administration ◽  
Employee Perceptions ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Content Type

Purpose – The purpose of this paper is to explore employee perceptions of communication in psychologically safe and unsafe clinical care environments. Design/methodology/approach – Clinical providers at the USA Veterans Health Administration were interviewed as part of planning organizational interventions. They discussed strengths, weaknesses, and desired changes in their workplaces. A subset of respondents also discussed workplace psychological safety (i.e. employee perceptions of being able to speak up or report errors without retaliation or ostracism – Edmondson, 1999). Two trained coders analysed the interview data using a grounded theory-based method. They excerpted passages that discussed job-related communication and summarized specific themes. Subsequent analyses compared frequencies of themes across workgroups defined as having psychologically safe vs unsafe climate based upon an independently administered employee survey. Findings – Perceptions of work-related communication differed across clinical provider groups with high vs low psychological safety. The differences in frequencies of communication-related themes across the compared groups matched the expected pattern of problem-laden communication characterizing psychologically unsafe workplaces. Originality/value – Previous research implied the existence of a connection between communication and psychological safety whereas this study offers substantive evidence of it. The paper summarized the differences in perceptions of communication in high vs low psychological safety environments drawing from qualitative data that reflected clinical providers’ direct experience on the job. The paper also illustrated the conclusions with multiple specific examples. The findings are informative to health care providers seeking to improve communication within care delivery teams.

TRUU-Lab: Methods for Optimizing Test Names for Understanding and Utilization

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S120-S121
Author(s):  
J Wang ◽  
E Garnett ◽  
I Singh ◽  
C Bierl ◽  
B Jackson
Keyword(s):  
Identity Development ◽  
Laboratory Test ◽  
Guideline Development ◽  
Primary Care Providers ◽  
Second Phase ◽  
Care Providers ◽  
Current Test ◽  
Adoption And Implementation ◽  
Clinical Scenarios ◽  
National Initiative

Abstract Introduction/Objective Poor understandability of laboratory test names increases the risk for inappropriate test utilization and medical errors. Yet, human understandability has not been a major consideration in existing laboratory test names or naming guidelines. TRUU-Lab (Test Renaming for Understanding and Utilization for Laboratory Test Names) is a national initiative that now has more than 45 members representing more than 20 academic and industry organizations, the CDC, and the FDA. The goals of the initiative include: 1) Identify root causes and challenges in understanding and using laboratory test names; 2) Share resources related to potential solutions; 3) Develop consensus guidelines for laboratory test naming; 4) Establish consensus names for existing laboratory tests; and 5) Promote the adoption and implementation of consensus laboratory test names. Methods We previously addressed the first two goals of this initiative by identifying problematic test names and features of test names that contribute to misutilization. We also identified the advantages and limitations of current test naming guidelines and previous standardization efforts. This current study addresses goals 3 and 4. We developed an iterative process of guideline development. This process includes collecting feedback on consensus names to improve guidelines, which then informs the improvement of the consensus names. Results By analyzing test name characteristics, we found that the requirements for understandability vary with respect to the clinical scenario and provider background. We have used these results to design a 30-min long survey to test candidate names. The survey will be distributed through the Brand Institute, which offers expertise in pharmaceutical name and brand identity development. This pilot survey will be sent to primary care providers to assesses intuitive name preferences given a short and specific prompt. The second phase will take place in a simulated electronic medical record environment to present clinical scenarios where physicians will select an appropriate test. Conclusion We expect that results from survey studies will directly inform the development of TRUU-Lab naming guidelines, in turn permitting development of better-optimized laboratory test names. This process represents a new strategy for the intentional design of laboratory test names that are understandable and promote correct provider utilization.

scholarly journals An Evaluation of the Five Most Used Evidence Based Bedside Information Tools in Canadian Health Libraries

2008 ◽  
Vol 3 (2) ◽  
pp. 3 ◽  
Author(s):  
Alison Farrell
Keyword(s):  
Electronic Mail ◽  
Clinical Evidence ◽  
Resource Assessment ◽  
Ease Of Use ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Levels Of Evidence ◽  
Information Tools ◽  
Canadian Health ◽  
Clinical Questions

Objective – This project sought to identify the five most used evidence based bedside information tools used in Canadian health libraries, to examine librarians’ attitudes towards these tools, and to test the comprehensiveness of the tools. Methods – The author developed a definition of evidence based bedside information tools and a list of resources that fit this definition. Participants were respondents to a survey distributed via the CANMEDLIB electronic mail list. The survey sought to identify information from library staff regarding the most frequently used evidence based bedside information tools. Clinical questions were used to measure the comprehensiveness of each resource and the levels of evidence they provided to each question. Results – Survey respondents reported that the five most used evidence based bedside information tools in their libraries were UpToDate, BMJ Clinical Evidence, First Consult, Bandolier and ACP Pier. Librarians were generally satisfied with the ease of use, efficiency and informative nature of these resources. The resource assessment determined that not all of these tools are comprehensive in terms of their ability to answer clinical questions or with regard to the inclusion of levels of evidence. UpToDate was able to provide information for the greatest number of clinical questions, but it provided a level of evidence only seven percent of the time. ACP Pier was able to provide information on only 50% of the clinical questions, but it provided levels of evidence for all of these. Conclusion – UpToDate and BMJ Clinical Evidence were both rated as easy to use and informative. However, neither product generally includes levels of evidence, so it would be prudent for the practitioner to critically appraise information from these sources before using it in a patient care setting. ACP Pier eliminates the critical appraisal stage, thus reducing the time it takes to go from forming a clinical question to implementing the answer, but survey respondents did not rate it as high in terms of usability. There remains a need for user-friendly, comprehensive resources that provide evidence summaries relying on levels of evidence to support their conclusions.

Sign in / Sign up

Export Citation Format

Share Document