scholarly journals Clinical practice guideline on the prevention and management of neonatal extravasation injury: a before-and-after study design

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kam Ming Chan ◽  
Janita Pak Chun Chau ◽  
Kai Chow Choi ◽  
Genevieve Po Gee Fung ◽  
Wai Wa Lui ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Central Line ◽  
Evidence Based ◽  
Post Intervention ◽  
Before And After ◽  
Level Of Knowledge ◽  
Intravenous Catheters ◽  
Before And After Study

Abstract Background Extravasation injury resulting from intravenous therapies delivered via peripheral intravenous catheters or umbilical and peripherally inserted central venous catheters is a common iatrogenic complication occurring in neonatal intensive care units. This study aimed to evaluate the effectiveness of an evidence-based clinical practice guideline in the prevention and management of neonatal extravasation injury by nurses. Methods A controlled before-and-after study was conducted in a neonatal unit. The clinical practice guideline was developed, and a multifaceted educational program was delivered to nurses. Neonatal outcomes, including the rates of peripheral intravenous extravasation and extravasation from a central line, were collected at the pre- and post-intervention periods. Post-intervention data for nurses, including the nurses’ level of knowledge and adherence, were collected at six months after the program. Results 104 and 109 neonates were recruited in the pre-intervention period (control) and the post-intervention period (intervention), respectively. The extravasation rate before and after the intervention was 14.04 and 2.90 per 1,000 peripheral intravenous catheters days, respectively. The adjusted odds ratio of peripheral intravenous extravasation post-intervention compared with that of pre-intervention was 0.20 (95% confidence interval: 0.05–0.74; p = 0.02) after adjusting for peripheral intravenous catheter days. The extravasation from a central line rate of the control and intervention groups post-intervention was 4.94 and zero per 1,000 central venous catheter days, respectively. Fifty-nine registered nurses were recruited. At six months post-program, there were significant improvements in the nurses’ level of knowledge and adherence. Conclusions These findings suggest that the implementation of an evidence-based clinical practice guideline significantly reduced the rate of peripheral intravenous extravasation and extravasation from a central line in neonates. However, to maintain nurses’ knowledge and adherence to the evidence-based practice, the educational program will have to be conducted periodically and incorporated into the nurses’ induction program. Trial registration ClinicalTrials.gov, Identifiers: NCT04321447. Registered 20 March 2020 - Retrospectively registered.

scholarly journals The development and evaluation of an online educational tool for the evidence-based management of neck pain by chiropractic teaching faculty

2020 ◽  
Author(s):  
Leslie Verville ◽  
Pierre Côté DC ◽  
Diane Grondin ◽  
Silvano Mior DC ◽  
Robin Kay
Keyword(s):  
Clinical Practice ◽  
Neck Pain ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Thinking Skills ◽  
Faculty Members ◽  
Evidence Based ◽  
Learning Design ◽  
Educational Tool ◽  
Learning Tool

Objective To develop an online, interactive educational tool to deliver an evidence-based clinical practice guideline to faculty members at a Canadian chiropractic college. Second, to evaluate the learning, design, and engagement constructs of the tool in a sample of chiropractic faculty members. Methods Using an integrated knowledge translation methodology and the Knowledge to Action Framework, we developed an evidence-based online learning tool. The context of the tool focused on a clinical practice guideline on the management of neck pain. We evaluated the learning, design, and engagement constructs in a sample of faculty members and residents using the Learning Object Evaluation Scale for Students. Participants were also asked to provide suggestions for improvement of the tool. Results Sixteen participants completed the evaluation. Most (68.8%) participants were chiropractors, 75% were male and 56% were between the ages of 25 and 44 years. At least 75% of participants agreed that the learning, design, and engagement constructs of the learning tool were adequate. The open-ended suggestions unveiled 3 pedagogical themes, relating to multimedia, thinking skills, and learner control, within the tool that could benefit from further development. These themes informed recommendations to improve the tool. Conclusion Our online, interactive, module-based learning tool has sound pedagogical properties. Further research is needed to determine if its use is associated with a change in knowledge.

Evidence-Based Clinical Practice Guideline: Reconstruction after Skin Cancer Resection

2021 ◽  
Vol 47 (7) ◽  
pp. 891-907
Author(s):  
Andrew Chen ◽  
John G. Albertini ◽  
Jeremy S. Bordeaux ◽  
Michael W. Chen ◽  
Jonathan L. Cook ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Skin Cancer ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Evidence Based ◽  
Cancer Resection

scholarly journals Referral and treatment rates of neoadjuvant chemotherapy in muscle-invasive bladder cancer before and after publication of a clinical practice guideline

2013 ◽  
Vol 4 (4) ◽  
pp. 263
Author(s):  
Brendan J.W. Miles ◽  
Adrian S. Fairey ◽  
Michael Eliasziw ◽  
Eric P. Estey ◽  
Peter Venner ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Clinical Practice ◽  
Neoadjuvant Chemotherapy ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Oncology Group ◽  
Chimiothérapie Néoadjuvante ◽  
Cancer De La Vessie ◽  
Before And After ◽  
Muscle Invasive

Introduction: The objective of this study was to compare referraland treatment rates of neoadjuvant chemotherapy for patients withmuscle-invasive bladder cancer before and after publication of aclinical practice guideline.Methods: This was a retrospective comparative cohort study of236 patients diagnosed with clinical stage ≥ T2 bladder cancerin Alberta, Canada. Patients were divided into 2 groups basedon the time of diagnosis relative to the publication of the AlbertaGenitourinary Oncology Group Clinical Practice Guideline onBladder Cancer (CPG), which recommends cisplatin-based neoadjuvantchemotherapy for muscle-invasive disease. The pre-CPGgroup included patients (n = 129) diagnosed prior to publicationof the CPG (November 1, 2002 to October 31, 2004, inclusively).The post-CPG group included patients (n = 107) diagnosed afterpublication of the CPG (November 1, 2005 to October 31, 2007).There was an accrual blackout period of 6 months before and afterthe CPG release date. The primary analysis compared the twogroups with respect to neoadjuvant chemotherapy referral rates,treatment-offered rates and treatment-administered rates.Results: Referral to medical oncology regarding neoadjuvantchemotherapy occurred in 2.3% and 23.4% of patients in thepre- and post-CPG groups, respectively (p < 0.01). Neoadjuvantchemotherapy was offered to 0.8% and 18.7% of patients in thepre- and post-CPG groups, respectively (p < 0.01). Neoadjuvantchemotherapy was administered to 0.8% and 14.0% of patients inthe pre- and post-CPG groups, respectively (p < 0.01).Interpretation: Neoadjuvant referral and treatment rates increasedafter publication of the CPG. However, overall referral and treatmentrates remained low, which warrants additional exploration.Introduction : L’objectif de l’étude était de comparer les taux derecommandation et de traitement par chimiothérapie néoadjuvantechez les patients atteints de cancer de la vessie avec envahissementmusculaire avant et après la publication d’un guide de pratiqueclinique.Méthodologie : Il s’agit ici d’une étude comparative rétrospectivede cohorte comptant 236 patients de l’Alberta, au Canada, chezqui on avait diagnostiqué un cancer de la vessie de stade cliniqueT2 ou pire. Les patients ont été répartis en 2 groupes selon que leurdiagnostic avait été posé avant ou après la publication du guidede pratique clinique sur le cancer de la vessie (GPC) de l’AlbertaGenitourinary Oncology Group, qui recommande une chimiothérapienéoadjuvante à base de cisplatine pour le traitement descas de cancer avec envahissement musculaire. Le groupe pré-GPCcomprenait des patients (n = 129) chez qui le diagnostic avaitété posé avant la publication du GPC (du 1er novembre 2002 au31 octobre 2004, inclusivement). Le groupe post-GPC incluait despatients (n = 107) chez qui le diagnostic avait été posé après lapublication du GPC (du 1er novembre 2005 au 31 octobre 2007).Une période cumulative de censure a été calculée 6 mois avant etaprès la date de publication du GPC. L’analyse préliminaire a comparéles deux groupes quant aux taux de recommandation de lachimiothérapie néoadjuvante, aux taux d’offre et d’administrationdu traitement.Résultats : La chimiothérapie néoadjuvante a été recommandée chez2,3 et 23,4 % des patients dans les groupes pré-GPC et post-GPC,respectivement (p < 0,01). Elle a été offerte à 0,8 % et 18,7 % despatients de ces mêmes groupes (p < 0,01), et administrée à 0,8 et14,0 % des patients des groupes pré-GPC et post-GPC, respectivement(p < 0,01).Interprétation : Les taux de recommandation et de traitement concernantla chimiothérapie néoadjuvante ont augmenté après lapublication du GPC, mais sont tout de même demeurés faibles,ce qui nécessite une analyse plus poussée.

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