scholarly journals The Australian living guidelines for the clinical care of people with COVID-19: What worked, what didn’t and why, a mixed methods process evaluation

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261479
Author(s):  
Tari Turner ◽  
Julian Elliott ◽  
Britta Tendal ◽  
Joshua P. Vogel ◽  
Sarah Norris ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Process Evaluation ◽  
Online Survey ◽  
Clinical Evidence ◽  
Treatment Guidelines ◽  
Guideline Development ◽  
Clinical Care ◽  
Evidence Based ◽  
National Guidelines ◽  
Concurrent Process

Introduction The Australian National COVID-19 Clinical Evidence Taskforce is producing living, evidence-based, national guidelines for treatment of people with COVID-19 which are updated each week. To continually improve the process and outputs of the Taskforce, and inform future living guideline development, we undertook a concurrent process evaluation examining Taskforce activities and experience of team members and stakeholders during the first 5 months of the project. Methods The mixed-methods process evaluation consisted of activity and progress audits, an online survey of all Taskforce participants; and semi-structured interviews with key contributors. Data were collected through five, prospective 4-weekly timepoints (beginning first week of May 2020) and three, fortnightly retrospective timepoints (March 23, April 6 and 20). We collected and analysed quantitative and qualitative data. Results An updated version of the guidelines was successfully published every week during the process evaluation. The Taskforce formed in March 2020, with a nominal start date of March 23. The first version of the guideline was published two weeks later and included 10 recommendations. By August 24, in the final round of the process evaluation, the team of 11 staff, working with seven guideline panels and over 200 health decision-makers, had developed 66 recommendations addressing 58 topics. The Taskforce website had received over 200,000 page views. Satisfaction with the work of the Taskforce remained very high (>90% extremely or somewhat satisfied) throughout. Several key strengths, challenges and methods questions for the work of the Taskforce were identified. Conclusions In just over 5 months of activity, the National COVID-19 Clinical Evidence Taskforce published 20 weekly updates to the evidence-based national treatment guidelines for COVID-19. This process evaluation identified several factors that enabled this achievement (e.g. an extant skill base in evidence review and convening), along with challenges that needed to be overcome (e.g. managing workloads, structure and governance) and methods questions (pace of updating, and thresholds for inclusion of evidence) which may be useful considerations for other living guidelines projects. An impact evaluation is also being conducted separately to examine awareness, acceptance and use of the guidelines.

scholarly journals Evidence-Based Practices and Use among Employees and Students at an Austrian Medical University

2021 ◽  
Vol 10 (19) ◽  
pp. 4438
Author(s):  
Daniela Haluza ◽  
David Jungwirth ◽  
Susanne Gahbauer
Keyword(s):  
Online Survey ◽  
Ad Hoc ◽  
Point Of Care ◽  
Clinical Care ◽  
Evidence Based ◽  
Cross Sectional ◽  
Total N ◽  
Academic Context ◽  
Scientific Debate ◽  
Medical University

Developed in the pre-internet era in the early 1980s, empirical medical practice, i.e., evidence-based practice (EBP) has become crucial in critical thinking and statistical reasoning at the point-of-care. As little evidence is available so far on how EBP is perceived in the Austrian academic context, we conducted a cross-sectional online survey among a nonrandom purposive sample of employees and students at the Medical University Vienna, Austria (total n = 1247, 59.8% females). The German questionnaire assessed both EBP capability beliefs and EBP use, with the respective indices both yielding good internal consistency. We conducted subgroup comparisons between employees (n = 638) and students (n = 609). In line with Bandura’s self-efficacy theory, we found a correlation between EBP capability beliefs and EBP use, with higher scores reported in the employee group. The results indicated that the participants did not strictly follow the sequential EBP steps as grounded in the item-response theory. Since its emergence, EBP has struggled to overcome the dominating traditional way of conducting medicine, which is also known as eminence-based medicine, where ad hoc decisions are based upon expert opinions, and nowadays frequently supplemented by quick online searches. Medical staff and supervisors of medical students should be aware of the existing overlaps and synergies of these potentially equivalent factors in clinical care. There is a need for intensifying the public and scientific debate on how to deal with the divergence between EBP theory and EBP practice.

Antimicrobial prescribing behaviour in dogs and cats by Belgian veterinarians

2017 ◽  
Vol 182 (11) ◽  
pp. 324-324 ◽  
Author(s):  
Alexia Van Cleven ◽  
Steven Sarrazin ◽  
Hilde de Rooster ◽  
Dominique Paepe ◽  
Sofie Van der Meeren ◽  
...  
Keyword(s):  
Primary Care ◽  
Online Survey ◽  
Treatment Guidelines ◽  
Current Treatment ◽  
Antimicrobial Treatment ◽  
Fourth Generation ◽  
National Guidelines ◽  
First Line ◽  
Clinical Scenarios ◽  
Prescribing Behaviour

The objective of this study is to survey general prescribing behaviour by Belgian companion animal veterinarians and to assess agreement of these practices with current treatment guidelines. Therefore an online survey was administered with five realistic and frequently occurring first-line cases to primary-care veterinary practitioners. For each case a predefined pattern of questions were asked about whether or not they would prescribe antimicrobials, if they would prescribe a non-antimicrobial treatment and if they would perform additional diagnostic steps. The responses were compared with recommendations in national guidelines and recent literature. The overall most prescribed antimicrobials were potentiated amoxicillin (43.0 per cent), fluoroquinolones (14.7 per cent), third-generation and fourth-generation cephalosporins (10.9 per cent) and tetracyclines (10.9 per cent). Only 48.3 per cent of the veterinarians complied with the guidelines in nearly all of the clinical scenarios (ie, prescribing antimicrobials when indicated, not prescribing antimicrobials when it is not indicated). Moreover, when prescribing highest priority critically important antimicrobials, susceptibility testing on bacterial cultures was performed in only 12.4 per cent of the prescriptions. The results showed that the prescribing behaviour of antimicrobial compounds by primary-care veterinary practitioners in dogs and cats is often not in agreement with national guidelines. Focus in improvement of this prescribing behaviour should be on performing the appropriate diagnostic steps and decreasing the use of highest priority critically important antimicrobials.

scholarly journals Implementation Science Research Examining the Integration of Evidence-Based Practices Into HIV Prevention and Clinical Care: Protocol for a Mixed-Methods Study Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Model (Preprint)

2018 ◽  
Author(s):  
April Idalski Carcone ◽  
Karin Coyle ◽  
Sitaji Gurung ◽  
Demetria Cain ◽  
Rafael E Dilones ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Hiv Prevention ◽  
Implementation Science ◽  
Real World ◽  
Clinical Care ◽  
The United States ◽  
Barriers And Facilitators ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Ebp Implementation

BACKGROUND The Exploration, Preparation, Implementation, and Sustainment (EPIS) model is an implementation framework for studying the integration of evidence-based practices (EBPs) into real-world settings. The EPIS model conceptualizes implementation as a process starting with the earliest stages of problem recognition (Exploration) through the continued use of an EBP in a given clinical context (Sustainment). This is the first implementation science (IS) study of the integration of EBPs into adolescent HIV prevention and care settings. OBJECTIVE This protocol (ATN 153 EPIS) is part of the Scale It Up program, a research program administered by the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN), described in this issue by Naar et al. The EPIS study is a descriptive study of the uptake of 4 EBPs within the Scale It Up program. The goal of EPIS is to understand the barriers and facilitators associated with the Preparation, Implementation, and Sustainment of EBPs into HIV prevention and clinical care settings. METHODS The EPIS study is a convergent parallel mixed-methods IS study. Key implementation stakeholders, that is, clinical care providers and leaders, located within 13 ATN sites across the United States will complete a qualitative interview conducted by telephone and Web-based surveys at 3 key implementation stages. The Preparation assessment occurs before EBP implementation, Implementation occurs immediately after sites finish implementation activities and prepare for sustainment, and Sustainment occurs 1 year postimplementation. Assessments will examine stakeholders’ perceptions of the barriers and facilitators to EBP implementation within their clinical site as outlined by the EPIS framework. RESULTS The EPIS baseline period began in June 2017 and concluded in May 2018; analysis of the baseline data is underway. To date, 153 stakeholders have completed qualitative interviews, and 91.5% (140/153) completed the quantitative survey. CONCLUSIONS The knowledge gained from the EPIS study will strengthen the implementation and sustainment of EBPs in adolescent prevention and clinical care contexts by offering insights into the barriers and facilitators of successful EBP implementation and sustainment in real-world clinical contexts. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/11202

scholarly journals Active & Safe Central: using a mixed-methods design and the RE-AIM framework to evaluate a sport and recreational injury prevention resource for practitioners in Canada

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e039070
Author(s):  
Sarah A. Richmond ◽  
Samantha Bruin ◽  
Amanda M Black ◽  
Ian Pike ◽  
Shelina Babul
Keyword(s):  
Mixed Methods ◽  
Focus Group ◽  
Injury Prevention ◽  
Online Survey ◽  
Perceived Usefulness ◽  
Ice Hockey ◽  
Public Health Approach ◽  
Evidence Based ◽  
Local Health ◽  
Prevention Programmes

ObjectivesAn online, evidence-based resource was created to support the development of sport and recreational injury prevention programmes. The resource, called Active & Safe Central (www.activesafe.ca), provides evidence-based information across the public health approach for a number of sport and recreational activities. The objective of this project was to evaluate the perceived usefulness of Active & Safe Central as an educational tool.DesignA mixed-methods study design, guided by the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework, was used to evaluate Active & Safe Central.SettingData were collected using an online survey, available to all users of the site, and focus groups (n=2) that took place in Vancouver and Toronto, Canada.ParticipantsSurvey respondents (n=87) were recruited online, including parents, coaches, youth and adult athletes, and teachers. Focus group participants (n=16) were key stakeholders and end users, recruited from academia, local health sectors, sport and recreational organisations, and not-for-profit injury prevention organisations.ResultsPost launch, there were 1712 users visiting the website 2306 times (sessions), with the majority representing new users, over returning users (87.5% and 12.5%, respectively). There were 6340 page visits, with the most popular pages including soccer, playgrounds and ice hockey. Active & Safe Central was reported as a credible source of evidence-based sport and recreational information and that the site would be recommended to others. Information collected from focus group participants was used to inform necessary adaptations to the online platform, including critical navigation issues, visualisations and interactivity. The major themes that emerged from focus group and survey data included increased awareness of injury prevention recommendations and that the recommendations would be used in one’s own sporting activity and/or practice.ConclusionsThe results of the evaluation suggest the tool is a useful resource for sport and recreational injury information that has significant potential to impact prevention practice.

Bringing stroke clinical guidelines to life

2019 ◽  
Vol 14 (4) ◽  
pp. 337-339 ◽  
Author(s):  
Coralie English ◽  
Mark Bayley ◽  
Kelvin Hill ◽  
Peter Langhorne ◽  
Marja Molag ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Practice Guidelines ◽  
Research Evidence ◽  
Guideline Development ◽  
Clinical Care ◽  
Evidence Based ◽  
Use Of Resources ◽  
New Models ◽  
New Evidence ◽  
Technological Platforms

Clinical practice guidelines are essential for driving evidence-based clinical care to patients. In an era of ever-increasing research evidence, keeping guidelines up to date is a challenging and resource-intensive process. Advances in technological platforms provide opportunities to develop new models of guideline development that will allow for continuous, rapid updates to recommendations as new evidence emerges. As Australia and other countries begin to develop these models, we have an opportunity to work more closely together to ensure the most efficient use of resources.

scholarly journals Mixed-methods Process Evaluation of a Residence-based SARS-CoV-2 Testing Participation Pilot on a UK University Campus during the COVID-19 Pandemic

2021 ◽  
Author(s):  
Holly Blake ◽  
Sophie Carlisle ◽  
Lauren Fothergill ◽  
Juliet Hassard ◽  
Alex Favier ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Process Evaluation ◽  
Online Survey ◽  
Management Strategies ◽  
Mental Wellbeing ◽  
University Campus ◽  
Implementation Barriers ◽  
Intervention Delivery ◽  
University Life ◽  
Mixed Messages

Abstract BackgroundRegular testing for SARS Coronavirus-2 (SARS-CoV-2) is an important strategy for controlling virus outbreaks on university campuses during the COVID-19 pandemic but testing participation rates can be low. The Residence-Based Testing Participation Pilot (RB-TPP) was a novel intervention implemented at two student residences on a large UK university campus over four weeks. The aim of the pilot was to increase the frequency of asymptomatic SARS-CoV-2 saliva testing onsite. This process evaluation aimed to determine whether RB-TPP was implemented as planned and identify implementation barriers and facilitators.MethodsA mixed-methods process evaluation was conducted alongside the RB-TPP. Evaluation participants were students (opting in, or out of RB-TPP) and staff with a role in service provision or student support. Monitoring data were collected from the intervention delivery team and meeting records. Data were collected from students via online survey (n=152) and seven focus groups (n=30), and from staff via individual interviews (n=13). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the ‘Capability, Opportunity, Motivation–Behaviour’ (COM-B) behaviour change framework.Results464 students opted to participate in RB-TPP (98% of students living onsite). RB-TPP was implemented broadly as planned but was terminated early due to concerns relating to national escalation of the COVID-19 Delta variant. Most students (97.9%) perceived the relaxing of social distancing regulations within residences positively. The majority engaged in asymptomatic testing (88%); 46% (52% of testers) were fully compliant with pre-determined testing frequency. Implementation was facilitated by convenience and efficiency of testing, reduction in the risk of self-isolation and opportunities for students to socialise. Main barriers to implementation were mixed-messages about the rules, ambivalent attitudes, and lack of adherence to COVID-19 protective measures in the minority.ConclusionsThis process evaluation identifies factors that help or hinder the success of university residence-based outbreak prevention and management strategies. RB-TPP led to increased rates of COVID-19 testing participation among students in university residences. Perceived normalisation of university life significantly enhanced student mental wellbeing. The complexity and challenge generated by multiple lines of communication and rapid adaptions to a changing pandemic context was evident.Trial registration numberUKAS 307727-02-01; Pre-results. ClinicalTrials.gov Identifier: NCT05045989; post-results (first posted, 16/09/21).Ethical ApprovalFMHS 96-0920

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