scholarly journals Addressing low-value pharmacological prescribing in primary prevention of CVD through a structured evidence-based and theory-informed process for the design and testing of de-implementation strategies: the DE-imFAR study

2019 ◽  
Author(s):  
Alvaro Sanchez ◽  
Jose Ignacio Pijoan ◽  
Susana Pablo ◽  
Marta Maialen Mediavilla ◽  
Rita Sainz ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Primary Prevention ◽  
Clinical Care ◽  
Implementation Strategies ◽  
Research Field ◽  
Evidence Based ◽  
Policy Makers ◽  
Behavior Change Wheel ◽  
High Prevalence ◽  
Comprehensive Framework

Abstract Background: De-implementation or abandonment of ineffective or low-value healthcare is becoming a priority research field globally due to the growing empirical evidence of the high prevalence of such care and its impact in terms of patient safety and social inefficiency. Little is known, however, about the factors, barriers and facilitators involved or about interventions that are effective in promoting and accelerating the de-implementation of low-value healthcare. The De-imFAR study seeks to carry out a structured, evidence-based and theory-informed process involving the main stakeholders (clinicians, managers, patients and researchers) for the design, deployment and assessment of de-implementation strategies for reducing low-value pharmacological prescribing.Methods: A Phase I formative study using a systematic and comprehensive framework based on theory and evidence for the design of implementation strategies – specifically, the Behavior Change Wheel (BCW) - will be conducted to design and model de-implementation strategies to favour reductions in low-value pharmacological prescribing of statins in primary prevention of cardiovascular disease (CVD) by main stakeholders (clinicians, managers, patients and researchers) in a collegiate way. Subsequently, a Phase II comparative hybrid trial will be conducted to assess the feasibility and potential effectiveness of at least one active de-implementation strategy to reduce low-value pharmacological prescribing of statins in primary prevention of CVD compared to the usual procedures for dissemination of clinical practice guidelines ("what-not-to-do" recommendations). A mixed methods evaluation will be used: quantitative for the results of the implementation at the professional level (e.g., adoption, reach and implementation or execution of the recommended clinical practice); and qualitative to determine the feasibility and perceived impact of the de-implementation strategies from the clinicians’ perspective, and patients’ experiences related to the clinical care received.Discussion: The DE-imFAR study aims to generate valid scientific knowledge about the design and development of de-implementation strategies using theory- and evidence-based methodologies suggested by implementation science. It will explore the effectiveness of these strategies and their acceptability among clinicians, policy makers and patients. Its ultimate goal is to maximize the quality and efficiency of our health system by abandoning low-value pharmacological prescribing.

scholarly journals Psychiatry in the future

2004 ◽  
Vol 28 (8) ◽  
pp. 277-278
Author(s):  
Frank Holloway
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Evidence Based Medicine ◽  
Cochrane Collaboration ◽  
Routine Clinical Practice ◽  
Evidence Based ◽  
Policy Makers ◽  
The Future ◽  
The Cochrane Collaboration ◽  
Based Medicine

In an era of evidence-based medicine, policy-makers and researchers are preoccupied by the task of ensuring that advances in research are implemented in routine clinical practice. This preoccupation has spawned a small but growing research industry of its own, with the development of resources such as the Cochrane Collaboration database and journals such as Evidence-Based Mental Health. In this paper, I adopt a philosophically quite unfashionable methodology – introspection – to address the question: how has research affected my practice?

scholarly journals COVID-19: Military Nurses Leading Innovation Through Research, Clinical Care, Education, and Collaboration

2021 ◽  
Vol 186 (Supplement_2) ◽  
pp. 1-3
Author(s):  
Heather C King ◽  
Laura A Talbot
Keyword(s):  
Clinical Practice ◽  
Evidence Based Practice ◽  
Clinical Care ◽  
Armed Forces ◽  
Evidence Based ◽  
Leadership Roles ◽  
Military Nurses ◽  
Care Education ◽  
Military Nursing ◽  
Practice Projects

ABSTRACT Military nurses have been placed in the forefront of clinical and leadership roles during the COVID-19 pandemic. Serving in critical roles, military nurses have spearheaded innovations in clinical practice, conducted research, and implemented evidence-based practice projects that have advanced the capabilities of the Armed Forces Nurse Corps. This collection captures and highlights many of these military nursing contributions combating the COVID-19 pandemic.

scholarly journals The pragmatic randomised controlled trial

2002 ◽  
Vol 8 (5) ◽  
pp. 326-333 ◽  
Author(s):  
Matthew Hotopf
Keyword(s):  
Clinical Practice ◽  
Controlled Trial ◽  
Poor Quality ◽  
Evidence Based ◽  
Policy Makers ◽  
Randomised Controlled ◽  
New Treatments ◽  
Based Medicine ◽  
Pragmatic Randomised Controlled Trial ◽  
Clinical Problems

In recent years there has been much debate regarding the evaluation of treatments in medicine. The evidence-based medicine (EBM) movement has formed partly out of the realisation that clinical practice is often poorly informed by the best available evidence, and that many widely used treatments are either completely untested, or tested and proven to be ineffective or even harmful. EBM has been characterised as a stick by which policy-makers and academics beat clinicians (Williams & Garner, 2002). However, another side to EBM has been the realisation that research performed to test new treatments has often been of poor quality, or has asked the wrong questions (Hotopf et al, 1997; Thornley & Adams, 1998; Barbui & Hotopf, 2001). We have previously argued that clinicians could justifiably criticise the research establishment for failing to provide answers to relevant clinical problems of everyday practice (Hotopf et al, 1999).

Evidence-Based Approach to Advanced Wound Care Products

2015 ◽  
Vol 105 (5) ◽  
pp. 456-467 ◽  
Author(s):  
Jeffrey M. Robbins ◽  
Jeremiah Dillon
Keyword(s):  
Wound Care ◽  
Clinical Care ◽  
Program Review ◽  
Current Evidence ◽  
Evidence Based ◽  
Policy Makers ◽  
Department Of Veteran Affairs ◽  
Fiduciary Responsibility ◽  
Based Medicine ◽  
Evidence Based Care

There is increasing pressure from industry to use advanced wound care products and technologies. Many are very expensive but promise to reduce overall costs associated with wound care. Compelling anecdotal evidence is provided that inevitably shows wounds that failed all other treatments but responded positively to the subject product. Evidence-based medicine is the standard by which physician-scientists must make their clinical care decisions. In an attempt to provide policy makers with the most current evidence on advanced wound care products, the Department of Veteran Affairs conducted an Evidence-based Synthesis Program review of advanced wound care products. This paper suggests how to take this information and apply it to policy to drive evidence-based care to improve outcomes and fiduciary responsibility.

Identifying Effective Talent Management Policies and Practices in the United Arab Emirates (UAE)

2016 ◽  
pp. 292-305
Author(s):  
Joana Vassilopoulou ◽  
Ahu Tatli ◽  
Mustafa Ozbilgin ◽  
Ashly H. Pinnington ◽  
Abdullah Mohammed Alshamsi
Keyword(s):  
United Arab Emirates ◽  
Academic Research ◽  
Talent Management ◽  
Research Field ◽  
Management Approach ◽  
Evidence Based ◽  
Public And Private ◽  
Policy Makers ◽  
The Public ◽  
Management Policies

Talent management is an increasingly popular management approach and academic research field, yet it is understudied in non-western contexts. Understanding the issues of the management of talent is important in the context of the UAE, where talent shortages exist alongside high unemployment of Emirati nationals. Drawing on a larger study titled: ‘Movers and shakers of talent management in the UAE'', this chapter addresses this gap and generates recommendations for policy and decision making in UAE workplaces. We offer a foundation for evidence-based talent management for governmental policy makers and for organisations in the public and private sectors. Particularly, we suggest that focusing on empowerment and employment of Emirati talent is important but insufficient for organisations to tackle the complexity of talent. Legal and voluntary measures should focus on the current dynamics of talent locally and internationally in order to foresee the future of talent needs. This process is called future proofing, which can help organisations to prepare for future talent challenges.

Implementation of clinical practice guidelines in a multicenter radiation oncology department.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 117-117
Author(s):  
Sewit Teckie ◽  
Lucille Lee ◽  
Henry Chou ◽  
Petrina Zuvic ◽  
Louis Potters
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Radiation Oncology ◽  
Cancer Care ◽  
Clinical Care ◽  
Care Process ◽  
Standards Of Care ◽  
Cancer Site ◽  
Evidence Based

117 Background: Recent reports suggest that less than 20% of cancer care is based upon level I evidence. As a result, the majority of cancer care tends to be ad-hoc. Furthermore, deviations from established standards-of-care are associated with worse clinical outcomes. Systematic and evidence-based approaches to cancer care are widely regarded as an effective way of improving quality and value in oncology, yet their implementation remains broadly circumspect. In our multicenter radiation medicine department, we developed clinical practice guidelines (CPGs) that encourage consistent care in order to minimize variations in patient treatment, outcome, and experience. We hypothesized that CPGs would also improve efficiency, performance, and cost. Methods: We developed a system for prioritizing value in radiation oncology (Smarter Radiation Oncology) comprising three pillars – quality, evidence-based care, and patient experience. We created 87 unique, evidence-based and consensus-driven electronic CPGs that apply to the majority of patients undergoing radiation therapy in our department. Each CPG delineates an evidence-based treatment approach for a specific cancer site and stage, as well as many technical components such as simulation, treatment planning, quality assurance, clinical care requirements and survivorship. Results: Overall compliance to CPGs was >88%. Six-sigma Z-scores indicated improvement in efficiency and compliance. Treatment delays decreased and patients reported more favorable ratings on a variety of measures, including likelihood to recommend, wait times, understanding of treatment, and physician sensitivity. For breast and prostate cancer, adherence to CPG treatment resulted in 20% and 15% average lower costs than standard, non-CPG treatment. Conclusions: We demonstrate that consensus- and evidence-based CPGs can be successfully implemented in a multicenter department, with high adherence rates. CPGs improve safety and reduce costs by minimizing variation and deviations from standards-of-care. In an era of rising cancer spending, CPGs can be expanded beyond radiation oncology to the entire oncologic care process, thereby improving value for all cancer patients.

AGA Clinical Practice Guidelines: Robust, Evidence-Based Tools for Guiding Clinical Care Decisions

2015 ◽  
Vol 149 (2) ◽  
pp. 493-495
Author(s):  
Madelin R. Siedler ◽  
John I. Allen ◽  
Yngve T. Falck-Ytter ◽  
David S. Weinberg
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Care ◽  
Evidence Based ◽  
Robust Evidence

scholarly journals Approved Clinical Instructors' Perspectives on Implementation Strategies in Evidence-Based Practice for Athletic Training Students

2011 ◽  
Vol 46 (6) ◽  
pp. 655-664 ◽  
Author(s):  
Dorice A. Hankemeier ◽  
Bonnie L. Van Lunen
Keyword(s):  
Critical Thinking ◽  
Clinical Practice ◽  
Athletic Training ◽  
Evidence Based Practice ◽  
Implementation Strategies ◽  
Athletic Training Education ◽  
Evidence Based ◽  
Clinical Instructors ◽  
Approved Clinical Instructors ◽  
Ebp Implementation

Context: Understanding implementation strategies of Approved Clinical Instructors (ACIs) who use evidence-based practice (EBP) in clinical instruction will help promote the use of EBP in clinical practice. Objective: To examine the perspectives and experiences of ACIs using EBP concepts in undergraduate athletic training education programs to determine the importance of using these concepts in clinical practice, clinical EBP implementation strategies for students, and challenges of implementing EBP into clinical practice while mentoring and teaching their students. Design: Qualitative study. Setting: Telephone interviews. Patients or Other Participants: Sixteen ACIs (11 men, 5 women; experience as a certified athletic trainer = 10 ± 4.7 years, experience as an ACI = 6.8 ± 3.9 years) were interviewed. Data Collection and Analysis: We interviewed each participant by telephone. Interview transcripts were analyzed and coded for common themes and subthemes regarding implementation strategies. Established themes were triangulated through peer review and member checking to verify the data. Results: The ACIs identified EBP implementation as important for validation of the profession, changing paradigm shift, improving patient care, and improving student educational experiences. They promoted 3 methods of implementing EBP concepts with their students: self-discovery, promoting critical thinking, and sharing information. They assisted students with the steps of EBP and often faced challenges in implementation of the first 3 steps of EBP: defining a clinical question, literature searching, and literature appraisal. Finally, ACIs indicated that modeling the behavior of making clinical decisions based on evidence was the best way to encourage students to continue using EBP. Conclusions: Athletic training education program directors should encourage and recommend specific techniques for EBP implementation in the clinical setting. The ACIs believed that role modeling is a strategy that can be used to promote the use of EBP with students. Training of ACIs should include methods by which to address the steps of the EBP process while still promoting critical thinking.

scholarly journals Review of implementation strategies to change healthcare provider behaviour in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (3) ◽  
pp. 453-460 ◽  
Author(s):  
Kerstin de Wit ◽  
Janet Curran ◽  
Brent Thoma ◽  
Shawn Dowling ◽  
Eddy Lang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Implementation Research ◽  
Best Practice ◽  
Clinical Care ◽  
Intervention Strategy ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Medicine Research ◽  
Canadian Association ◽  
New Evidence

AbstractObjectivesAdvances in emergency medicine research can be slow to make their way into clinical care, and implementing a new evidence-based intervention can be challenging in the emergency department. The Canadian Association of Emergency Physicians (CAEP) Knowledge Translation Symposium working group set out to produce recommendations for best practice in the implementation of a new science in Canadian emergency departments.MethodsA systematic review of implementation strategies to change health care provider behaviour in the emergency department was conducted simultaneously with a national survey of emergency physician experience. We summarized our findings into a list of draft recommendations that were presented at the national CAEP Conference 2017 and further refined based on feedback through social media strategies.ResultsWe produced 10 recommendations for implementing new evidence-based interventions in the emergency department, which cover identifying a practice gap, evaluating the evidence, planning the intervention strategy, monitoring, providing feedback during implementation, and desired qualities of future implementation research.ConclusionsWe present recommendations to guide future emergency department implementation initiatives. There is a need for robust and well-designed implementation research to guide future emergency department implementation initiatives.

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