International Journal of Evidence-Based Healthcare最新文献

The current article provides an overview of an approach to incorporating a range of evidence, including qualitative research findings, which the authors piloted when developing a clinical guideline on epilepsies in children and young people. We describe methods used for incorporating literature types not usually included in Scottish Intercollegiate Guidelines Network guidelines, including critical appraisal, and establishing dependability and credibility of qualitative findings. We highlight limitations encountered and make suggestions for future work.

Despite a significant transformation of ischaemic stroke management, it remains one of the leading causes of death, disability, functional impairment and cognitive deficits. With the advent of intravenous thrombolysis and mechanical thrombectomy, stroke is not an untreatable disease, mostly occurring in older people, any more. The most common cause of cardioembolic strokes is atrial fibrillation or flutter and atrial fibrillation is the most prevalent arrhythmia.The aim of this short communication is to describe the methodology of the Czech stroke guidelines development.High-quality 2017 Australian Stroke Foundation stroke guideline was considered for adaptation and a new guideline was developed and disseminated.

A qualitative systematic review was carried out to identify men's perceptions of the impact of the physical consequences of a radicalized prostatectomy on their quality of life (QOL). The review included men of all ages and nationalities who had radicalized prostatectomy as treatment for all stages of prostate cancer. Inclusion criteria were studies that investigated the physical consequences of radicalized prostatectomy and its impact on QOL and life experience as identified by the men and the psychosocial implications of the identified physical consequences of radicalized prostatectomy as identified by the men. A search across six databases aimed to find English language studies (November 2017). Critical appraisal was conducted using the Joanna Briggs Institute critical appraisal instrument for qualitative studies. Nineteen qualitative studies were included and the findings are presented as five aggregated qualitative syntheses.Urinary incontinence and erectile dysfunction are significant side-effects of radicalized prostatectomy that have a negative impact on men's QOL for which they feel ill prepared. Men are often reluctant to discuss their emotions and therefore the need to create suitable opportunities for them to express their feelings in conjunction with appropriate evidence-based emotional support and advice is pivotal to the development of support interventions. This review highlights the importance of men being made aware of the impact the physical effects that radicalized prostatectomy can have on their QOL and that those who select radicalized prostatectomy as a treatment strategy must be provided with appropriate information and support from healthcare professionals.

Aim: Evidence-based practice (EBP) plays a significant part in healthcare. There has been little research into the standard of care that healthcare workers provide to patients in Saudi Arabia. The purpose of this study was to investigate occupational therapy practitioners' (OTPs) decision-making preferences, attitudes and awareness in relation to EBP as well as to discover any barriers possibly limiting EBP implementation.

Methods: A cross-sectional study was conducted using an online survey. The survey was distributed to OTPs in Saudi Arabia from May to July 2018. Data were collected on demographics, decision-making preferences, attitudes and awareness as well as on the barriers obstructing implementation of EBP. The percentages and frequencies of OTPs' responses were analysed and reported. Pearson's Chi-square test was performed to explore the association between demographic variables and the attitudes and awareness of OTPs. The data were analysed using IBM SPSS Statistics 24.

Results: A total of 144 participants responded to the questionnaire, out of which 54 participants were excluded as they only completed the demographics section, and they did not answer any of the following sections. Among the completed responses (n = 90), one undergraduate participant was excluded. The final number of respondents whose data were analysed was 89 (61.8%). Out of the respondents, 58.4% were female and 73% had completed a bachelor's degree. No formal training in EBP was received by many of the respondents (53.9%). Although the attitude of 79.8% of OTPs about using research in practice was positive, a number were unfamiliar with some of the terms and with EBP implementation. The most important barrier to EBP implementation mentioned by the respondents was that their previous education had involved insufficient teaching (45%), while 42.7% mentioned inadequate resources and funding and 38.2% pointed to a lack of skills and research knowledge. The only significant association found in this study was between the awareness of OTPs and their education level.

Conclusion: Although the attitude of OTPs toward EBP implementation was positive, their awareness regarding the use of EBP was relatively low, indicating a gap in how they understand and apply EBP in Saudi Arabia. Thus, its inclusion in the curricula for graduates and undergraduates should be considered.

Currently in the Czech Republic, there does not exist such an institution as a 'National Centre for Clinical Practice Guidelines'. In 2017, there were about 123 professional medical organizations which developed about 1909 'guidelines' until 2017. However, the majority of these guidelines are 'expert opinion' or 'consensual' based 'guidance' or rather recommendations in the most cases missing a systematic approach that reflects evidence-based medicine principles and methods. The project is led by the Czech Health Research Council, the first partner is the Ministry of Health of the Czech Republic and the second partner is the Institute of Health Information and Statistics of the Czech Republic with support from policy makers, academics, clinicians and members of the Czech National Centre for Evidence-Based Healthcare and Knowledge Translations. This centre is an umbrella for three very important international collaborations which play a key role in Evidence-Based Healthcare, Evidence Synthesis, Evidence Implementation and trustworthy guidelines development. These are Cochrane Czech Republic, Masaryk University Grade Centre and the Czech Republic Centre for Evidence-Based Healthcare: The Joanna Briggs Institute Centre of Excellence.The main aim of this article is to present the Czech National Methodology of the Trustworthy Clinical Practice Guideline (CPG) development and the first results of the project 'Clinical Practice Guidelines'.A pilot phase of the project was realized during the first year of the project from January to December 2018. As the first step, there were established managing authorities including a Guarantee Committee and an Appraisal (Methodological) Committee. The Members of the Appraisal Committee developed a pilot version of the National Methodology of CPG development based on the best available approaches to Trustworthy CPGs development followed by testing on the first five pilot CPGs.

Aim: Clinical supervision has been recognized as a valuable mechanism through which healthcare professionals may evaluate, reflect upon and develop their clinical practice within the context of safeguarding. However, while there is a general consensus with regard to the value of clinical supervision there are multiple approaches to utilization in practice. This brief communication provides an overview of an evaluation of one model of safeguarding clinical supervision which was explicitly developed to support healthcare professionals in their everyday practice.

Methods: The current study used a survey approach, which involved the development and administration of an online anonymous survey with clinical supervisors and supervisees working within the one service of the Trust.

Results: The survey results showed that individuals were overall confident, knowledgeable and satisfied with their safeguarding supervisions. However, individuals at a lower band were significantly less positive about supervision, particularly in relation to how much they felt enabled to explore their safeguard concerns, how much they felt equipped to provide/receive safeguarding supervision and about how much they understood clearly the difference between managerial supervision/clinical and safeguarding supervision.

Conclusion: A number of key recommendations arising from the findings of the evaluation are presented in this article and are considered in terms of the question 'what constituents form the core components of a successful Safeguarding Supervision Framework relationship?'

Despite the undisputable benefits of tracheostomy, it has been reported to have links with impaired communication, reduced quality of life and a risk of health complications such as bleeding, tracheal stenosis and in some cases resulting in mortality. There is a paucity of literature on tracheostomy decannulation methods and procedures, leaving the decision to expert opinion and institutional guidelines. This study aimed to map evidence on methods and procedures of tracheostomy decannulation in adults and assessment of readiness for decannulation, to reveal knowledge gaps and inform further research. We conducted a systematic search of peer reviewed and grey literature on PubMed/MEDLINE, Google Scholar, Union Catalogue of Theses and Dissertations via SABINET Online, World Cat Dissertations and Theses via OCLC, WHO library and governmental websites from 1985 to present. Following title screening, abstract and full article screening was performed by two independent reviewers guided by the eligibility criteria. Data from included studies were extracted, collated, summarized and synthesized into the following themes: assessment, removal, monitoring and definition of failure of decannulation. Quality of the included studies was assessed using the Mixed Methods Appraisal Tool version 2011. Twenty-five out of 51 screened articles were eligible for data extraction. There was wide variation in the assessment methods employed across and within similar patient groups. The common themes that emerged in the assessment for readiness for decannulation are informed consent, clinical stability, airway patency, physiological decannulation, swallowing assessment, level of consciousness, effectiveness of cough and clearance of secretions. In conclusion, the current body of evidence is inadequate and requires further research, particularly validation of different parameters used. A protocol approach to decannulation may be inappropriate but rather an algorithmic approach using validated parameters.

Aim: In this article, the authors discuss a multiphase approach for developing quality indicators based on pain practice guidelines, and the challenges associated with the process. The presentation is based on previously published reporting standards for guideline-based quality indicators.

Methods: The following steps of the indicator development process were undertaken: topic selection; guideline selection; extraction of recommendations; quality indicator selection and practice test.

Results: Eleven practice guidelines were reviewed for quality, and three high-quality guidelines were compared for pertinent recommendations. From these three guidelines, 12 recommendations were extracted and judged appropriate to examine the practice gap for nursing students and clinicians on an oncology and palliative care unit. Quality indicators were then identified by a consensus process, resulting in 24 discrete indicators that were included in the practice test.

Conclusion: Quality indicators can be used to examine gaps in pain management practice, and to evaluate change after guideline implementation. However, their development can be challenging, and guideline developers could facilitate uptake of guidelines by including clear, relevant quality indicators as part of guideline creation and presentation.

Aim: Heterogeneity is an important consideration in systematic reviews, as high heterogeneity may imply that it is not suitable to perform meta-analysis. The degree of variation could be caused by clinical or methodological differences among the studies, or it could be due to the randomness of chance. Methods of assessing heterogeneity are calculating a statistical test for heterogeneity (the I value), visual evaluations of forest plots, conducting subgroup analysis or meta-regression. We conducted meta-regression on data of our previous systematic review on the effectiveness of robotic rehabilitation, and in this article, we present the findings and discuss its implications.

Method: In our meta-regression plots, plotted on the x-axis was the trial covariate (duration of intervention group therapy), and plotted on the y-axis was the effect size measure (standardized mean differences), with positive effect sizes favouring robotic intervention. Analysis using random effects was applied, and each study symbol was sized in proportion to its precision (inverse-variance weighting).

Results: Differences were observed in the meta-regression plots between the subgroups of therapy ratio = 0 and therapy ratio more than 0 for upper limb movement, lower limb walking and activities of daily living. For upper limb movement, positive linear relationships were found for both subgroups. However, in terms of the strength of the relationship, a stronger relationship was found for therapy ratio = 0. For lower limb walking, opposing linear relationships were found in both subgroups: therapy ratio = 0 had a negative linear relationship, whereas therapy ratio more than 0 had a positive linear relationship. For activities of daily living, positive linear relationships were found for both subgroups, but a stronger linear relationship was found for therapy ratio = 0.

Conclusion: From the meta-regression analysis, we found that differing levels of linear relationships and the varying spread of effect sizes across positive and negative ranges were the likely sources of heterogeneity. This was especially so in the meta-regression of lower limb walking, which showed opposing directions of linear relationships. The wider spread of effect sizes for therapy ratio = 0 could indicate that some robotic devices were more effective than others. In addition, for therapy ratio more than 0, the effect sizes were mainly found in the positive region, which implied that adding conventional training to robotic training was generally positive for robotic devices.