International Journal of Evidence-Based Healthcare最新文献

Background: Health services across the world are constantly introducing changes into their workplaces and these affect many people. As new robust and reliable evidence becomes available, it is important that changes to practice are made. As health professionals, we have to be flexible and accommodate this change; for some this means disruption, challenge and having to learn new ways of doing things. Barriers exist that prevent or delay changes being made to established practice in all organizations, whatever the culture. This is a world-wide problem. It is important to understand the barriers to change so that solutions can be found. Some changes that are needed don't occur, because clinicians are unaware of the new evidence, while for others there needs to be something introduced to drive forward the change. This process is not a passive one; active involvement is needed for the change to be successful. Individual attitudes and beliefs play a significant part in change, and their influences are often underestimated, so these also need to be explored. Practice change may require new skills to be learnt - another obstacle for change.

Aim: In this short communication, the science behind evidence implementation is introduced and then some of the factors that impact on change are explored, drawing on three useful models and frameworks.

Conclusion: Ultimately there remains a gap between interventions that research has shown to be effective and their translation into practice; this has to be closed.

The notion of context, while underpinning everything that we do in health care, remains something that is difficult to define; however, it determines the success or failure of everything that we do, particularly in the global healthcare arena. Whether we consider context as an objective or subjective construct, it should influence every evidence-based decision we make as healthcare professionals. Methods developed as part of the implementation science movement, including realist synthesis and 'mindlines', emphasize the important of addressing social, cultural and environmental context-specific influences when considering the implementation of complex interventions, particularly in diverse populations. The Joanna Briggs Institute evidence-based clinical fellowship program empowers practitioners, through education, to implement evidence into their own practice areas, taking into account the key variables that impact on successful adoption.

Frailty is an age-related condition characterized by increased vulnerability to negative outcomes. To enable informed decision-making and implementation of individually tailored practices for frailty management, it is necessary to develop screening tools that cover different domains of individual functioning, reliably predict future adverse outcomes and are generalizable to healthcare settings other than primary care. The Sunfrail Tool, an easy-to-use nine-item instrument, seems to meet all these requirements. The current study aimed to perform a cross-cultural adaptation of the Sunfrail Tool for the European Portuguese population and to perform the feasibility, appropriateness and meaningfulness analyses of the Sunfrail Tool Portuguese version.

Methods: The process of cross-cultural adaptation was conducted in four-phases (translation, synthesis, back translation and creation of consensual version). To reinforce the content validity, the additional analysis on feasibility, appropriateness and meaningfulness were conducted with end-users (older adults, informal caregivers and health and social care professionals).

Results: The frailty concept was considered suitable for the European Portuguese population. A consensus version was reached by an expert panel after considering the results of two forward and two back-translations. This prefinal version was endorsed to the first author of the original version of the instrument, as recommended by international guidelines. The content validation performed by healthcare professionals (n = 7), patients (n = 18) and informal caregivers (n = 3) showed that the Sunfrail Tool was moderately comprehensible and ambiguous. Five items required changes for cultural adaptation.

Conclusion: The Sunfrail Tool seems to be a promising instrument for the early identification of frailty to be used in the European Portuguese context to inform clinical decisions on preventive responses. However, to enable identification of frail and nonfrail individuals with this tool and ensure effectiveness on pathways activation for frailty management, there is a need to define cut-off points. Guidelines supporting the interview process are also desirable.

The prevalence of diabetes is on the rise worldwide especially in developed countries. The aim of glucose management in all types of diabetes is to minimize chronic and acute complications associated with diabetes. All patients with type 1 diabetes mellitus (T1DM) require insulin. Main areas of technology advances in diabetes are continuous subcutaneous insulin infusion (CSII) and also continuous glucose monitoring systems for the management of patients with both types of diabetes. It is very important to analyse the epidemiological situation within each country before and during the clinical practice guidelines (CPGs) development and implementation. The analyses will allow us to monitor the effect of the CPG after its implementation.The aim of this short communication is to analyse the epidemiology of prevalence and incidence of diabetes mellitus and use of CSII to inform development of CPGs in the Czech Republic.The analysis is developed based on the data managed by Institute of Health Information and Statistics of the Czech Republic. We used the National Register of Reimbursed Health Services 2015-2017 as primary source, and the annual report type A (Ministry of Health) 1-01: for Diabetology (A MH 004) 2007-2017 was used as validation source. The presented data are related to the year 2016 because we were able to validate them based on the data from 2015 to 2017 for this cohort of patients.The number of patients with T1DM is increasing in the Czech Republic with no significant sex difference. Life expectancy is about 11 years lower in the T1DM population. The majority of the patients are in older age; however, these are not treated with CSII compared with the younger population. From 61 533 patients with T1DM, 81% were reported with acute and chronic complications in 2016. Only 5011 of these patients were reported as using CSII.

Methodological flaws, limitations, and inadequate practices in research are well known and pose threats to the internal validity of any research study. However, there are ways of safeguarding research conduct to reduce the chance of research producing distorted results. Numerous tools now exist to assess the incorporation of such safeguards into primary research studies (also known as quality and/or risk-of-bias assessment). These tools typically include a variety of items that are then checked against those implemented in the study. Despite a lot of research in this area, no comprehensive generic classification of safeguards across study designs exist, although attempts have been made to clarify aspects of this. We review the developments in this area as well as use preliminary data from 100 methodological studies to illustrate our proposed approach. We conclude by proposing a new framework for identifying research studies at risk of being biased and the information in this article will promote a unification of the diverse approaches to facilitating bias assessment in clinical research.