Medicine and Health Sciences Commons^™

Can Evidence-Based Medicine And Clinical Quality Improvement Learn From Each Other?, Paul Glasziou, Greg Ogrinc, Steve Goodman

Paul Glasziou

The considerable gap between what we know from research and what is done in clinical practice is well known. Proposed responses include the Evidence-Based Medicine (EBM) and Clinical Quality Improvement. EBM has focused more on ‘doing the right things’dbased on external research evidenced whereas Quality Improvement (QI) has focused more on ‘doing things right’ based on local processes. However, these are complementary and in combination direct us how to ‘do the right things right’. This article examines the differences and similarities in the two approaches and proposes that by integrating the bedside application, the methodological development and the training of …

Patterns Of 'Leakage' In The Utilisation Of Clinical Guidelines: A Systematic Review, Sharon Mickan, Amanda Burls, Paul Glasziou

Paul Glasziou

Background Research: Evidence is insufficient to change physicians’ behaviour. In 1996, Pathman developed a four step model: that physicians need to be aware of, agree with, adopt, and adhere to guidelines. Objective: To review evidence in different settings on the patterns of ‘leakage’ in the utilisation of clinical guidelines using Pathman’s awareness-to-adherence model.Methods: A systematic review was conducted in June 2010. Primary studies were included if they reported on rates of awareness and agreement and adoption and/or adherence.Results: 11 primary studies were identified, reporting on 29 recommendations. Descriptive analyses of patterns and causes of leakage were tabulated and graphed. Leakage …

Patient Education About Anticoagulant Medication: Is Narrative Evidence Or Statistical Evidence More Effective?, Kathleen Mazor, Joann Baril, Elizabeth Dugan, Frederick Spencer, Pamela Burgwinkle, Jerry Gurwitz

Elizabeth Dugan

OBJECTIVE: To determine the relative impact of incorporating narrative evidence, statistical evidence or both into patient education about warfarin, a widely used oral anticoagulant medication.

METHODS: 600 patients receiving anticoagulant therapy were randomly assigned to view one of three versions of a video depicting a physician-patient encounter where anticoagulation treatment was discussed, or usual care (no video). The videos differed in whether the physician used narrative evidence (patient anecdotes), statistical evidence, or both to highlight key information. 317 patients completed both the baseline and post-test questionnaires. Questions assessed knowledge, beliefs and adherence to medication and laboratory monitoring regimens.

RESULTS: All …

Case Managers' Roles And Functions: Commission For Case Manager Certification's 2004 Research, Part I, H. Tahan, Diane Huber, W. Downey

Diane Huber

The Commission for Case Manager Certification (CCMC) conducted its third case managers' role and functions study in 2004. The purpose of this research was to validate the currency and relevancy of the certified case manager examination. The results of this study are shared in 2 parts of an article. Part I discusses the process the CCMC used for the development of the Case Manager's Role and Functions Survey Instrument (CMRFSI). The research leads to the identification of 6 new essential functions and 6 new knowledge areas, which describe case management practice. These findings were based on the survey of a …

Acuity And Case Management: A Healthy Dose Of Outcomes, Part Ii, K. Craig, Diane Huber

Diane Huber

PURPOSE: This is the second of a 3-part series presenting 2 effective applications-acuity and dosage-that describe how the business case for case management (CM) can be made. In Part I, dosage and acuity concepts were explained as client need-severity, CM intervention-intensity, and CM activity-dose prescribed by amount, frequency, duration, and breadth of activities. Part I also featured a specific exemplar, the CM Acuity Tool, and described how to use acuity to identify and score the complexity of a CM case. Appropriate dosage prescription of CM activity was discussed. Part II further explains dosage and presents two acuity instruments, the Acuity …

Using Existing Databases For Product Evaluation: Silver-Treated Catheter Trial, M. Wagner, L. Dolan, Victoria Steelman, M. Boyd

Victoria J. Steelman

No abstract provided.

Prion Diseases--An Evidence-Based Protocol For Infection Control, Victoria Steelman

Victoria J. Steelman

Prion diseases are fatal, infectious, neurodegenerative disorders with special implications for infection control in the OR. The causative agent is highly resistant to disinfection and sterilization processes and has been transmitted during health care interactions. It is important to use evidence gained through research and case reports to minimize risk of infection. This article describes an infection control protocol developed for identifying high-risk patients, providing perioperative care, decontaminating the OR, and protecting health care personnel. This protocol provides multidisciplinary team members with a guideline for preventing transmission of these fatal diseases.

Evidence-Based Practice And School Nursing, S. Adams, Ann Mccarthy

Ann Marie McCarthy

School nurses need to demonstrate that their practice is based on the best evidence available, which is usually data obtained from research. Evidence-based practice involves combining the best evidence available with nursing expertise and patient and family preferences to determine optimum care. Evidence-based practice guidelines are developed by carefully reviewing the available evidence on a topic and synthesizing this information into recommendations for practice. This article defines evidence-based practice and best evidence, describes the development of evidence-based practice guidelines, discusses factors that affect the use of research and evidence-based practice guidelines in school nursing, and reviews current sources of evidence-based …

Exploring Obstacles To Proper Timing Of Prophylactic Antibiotics For Surgical Site Infections, J. Tan, V. Naik, Lorelei Lingard

Lorelei Lingard

BACKGROUND: Surgical site infections remain one of the leading types of nosocomial infections. The administration of prophylactic antibiotics within a specific interval has been shown to reduce the burden of surgical site infections, but adherence to proper timing guidelines remains problematic. This study examined perceived obstacles to the use of evidence-based guidelines for the timely administration of prophylactic antibiotics to prevent surgical site infections. METHODS: 27 semi-structured interviews were conducted with anesthesiologists (n = 12), surgeons (n = 11), and perioperative administrators (n = 4) in two large academic hospitals to elicit their perceptions of the factors that prevent the …