Measuring outcomes and monitoring progress in the era of evidence-based clinical practice

2019 ◽  
Vol 20 (3) ◽  
pp. 276-288
Author(s):  
Robyn L. Tate
Keyword(s):  
Clinical Practice ◽  
Outcome Measurement ◽  
Presidential Address ◽  
Assessment Instruments ◽  
Scientific Quality ◽  
Evidence Based ◽  
Behavioural Assessment ◽  
The Status ◽  
Measuring Outcomes

AbstractHealth outcome measurement is a growth industry. Thousands of behavioural assessment instruments, developed for neurological populations alone, are available for diagnosis, prediction and evaluation of interventions. The task of selecting the best instrument for the purpose at hand is thus a daunting one for the clinician and researcher. Fortunately, there are guides that make the task easier. This presidential address covers three interrelated themes that inform assessment in neurorehabilitation: First, it reviews current concepts and the status of behavioural assessment in neurorehabilitation. It then examines evidence-based clinical practice as applied to assessment of function, along with methods to benchmark the scientific quality of assessment instruments. Finally, the article considers the need to move beyond outcome measurement in the neurorehabilitation setting.

scholarly journals Analysis of the Status and Trends of Chinese Clinical Practice Guideline Development Between 2010 and 2020: A Systematic Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Rong Zhang ◽  
Si-yu Yan ◽  
Yun-yun Wang ◽  
Qiao Huang ◽  
Xiang-ying Ren ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Methodological Quality ◽  
Evidence Based ◽  
Healthcare Decision ◽  
Inclusion Criteria ◽  
Healthcare Decision Making ◽  
Status And Trends ◽  
The Status

Objective: This study aimed to systematically review the status and trends of Chinese clinical practice guidelines (CPGs) during the time period 2010–2020 and explore their methodological characteristics. Then, based on the strengths and weaknesses in development, offer several recommendations for the quality improvement which will serve as a reference for the users and developers of CPG.Introduction: With the development of evidence-based medicine (EBM), the CPGs play an increasingly important role in healthcare decision-making both in China and worldwide.Inclusion criteria: The CPGs that have been used to help the health professionals in the healthcare decision-making were included.Methodology: The China National Knowledge Infrastructure (CNKI) and WanFang databases were searched from 2010 to 2020 for the studies describing the general and methodological characteristics of Chinese CPGs. Comparisons of the methodological characteristics between the groups were conducted using the chi-square test or Fisher's exact test. The M-K test was adopted to identify the monotonically increasing or decreasing trends of methodological characteristics over the timespan.Results: A total of 2,654 CPGs fulfilled the inclusion criteria. The quantity and quality of the guidelines developed in China have improved over the time span. From 2010 to 2020,the guidelines had differing characteristics and covered a wide range of subjects. In total, 2,318(87.34%) guidelines focused on Western Medicine. Eight (0.30%) had been developed for patient versions of guidelines, 10(0.38%) were tentative guidelines, and 16(0.60%) were rapid advice guidelines. Medical specialty societies (including their branches) (71.1%) were the main guideline makers. The most addressed diseases were neoplasms (14.43%). The target population is mainly adults (84.97%). The methodological quality of consensus-based (CB)-CPGs was obviously lower than evidence-based (EB)-CPGs. Except for the item, “recommendations were based on evidence of systematic reviews,” there were statistical differences in all other methodological items between the EB-CPGS and CB-CPGS (P < 0.01). Higher methodological quality has been observed in EB-CPGs. All the data relating to the methodological characteristics indicated that higher methodological quality was present in the guidelines using GRADE (P < 0.01).Conclusion: The quantity and quality of the guidelines developed in China have improved between 2010 and 2020. CB-CPGs have also paid attention to the methodology quality, but obviously, this is lower than that in the EB-CPGs.

scholarly journals The Palliative Outcome Scale (POS) applied to clinical practice and research: an integrative review

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Fernanda Capella Rugno ◽  
Marysia Mara Rodrigues do Prado De Carlo
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Clinical Practice ◽  
Scientific Literature ◽  
Service Organization ◽  
Units Of Analysis ◽  
Final Sample ◽  
Measuring Outcomes ◽  
Pc Method

ABSTRACT Objective: to identify and evaluate the evidence found in the international scientific literature on the application of the Palliative Outcome Scale (POS) in clinical practice and research in Palliative Care (PC). Method: integrative literature review, through the search of publications in journals indexed in PubMed / MEDLINE, LILACS, SciELO and CINAHL databases, between the years 1999 and 2014. Results: the final sample consisted of 11 articles. In the data analysis, the articles were classified into 2 units of analysis (studies using the POS as a resource in research and studies using the POS in clinical practice), in which the information was presented in the form of sub-themes related to publications of the selected studies, highlighting the synthesis of the results. Conclusion: POS emerged as an important tool for measuring outcomes to assess the quality of life of patients and families, of the quality of care provided and the PC service organization. The international scientific literature on the application of POS proved to be relevant to the advancement and consolidation of the field of knowledge related to PC.

scholarly journals Indian nurses’ views on a collaborative model of best practices: Evidence-based practice, job satisfaction, learning environment, and nursing quality

2018 ◽  
Vol 8 (9) ◽  
pp. 87
Author(s):  
Kaisa Bjuresäter ◽  
Sister Tessy Sebastian ◽  
Bhalchandra Kulkarni ◽  
Elsy Athlin
Keyword(s):  
Job Satisfaction ◽  
Quality Of Care ◽  
Clinical Practice ◽  
Nursing Students ◽  
Learning Environment ◽  
Evidence Based Practice ◽  
Positive Impact ◽  
Evidence Based ◽  
Collaborative Model

Introduction: This study is a part of a project aimed at implementing and evaluating the Collaborative Model of Best Practice, (CMBP) to promoting evidence-based practice (EBP) in health care contexts. The aim of the study was to assess nurses’ interest, attitudes, utilisation, and views on promotors of and resources related to EBP before and after taking part in the CMBP project, and to investigate their views on the CMBP in relation to collaboration between the academy and clinical practice, the earning environment, job satisfaction, and nursing quality.Methods: A descriptive, comparative design was used with pre- and post-test measurements. The Research Utilization Questionnaire (RUQ) and study-specific questions were distributed to ward nurses (n = 67) in a rural Indian hospital.Results: Most of the nurses thought that the CMBP had a positive impact on quality of care, on their attitudes to, interest in, and knowledge EBP, and on their job satisfaction. They also considered that the collaboration between the nursing college and clinical practice had a positive impact on the learning environment and that more resources were available at the end of the project.Conclusions: The CMBP project was an attempt to improve the quality of care for patients and the learning environment for nursing students and nurses on the project wards. The results indicated fulfilment of these goals, which strengthens the usability of the model. Implementation of EBP is challenging and requires long-lasting activities and comprehensive support from leaders and facilitators. More studies are needed in which EBP is systematically implemented, accomplished, evaluated, and reported.

CoCanCPG. Coordination of Cancer Clinical Practice in Europe

2008 ◽  
Vol 94 (2) ◽  
pp. 154-159 ◽  
Author(s):  
Bèatrice Fervers ◽  
Magali Remy-Stockinger ◽  
Valèrie Mazeau-Woynar ◽  
Renèe Otter ◽  
Alessandro Liberati ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cancer Survival ◽  
Guideline Development ◽  
Critical Mass ◽  
Added Value ◽  
Evidence Based ◽  
Patients With Cancer ◽  
Use Of Resources ◽  
Common Framework

All European countries are facing common challenges for delivering appropriate, evidence-based care to patients with cancer. Despite tangible improvements in diagnosis and treatment, marked differences in cancer survival exist throughout Europe. The reliable translation of new research evidence into consistent patient-oriented strategies is a key endeavour to overcome inequalities in healthcare. Clinical-practice guidelines are important tools for improving quality of care by informing professionals and patients about the most appropriate clinical practice. Guideline programmes in different countries use similar strategies to achieve similar goals. This results in unnecessary duplication of effort and inefficient use of resources. While different initiatives at the international level have attempted to improve the quality of guidelines, less investment has been made to overcome existing fragmentation and duplication of effort in cancer guideline development and research. To provide added value to existing initiatives and foster equitable access to evidence-based cancer care in Europe, CoCanCPG will establish cooperation between cancer guideline programmes. CoCanCPG is an ERA-Net coordinated by the French National Cancer Institute with 17 partners from 11 countries. The CoCanCPG partners will achieve their goal through an ambitious, step-wise approach with a long-term perspective, involving: 1. implementing a common framework for sharing knowledge and skills; 2. developing shared activities for guideline development; 3. assembling a critical mass for pertinent research into guideline methods; 4. implementing an appropriate framework for cooperation. Successful development of joint activities involves learning how to adopt common quality standards and how to share responsibilities, while taking into account the cultural and organisational diversity of the participating organisations. Languages barriers and different organisational settings add a level of complexity to setting up transnational collaboration. Through its activities, CoCanCPG will make an important contribution towards better access to evidence-based cancer practices and thus contribute to reducing inequalities and improving care for patients with cancer across Europe.

scholarly journals It’s time to eliminate the mismatch between pediatric training and practice

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Frank Oberklaid
Keyword(s):  
Clinical Practice ◽  
Training Programs ◽  
Evidence Based ◽  
Community Settings ◽  
Service Delivery Models ◽  
The Past ◽  
Repeated Calls ◽  
Delivery Models ◽  
Pediatric Morbidity

AbstractThe quality of pediatric clinical practice is dependent on the training received during residency. It is assumed that the content of the training will adequately prepare pediatricians for the sorts of problems and issues they will be asked to manage in community settings. While over the past several decades there have been major changes in pediatric morbidity, there is evidence that training and service delivery models have not evolved; there is a significant mismatch between training and evidence-based clinical practice. A recent paper published in this journal (1) drew attention to the inadequacy of pediatricians’ training in child development. The reality of major gaps in the content and experiences of pediatric training in Israel are widely held, and there have been repeated calls for an increased focus on community child health and developmental and behavioural pediatrics. While it appears that finally there are some small initial steps to this end, it is strongly recommended that there be a long overdue, radical rethink of pediatric training programs.

scholarly journals Overview of evidence-based clinical practice guidelines for preoperative care: a systematic review.

2020 ◽  
Author(s):  
Agustín Ciapponi ◽  
Tapia-López Elena ◽  
Virgilio Sacha ◽  
Ariel Bardach
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cochrane Library ◽  
Evidence Based ◽  
Agree Ii ◽  
Quality Of Evidence ◽  
Moderate Quality

Abstract Background Our aim was to summarize and compare relevant recommendations from evidence-based CPGs (EB-CPGs). Methods Systematic review of clinical practice guidelines. Data sources: PubMed, EMBase, Cochrane Library, LILACS, Tripdatabase and additional sources. In July 2017, we searched CPGs that were published in the last 10 years, without language restrictions, in electronic databases, and also searched specific CPG sources, reference lists and consulted experts. Pairs of independent reviewers selected EB-CPGs and rated their methodological quality using the AGREE-II instrument. We summarized recommendations, its supporting evidence and strength of recommendations according to the GRADE methodology. Results We included 16 EB-CPGs out of 2262 references identified. Only nine of them had searches within the last five years and seven used GRADE. The median (percentile 25-75) AGREE-II scores for rigor of development was 49% (35-76%) and the domain ‘applicability’ obtained the worst score: 16% (9-31%). We summarized 31 risk stratification recommendations, 21.6% of which were supported by high/moderate quality of evidence (41% of them were strong recommendations), and 16 therapeutic/preventive recommendations, 59% of which were supported by high/moderate quality of evidence (75.7% strong). We found inconsistency in ratings of evidence level. ‘Guidelines’ applicability’ and ‘monitoring’ were the most deficient domains. Only half of the EB-CPGs were updated in the past five years. Conclusions We present many strong recommendations that are ready to be considered for implementation as well as others to be interrupted, and we reveal opportunities to improve guidelines’ quality.

scholarly journals Computer analysis of the emotional modality of 20 million publications in PUBMED database indicates ways to increase the effectiveness of pharmacotherapy by identifying pseudoscientific publications aimed at negative emotional "pumping" of doctors

2021 ◽  
pp. 19-40
Author(s):  
V. A. Maximov ◽  
I. Yu. Torshin ◽  
O. A. Gromova ◽  
A. N. Galustyan ◽  
I. V. Gogoleva ◽  
...  
Keyword(s):  
Evidence Based Medicine ◽  
Clinical Medicine ◽  
International Standards ◽  
Scientific Quality ◽  
Evidence Based ◽  
Treatment Standards ◽  
Pronounced Increase ◽  
Pubmed Database ◽  
Based Medicine

The search for original publications on fundamental and clinical medicine that would produce results of the highest scientific quality represents an urgent need for every medical researcher. Such publications are essential, in particular, for the development of reliable treatment standards. The Englishlanguage resources PUBMED and EMBASE are essential to help in solving this problem. However, there is an obvious problem in assessing the quality of the studies found. The paper formulates a method for analyzing the texts of biomedical publications, which is based on an algorithmic assessment of the emotional modality of medical texts (so-called sentiment analysis). The use of the topological theory of data analysis made it possible to develop a set of high-precision algorithms for identifying 16 types of sentiments (manipulative turns of speech, research without positive results, propaganda, falsification of results, negative personal attitude, aggressiveness of the text, negative emotional background, etc.). On the basis of the developed algorithms, a point scale for assessing the sentiment quality of research was obtained, which we called the "β-score": the higher the β-score, the less the evaluated text contains manipulative language constructions. As a result, the ANTIFAKE system (http://antifake-news.ru) was developed to analyze the sentiment-quality of Englishlanguage scientific texts. An analysis of ~ 20 million abstracts from PUBMED showed that publications with low sentiment quality (β-score <0, that is, that the prevalence of manipulative constructions over meaningful ones) is only 19 %. In the overwhelming majority of thematic headings (27,090 out of 27,840 headings of the MESH system PUBMED), a positive dynamics of sentiment quality of the texts of publications is shown by years). At the same time, as a result of the study, 249 headings were identified with sharply negative dynamics of sentiment quality and with a pronounced increase in manipulative sentiments characteristic of the "yellow" English-language press. These headings include tens of thousands of publications in peer-reviewed journals, which are aimed at (1) legalizing ethically unacceptable practices (euthanasia, perversions, so-called "population control", etc.), (2) discrediting psychiatry as a science, (3) media the war against micronutrients and (4) discrediting evidence-based medicine under the guise of developing the so-called "international standards of evidence-based medicine". In general, the developed system of artificial intelligence allows researchers to filter out pseudoscientific publications, the text of which is overloaded with emotional manipulation and which are published under the guise of "evidence-based standards".

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