OBJECTIVES:To measure the effectiveness of an educational intervention designed to teach residents four essential evidence-based medicine (EBM) skills: question formulation, literature searching, understanding quantitative outcomes, and critical appraisal. DESIGN:Firm-based, controlled trial. SETTING: Urban public hospital.PARTICIPANTS: Fifty-five first-year internal medicine residents: 18 in the experimental group and 37 in the control group.INTERVENTION: An EBM course, taught 2 hours per week for 7 consecutive weeks by senior faculty and chief residents focusing on the four essential EBM skills. MEASUREMENTS AND MAIN RESULTS:The main outcome measure was performance on an EBM skills test that was administered four times over 11 months: at baseline and at three time points postcourse. Postcourse test 1 assessed the effectiveness of the intervention in the experimental group (primary outcome); postcourse test 2 assessed the control group after it crossed over to receive the intervention; and postcourse test 3 assessed durability. Baseline EBM skills were similar in the two groups. After receiving the EBM course, the experimental group achieved significantly higher postcourse test scores (adjusted mean difference, 21%; 95% confidence interval, 13% to 28%; P Ͻ .001). Postcourse improvements were noted in three of the four EBM skill domains (formulating questions, searching, and quantitative understanding [ P Ͻ .005 for all], but not in critical appraisal skills [ P ؍ .4]). After crossing over to receive the educational intervention, the control group achieved similar improvements. Both groups sustained these improvements over 6 to 9 months of follow-up. CONCLUSIONS:A brief structured educational intervention produced substantial and durable improvements in residents' cognitive and technical EBM skills. Clinicians recognize the potential value of evidencebased medicine (EBM) but many feel ambivalent about its use in patient care. Major barriers to implementation include a perception that the appeal of EBM is more academic than practical, and clinicians cite their own lack of EBM skills as a contributing factor. 1 Many postgraduate training programs currently attempt to teach EBM skills, primarily in journal clubs and through didactic lectures. However, published outcomes of these efforts have shown only limited effectiveness. [2][3][4][5][6][7][8] Most of the studies have focused on critical appraisal while excluding or inadequately measuring other EBM skills. 9 Consequently, there are no published studies that assess how best to teach more fundamental EBM skills: the ability to create searchable questions that arise from knowledge gaps in patient care and the ability to perform efficient literature searches to answer those questions. 10 The acquisition of these skills, in addition to those of critical appraisal, is essential if EBM is to favorably influence patient outcomes. [11][12][13] We conducted a trial to test whether an educational program could improve four essential EBM skills among firstyear internal m...
Recent advances in technology have engendered a renewed enthusiasm in the use of intracardiac echocardiography (ICE) to guide and assess cardiac interventions. AcuNav is a phased-array sector imaging probe equipped with color and spectral Doppler capabilities. Previous-generation imaging catheters yielded unfamiliar limited-depth radial images with no flow information. Current imaging technology such as the AcuNav has not only consolidated the role of ICE but opened newer applications in the interventional laboratory. ICE has clear advantages over transesophageal echocardiography as the imaging modality of choice in the cardiac catheterization and electrophysiological laboratories. We review the technical evolution of ICE and describe the expanded utility of the AcuNav imaging catheter during cardiac interventions.
A 55-year-old man suffered head injury during a motor vehicle accident. He underwent a prophylactic inferior vena cava Greenfield filter placement. The filter migrated and lodged in the right ventricle at the level of the tricuspid valve. Successful percutaneous, transvenous retrieval of the Greenfield filter from the right ventricle was carried out.
Since the advent of percutaneous coronary intervention (PCI), intravenous unfractionated heparin has been the primary antithrombotic therapy to prevent periprocedural ischemic complications. As compared with unfractionated heparin, low molecular weight heparins (LMWHs) have a greater bioavailability and a more predictable therapeutic response. In several recent studies of patients undergoing PCI, LMWHs have been shown to be as safe and effective as unfractionated heparin; given their better pharmacokinetic profile and the lack of need for coagulation monitoring, they have the potential to replace unfractionated heparin during coronary interventions. This article reviews the current status of anticoagulation therapy with unfractionated heparin and LMWHs in the cardiac catheterization laboratory.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.