Evidence‐based medicine: going beyond improving care provider viewpoints, using and challenges upcoming

Rezazadeh, Esmaeil; Rezaei‐Hachesu, Peyman; Rezapoor, Aziz; Alireza, Khaksarian

doi:10.1111/jebm.12083

Cited by 11 publications

(6 citation statements)

References 26 publications

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“…The 5-year survival rate is the percentage of people who lived at least 5 years after being diagnosed with a certain disease (26, 28). Quality of life is the degree to which an individual is healthy, comfortable, and able to participate in or enjoy life events (29-31). Patient satisfaction is an important and commonly used indicator for measuring the quality of health care, which affects clinical outcomes, patient retention, and medical malpractice claims (33).…”

Section: Introductionmentioning

confidence: 99%

Comparing the effectiveness of revascularization interventions with medical therapy in patients with ischemic cardiomyopathy: A systematic review and meta-analysis

Faradonbeh

Azar

Rezapour

et al. 2018

Med. J. Islam. Repub. Iran

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Background: Determining the effectiveness of cardiovascular interventions plays an important role in reimbursement decisions, health care pricing, and providing clinical guidance on the use of existing clinical technologies. This study aimed to review and analyze the effectiveness of revascularization interventions (CABG and PCI) compared to medical therapy in patients with ischemic cardiomyopathy. Methods: Different databases were searched up to December 2017. The articles were selected based on inclusion and exclusion criteria. Quality of all studies was evaluated by Jadad score and relevant checklists. The I2 test was used to test heterogeneity. Also, to integrate the results of similar studies, meta-analysis was done using STATA software. Results: A total of 18 studies were included. Based on the random effects model, the overall results of comparing the effectiveness of revascularization interventions with medical therapy were as follow: 38.94 [95% CI: 26.95-50.94, p<0.001, I 2 = 99.6%, p<0.001], [75.31, 95% CI: 74.06-76.57, p<0.001, I 2 = 88.8, p<0.001], and 75.76 [95% CI: 71.99-79.53, p<0.001, I2= 99.2, p<0.001] for cardiac mortality rate, quality of life, and 5-year survival, respectively. Also, in patient satisfaction index, revascularization interventions were shown to be more effective than medical therapy. Conclusion: This study showed that revascularization interventions in all studied indices were more effective than medical therapy. Also, between revascularization interventions, PCI was more effective in cardiovascular mortality and 5-year survival than CABG in terms of quality of life. Moreover, CABG was more effective than PCI. In patient satisfaction index, the results of the 2 included studies were contradictory.

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Section: Introductionmentioning

confidence: 99%

Comparing the effectiveness of revascularization interventions with medical therapy in patients with ischemic cardiomyopathy: A systematic review and meta-analysis

Faradonbeh

Azar

Rezapour

et al. 2018

Med. J. Islam. Repub. Iran

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“…The proformas available at the acute surgery workstations were modified into checklists. Trainees were also encouraged to include the checklists as a part of their patient treatment records [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Use of a Clinical Audit System in Implementing Surviving Sepsis Campaign Guidelines in Patients With Peritonitis

Valiveru¹,

Cherian²,

Srinivasan³

et al. 2021

Cureus

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Background Sepsis is the predominant cause of morbidity and mortality in patients with peritonitis. "Surviving Sepsis Campaign" (SSC) is an international effort in reducing mortality based on evidence-based guidelines. This study aims to assess the impact of audit-based feedback in a Plan-Do-Study-Act (PDSA) format on improving the implementation of the SSC guidelines in patients with generalized peritonitis at our center. Methods This prospective observational study was conducted in four audit cycles in PDSA format. Multi-departmental inputs were taken to suggest modifications in practice. A questionnaire-based analysis of reasons for non-compliance was performed to find out the opinions and reasons for non-compliance. Morbidity, mortality, and the length of ICU and hospital stay among these patients were also analyzed. Results Baseline compliance with intravenous (IV) bolus administration, central venous pressure (CVP)-guided fluids, and inotropes support when indicated were 100%. Over the course of the three audit cycles, statistically significant improvement in compliance was noted for obtaining blood cultures before antibiotics, antibiotic administration within three hours of presentation, and serum lactate measurement. Overall bundle compliance improved from 9.2% to 64.7% by the end of audit cycle III. Conclusions This study demonstrates that audit-based feedback is a dependable means of improving compliance with SSC guidelines. It brings about improvement by educating users, modifying their behavior through feedback, and enhances process improvement by identifying and correcting systemic deficiencies in the organization.

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“…Further arguments are that the delivery of care services is highly dependent on information [19], consequently the management and ultimately adequate use of the technology enablers are of paramount importance [20]. Healthcare institutions rely largely on information about the science of care, individual patients, care provided, result of care, as well as its performance to provide, coordinate, and integrate services [21]. According to [22] and [23], HIS emphasises on optimizing and utilizing information to increase efficiency and effectiveness in healthcare institutions.…”

Section: Information Systems In Healthcarementioning

confidence: 99%

A Critical Analysis of the Implementation of Health Information Systems for Public Healthcare Service Delivery in Resource-Constrained Environments: A South African Study

Achieng

Ruhode

2019

IFIP Advances in Information and Communication Technology

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The use of technological solutions is argued to offer quality enhancing efficiencies in the delivery process of healthcare services. For this to be realized certain objectives of these technological solutions have to be achieved. The public health system in South Africa faces various challenges such as poor coordination of most technological solutions therefore fragmented; a lack of interoperability between different systems, haphazard procurement processes and poor information management capabilities. The argument in this study establishes that the causes are not purely logistical but also linked to gaps in the adequacy of the health information systems (HISs) and the implementation process of these technological solutions. A case study strategy, whose empirical home is rural South Africa, was employed using qualitative methodology. Activity Analysis and Development (ActAD) framework was used as a theoretical lens within critical realist paradigm. The study was conducted in a public healthcare facility within a resource constrained environment. Semi-structured interviews was used as data collection method and analysis of data was through narrative and explanatory analyses, employing thematic analysis tool. The paper intends to come up with a framework that can be used to inform the implementation process of HIS(s) across board. With a focus on the context of a divergent national service delivery reality that impacts the right to healthcare service in under-served communities.

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Evidence‐based medicine: going beyond improving care provider viewpoints, using and challenges upcoming

Abstract: The attitude of the respondents towards EBM is fairly positive. But there is a deficit in knowledge and skills of EBM among respondents. Integration and implementation of training approaches like journal clubs or workshops in clinical practices is suggested.

Cited by 11 publications

References 26 publications

Comparing the effectiveness of revascularization interventions with medical therapy in patients with ischemic cardiomyopathy: A systematic review and meta-analysis

Comparing the effectiveness of revascularization interventions with medical therapy in patients with ischemic cardiomyopathy: A systematic review and meta-analysis

Use of a Clinical Audit System in Implementing Surviving Sepsis Campaign Guidelines in Patients With Peritonitis

A Critical Analysis of the Implementation of Health Information Systems for Public Healthcare Service Delivery in Resource-Constrained Environments: A South African Study

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