Current Issue : April - June Volume : 2014 Issue Number : 2 Articles : 6 Articles
Background: Research into chiropractors� use of evidence in clinical practice appears limited to a single small\r\nqualitative study. The paucity of research in this area suggests that it is timely to undertake a more extensive study\r\nto build a more detailed understanding of the factors that influence chiropractors� adoption of evidence-based\r\npractice (EBP) principles. This study aimed to identify Australian chiropractors� attitudes and beliefs towards EBP in\r\nclinical practice, and also examine their use of research literature and clinical practice guidelines.\r\nMethods: We used an online questionnaire about attitudes, beliefs and behaviours towards the use of EBP in\r\nclinical practice that had been developed to survey physiotherapists and modified it to ensure that it was relevant\r\nto chiropractic practice. We endeavoured to survey all registered Australian chiropractors (n = 4378) via email\r\ninvitation distributed by Australian chiropractic professional organisations and the Chiropractic Board of Australia.\r\nLogistic regression analyses were conducted to examine univariate associations between responses to items\r\nmeasuring attitudes and beliefs with items measuring: age; years since registration; attention to literature; and use\r\nof clinical practice guidelines.\r\nResults: Questionnaires were returned by 584 respondents (response rate approximately 13%). The respondents�\r\nperceptions of EBP were generally positive: most agreed that the application of EBP is necessary (77.9%), literature\r\nand research findings are useful (80.2%), EBP helps them make decisions about patient care (66.5%), and expressed\r\nan interest in learning or improving EBP skills (74.9%). Almost half of the respondents (45.1%) read between two to\r\nfive articles a month. Close to half of the respondents (44.7%) used literature in the process of clinical decision\r\nmaking two to five times each month. About half of the respondents (52.4%) agreed that they used clinical practice\r\nguidelines, and around half (54.4%) agreed that they were able to incorporate patient preferences with clinical\r\npractice guidelines. The most common factor associated with increased research uptake was the perception that\r\nEBP helps make decisions about patient care.\r\nConclusions: Most Australian chiropractors hold positive attitudes towards EBP, thought EBP was useful, and were\r\ninterested in improving EBP skills. However, despite the favourable inclination towards EBP, many Australian\r\nchiropractors did not use clinical practice guidelines. Our findings should be interpreted cautiously due to the low\r\nresponse rate....
Background: Accrual to Cancer Control and Supportive Care (CCL) studies can be challenging. Our objective was\r\nto identify facilitators and perceived barriers to successful Children�s Oncology Group (COG) CCL accrual from the\r\nclinical research associate (CRA) perspective.\r\nMethods: A survey was developed that focused on the following features from the institutional perspective:\r\n(1) Components of successful accrual; (2) Barriers to accrual; (3) Institutional changes that could enhance accrual; and\r\n(4) How COG could facilitate accrual. The survey was distributed to the lead CRA at each COG site with at least 2 CCL\r\naccruals within the previous year. The written responses were classified into themes and sub-themes.\r\nResults: 57 sites in the United States (n = 52) and Canada (n = 5) were contacted; 34 (60%) responded. The four\r\nmajor themes were: (1) Staff presence and dynamics; (2) Logistics including adequate numbers of eligible patients;\r\n(3) Interests and priorities; and (4) Resources. Suggestions for improvement began at the study design/conception\r\nstage, and included ongoing training/support and increased reimbursement or credit for successful CCL enrollment.\r\nConclusions: The comments resulted in suggestions to facilitate CCL trials in the future. Soliciting input from key\r\nteam members in the clinical trials process is important to maximizing accrual rates...
Patient-reported outcome (PRO) measures must provide evidence that their development followed a rigorous\r\nprocess for ensuring their content validity. To this end, the collection of data is performed through qualitative\r\ninterviews that allow for the elicitation of in-depth spontaneous reports of the patients� experiences with their\r\ncondition and/or its treatment. This paper provides a review of qualitative research applied to PRO measure\r\ndevelopment. A clear definition of what is a qualitative research interview is given as well as information about the\r\nform and content of qualitative interviews required for developing PRO measures. Particular attention is paid to the\r\ndescription of interviewing approaches (e.g., semi-structured and in-depth interviews, individual vs. focus group\r\ninterviews). Information about how to get prepared for a qualitative interview is provided with the description of\r\nhow to develop discussion guides for exploratory or cognitive interviews. Interviewing patients to obtain\r\nknowledge regarding their illness experience requires interpersonal and communication skills to facilitate patients�\r\nexpression. Those skills are described in details, as well as the skills needed to facilitate focus groups and to\r\ninterview children, adolescents and the elderly. Special attention is also given to quality assurance and interview\r\ntraining. The paper ends on ethical considerations since interviewing for the development of PROs is performed in\r\na context of illness and vulnerability. Therefore, it is all the more important that, in addition to soliciting informed\r\nconsent, respectful interactions be ensured throughout the interview process....
Background: Clinical reasoning is fundamental to all forms of professional health practice, however it is also\r\ndifficult to teach and learn because it is complex, tacit, and effectively invisible for students. In this paper we\r\npresent an approach for teaching clinical reasoning based on making expert thinking visible and accessible to\r\nstudents.\r\nMethods: Twenty-one experienced allied health clinical educators from three tertiary Australian hospitals attended\r\nup to seven action research discussion sessions, where they developed a tentative heuristic of their own clinical\r\nreasoning, trialled it with students, evaluated if it helped their students to reason clinically, and then refined it so\r\nthe heuristic was targeted to developing each studentââ?¬â?¢s reasoning skills. Data included participantsââ?¬â?¢ written\r\ndescriptions of the thinking routines they developed and trialed with their students and the transcribed action\r\nresearch discussion sessions. Content analysis was used to summarise this data and categorise themes about\r\nteaching and learning clinical reasoning.\r\nResults: Two overriding themes emerged from participantsââ?¬â?¢ reports about using the ââ?¬Ë?making thinking visible\r\napproachââ?¬â?¢. The first was a specific focus by participating educators on studentsââ?¬â?¢ understanding of the reasoning\r\nprocess and the second was heightened awareness of personal teaching styles and approaches to teaching clinical\r\nreasoning.\r\nConclusions: We suggest that the making thinking visible approach has potential to assist educators to become\r\nmore reflective about their clinical reasoning teaching and acts as a scaffold to assist them to articulate their own\r\nexpert reasoning and for students to access and use....
Background: Foot disease complications, such as foot ulcers and infection, contribute to considerable morbidity\r\nand mortality. These complications are typically precipitated by ââ?¬Å?high-risk factorsââ?¬Â, such as peripheral neuropathy\r\nand peripheral arterial disease. High-risk factors are more prevalent in specific ââ?¬Å?at riskââ?¬Â populations such as diabetes,\r\nkidney disease and cardiovascular disease. To the best of the authorsââ?¬â?¢ knowledge a tool capturing multiple high-risk\r\nfactors and foot disease complications in multiple at risk populations has yet to be tested. This study aimed to\r\ndevelop and test the validity and reliability of a Queensland High Risk Foot Form (QHRFF) tool.\r\nMethods: The study was conducted in two phases. Phase one developed a QHRFF using an existing diabetes foot\r\ndisease tool, literature searches, stakeholder groups and expert panel. Phase two tested the QHRFF for validity and\r\nreliability. Four clinicians, representing different levels of expertise, were recruited to test validity and reliability.\r\nThree cohorts of patients were recruited; one tested criterion measure reliability (n = 32), another tested criterion\r\nvalidity and inter-rater reliability (n = 43), and another tested intra-rater reliability (n = 19). Validity was determined\r\nusing sensitivity, specificity and positive predictive values (PPV). Reliability was determined using Kappa, weighted\r\nKappa and intra-class correlation (ICC) statistics.\r\nResults: A QHRFF tool containing 46 items across seven domains was developed. Criterion measure reliability of at\r\nleast moderate categories of agreement (Kappa > 0.4; ICC > 0.75) was seen in 91% (29 of 32) tested items. Criterion\r\nvalidity of at least moderate categories (PPV > 0.7) was seen in 83% (60 of 72) tested items. Inter- and intra-rater\r\nreliability of at least moderate categories (Kappa > 0.4; ICC > 0.75) was seen in 88% (84 of 96) and 87% (20 of 23)\r\ntested items respectively.\r\nConclusions: The QHRFF had acceptable validity and reliability across the majority of items; particularly items\r\nidentifying relevant co-morbidities, high-risk factors and foot disease complications. Recommendations have been\r\nmade to improve or remove identified weaker items for future QHRFF versions. Overall, the QHRFF possesses\r\nsuitable practicality, validity and reliability to assess and capture relevant foot disease items across multiple at risk\r\npopulation....
Background: A major aim of the i2b2 (informatics for integrating biology and the bedside) clinical data informatics\r\nframework aims to create an efficient structure within which patients can be identified for clinical and translational\r\nresearch projects.\r\nOur objective was to describe the respective roles of the i2b2 research query tool and the electronic medical\r\nrecord (EMR) in conducting a case-controlled clinical study at our institution.\r\nMethods: We analyzed the process of using i2b2 and the EMR together to generate a complete research database\r\nfor a caseââ?¬â??control study that sought to examine risk factors for kidney stones among gastrostomy tube (G-tube) fed\r\nchildren.\r\nResults: Our final case cohort consisted of 41/177 (23%) of potential cases initially identified by i2b2, who were\r\nmatched with 80/486 (17%) of potential controls. Cases were 10 times more likely to be excluded for inaccurate\r\ncoding regarding stones vs. inaccurate coding regarding G-tubes. A majority (67%) of cases were excluded due to\r\nnot meeting clinical inclusion criteria, whereas a majority of control exclusions (72%) occurred due to inadequate\r\nclinical data necessary for study completion. Full dataset assembly required complementary information from i2b2\r\nand the EMR.\r\nConclusions: i2b2 was critical as a query analysis tool for patient identification in our caseââ?¬â??control study. Patient\r\nidentification via procedural coding appeared more accurate compared with diagnosis coding. Completion of our\r\ninvestigation required iterative interplay of i2b2 and the EMR to assemble the study cohort....
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