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Improving diagnosis in healthcare: Local versus national adoption of recommended guidelines for the clinical breast examination.

ABSTRACT: BACKGROUND:This study explores the long-term effectiveness of a newly developed clinical skills curriculum. METHODS:Students (N = 40) were exposed to a newly developed, simulation-based, clinical breast exam (CBE) curriculum. The same students returned one year later to perform the CBE and were compared to a convenience sample of medical students (N = 15) attending a national conferences. All students were given a clinical vignette and performed the CBE. CBE techniques were video recorded. Chi-squared tests were used to assess differences in CBE technique. RESULTS:Students exposed to a structured curriculum performed physical examination techniques more consistent with national guidelines than the random, national student sample. Structured curriculum students were more organized, likely to use two hands, a linear search pattern, and include the nipple-areolar complex during the CBE compared to national sample (p < 0.01). CONCLUSIONS:Students exposed to a structured skills curriculum more consistently performed the CBE according to national guidelines. The variability in technique compared with the national sample of students calls for major improvements in adoption and implementation of structured skills curricula.

SUBMITTER: Nathwani JN

PROVIDER: S-EPMC5988913 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Improving diagnosis in healthcare: Local versus national adoption of recommended guidelines for the clinical breast examination.

Nathwani Jay N JN Garren Anna A Laufer Shlomi S Kwan Calvin C Pugh Carla M CM

American journal of surgery 20171205 6

<h4>Background</h4>This study explores the long-term effectiveness of a newly developed clinical skills curriculum.<h4>Methods</h4>Students (N = 40) were exposed to a newly developed, simulation-based, clinical breast exam (CBE) curriculum. The same students returned one year later to perform the CBE and were compared to a convenience sample of medical students (N = 15) attending a national conferences. All students were given a clinical vignette and performed the CBE. CBE techniques were video ...[more]

PMID: 29229379

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Project description:Background and objectivesGlobally, a number of countries have developed guidelines that describe the design and conduct of economic evaluations as part of health technology assessment (HTA) or pharmacoeconomic analysis for decision making. The current scoping review was undertaken with an objective to summarize the recommendations made on methods of economic evaluation by the national healthcare economic evaluation (HEE) guidelines.MethodologyA comprehensive search was undertaken in the website repositories of the International Society for Pharmacoeconomic and Outcomes Research (ISPOR) and Guide to Economic Analysis and Research (GEAR), and websites of national HTA agencies and ministries of health of individual countries. All guidelines in the English language were included in this review. Data were extracted with respect to general and methodological characteristics, and a descriptive analysis of recommendations made across the countries was undertaken.ResultsOverall, our review included 31 national HEE guidelines, published between 1997 and August 2020. Nearly half (45%) of the guidelines targeted the evaluation of pharmaceuticals. The nature of the guidelines was either mandatory (31%), recommendatory (42%), or voluntary (16%). There was a substantial consensus among the guidelines on several key principles, including type of economic evaluation (cost-utility analysis), time horizon of the analysis (long enough), health outcome measure (quality-adjusted life-years) and use of sensitivity analyses. The recommendations on study perspective, comparator, discount rate and type of costs to be included (particularly the inclusion of indirect costs) varied widely.ConclusionDespite similarity in the overall processes, variation in several recommendations given by various national HEE guidelines was observed. This is perhaps unsurprising given the differences in the health systems and financing mechanisms, capacity of local researchers, and data availability. This review offers important lessons and a starting point for countries that are planning to develop their own HEE guidelines.

Project description:BackgroundAlthough the mandate of recreational facilities is to enhance well-being, many offer foods inconsistent with recommendations for healthy eating. Little is known regarding recreational facility food environments and how they might be improved, as few studies exist. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are intended to ensure access to healthy food choices in schools, childcare and recreational facilities. This study investigated awareness, adoption and implementation of the ANGCY among recreational facilities in Alberta, Canada, one year following their release.MethodsA cross-sectional telephone survey was conducted from June - December, 2009 (n = 151) with managers of publicly funded recreational facilities that served food. The questionnaire included 10 closed and 7 open ended questions to assess the organizational priority for healthy eating, awareness, adoption and implementation of the ANGCY. Chi-squared tests examined quantitative variables, while qualitative data were analysed using directed content analysis. Greenhalgh's model of diffusion of complex innovations within health service organizations constituted the theoretical framework for the study.ResultsOne half of respondents had heard of the ANGCY, however their knowledge of them was limited. Although 51% of facilities had made changes to improve the nutritional quality of foods offered in the past year, only a small fraction (11%) of these changes were motivated by the ANGCY. At the time of the survey, 14% of facilities had adopted the ANGCY and 6% had implemented them. Barriers to adoption and implementation were primarily related to perceived negative attributes of the ANGCY, the inner (organizational) context, and negative feedback received during the implementation process. Managers strongly perceived that implementing nutrition guidelines would limit their profit-making ability.ConclusionsIf fully adopted and implemented, the ANGCY have the potential to make a significant and sustained contribution to improving the recreational facility food environment, however one year following their release, awareness, adoption and implementation of the ANGCY remained low. A mandated policy approach could offer an efficacious, cost-effective means of improving the food environment within recreational facilities.

Project description:ObjectiveTo identify the number of drug-disease and drug-drug interactions for exemplar index conditions within National Institute of Health and Care Excellence (NICE) clinical guidelines.DesignSystematic identification, quantification, and classification of potentially serious drug-disease and drug-drug interactions for drugs recommended by NICE clinical guidelines for type 2 diabetes, heart failure, and depression in relation to 11 other common conditions and drugs recommended by NICE guidelines for those conditions.SettingNICE clinical guidelines for type 2 diabetes, heart failure, and depressionMain outcome measuresPotentially serious drug-disease and drug-drug interactions.ResultsFollowing recommendations for prescription in 12 national clinical guidelines would result in several potentially serious drug interactions. There were 32 potentially serious drug-disease interactions between drugs recommended in the guideline for type 2 diabetes and the 11 other conditions compared with six for drugs recommended in the guideline for depression and 10 for drugs recommended in the guideline for heart failure. Of these drug-disease interactions, 27 (84%) in the type 2 diabetes guideline and all of those in the two other guidelines were between the recommended drug and chronic kidney disease. More potentially serious drug-drug interactions were identified between drugs recommended by guidelines for each of the three index conditions and drugs recommended by the guidelines for the 11 other conditions: 133 drug-drug interactions for drugs recommended in the type 2 diabetes guideline, 89 for depression, and 111 for heart failure. Few of these drug-disease or drug-drug interactions were highlighted in the guidelines for the three index conditions.ConclusionsDrug-disease interactions were relatively uncommon with the exception of interactions when a patient also has chronic kidney disease. Guideline developers could consider a more systematic approach regarding the potential for drug-disease interactions, based on epidemiological knowledge of the comorbidities of people with the disease the guideline is focused on, and should particularly consider whether chronic kidney disease is common in the target population. In contrast, potentially serious drug-drug interactions between recommended drugs for different conditions were common. The extensive number of potentially serious interactions requires innovative interactive approaches to the production and dissemination of guidelines to allow clinicians and patients with multimorbidity to make informed decisions about drug selection.

Project description:IntroductionThe most common cause of hospital emergency department visits is trauma resulting from a variety of underlying mechanisms. Unknown neck and spinal cord injuries and a lack of early diagnosis can have catastrophic consequences, such as paralysis of some or all limbs. The use of imaging techniques reduces the number of patients suffering from severe injuries.ObjectiveTo assess and compare the effectiveness and ease of utilizing two different sets of guidelines, the National Emergency X-Radiography Utilization Study guidelines (NEXUS) and the Canadian C-Spine guidelines (CCR), on trauma patients.MethodsThis study was approved by the Ethics Committee of Tabriz University of Medical Sciences. Of all the patients presenting to the hospital, 200 trauma patients were randomly included in the study. NEXUS and CCR were surveyed for each patient, and subsequent radiographies were also requested. The specificity and sensitivity of each of the methods was calculated, and the two methods were compared using Kendall's W test.ResultsA total of 200 trauma patients who met the inclusion criteria were included in the study. A total of 69.5% of the patients were male, and 30.5% were female. According to NEXUS guidelines, 47.5% of the patients were required to undergo neck radiography. According to CCR guidelines, 57.5% of the patients were required to undergo neck radiography. The sensitivity was found to be 90% for neck radiography by both NEXUS and CCR guidelines, while specificities were found to be 54.73% and 44.2% for NEXUS and CCR guidelines, respectively.ConclusionThis study showed that the two guidelines have the same sensitivity for evaluating which trauma patients need to undergo radiography. It seems that the NEXUS guidelines have the same effectiveness as CCR for determining which trauma patients need to undergo radiography. They also perform better than CCR guidelines in terms of ruling out which cases need no further radiologic investigation.

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Improving diagnosis in healthcare: Local versus national adoption of recommended guidelines for the clinical breast examination.

Publications

Improving diagnosis in healthcare: Local versus national adoption of recommended guidelines for the clinical breast examination.

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