Journal of evaluation in clinical practice
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Clinical inertia, defined as a delay in treatment intensification, is prevalent in people with diabetes. Treatment intensification rates are as low as 37.1% in people with haemoglobin A1c (HbA1c) values >7%. Intensification by addition of medication therapy may take 1.6 to more than 7 years. Clinical inertia increases the risk of cardiovascular events. The primary objective was to evaluate rates of clinical inertia in people whose diabetes is managed by both pharmacists and primary care providers (PCPs). Secondary objectives included characterizing types of treatment intensification, HbA1c reduction, and time between treatment intensifications. ⋯ Pharmacist involvement in diabetes management may reduce the clinical inertia patients may otherwise experience in the primary care setting.
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Non-adherence is a major problem among patients with chronic diseases. Community pharmacists are ideally positioned to detect non-adherence and to provide patient-centred interventions. ⋯ Pharmacist-led intervention can improve LLM adherence, but its influence on clinical outcomes, including lipid level control, remains to be clarified.
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Low back pain is a common condition and one of the leading reasons for years of chronic disability. Rehabilitation has been shown to be effective on low back pain, because it is based on the complex and multifactorial mechanisms that low back pain entails. ⋯ This Interpretive Description study provides insight into the complexity and challenges related to implementation practice. It identifies important elements when implementing a new rehabilitation intervention in clinical practice and emphasizes the importance of expectations among rehabilitation team members in the implementation process. There should be a specific focus on the importance of involving rehabilitation team members when new interventions are to be implemented, as participation contributes to increased positivity in relation to new initiatives.
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Like most healthcare disciplines, the physiotherapy profession has embraced the concept of evidence-based practice (EBP) worldwide. However, there is a discrepancy between the amount of research evidence that exists and its use in clinical decision making. ⋯ Insufficient time, lack of organizational mandates, lack of research skills, poor ability to critically appraise literature and unavailability of resources and organizational support are key barriers to EBP among Nigerian physiotherapists. Nigerian physiotherapists, their regulatory board, and Government need to work in tandem to improve EBP among Nigerian physiotherapists.
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Assessing the performance of diagnostic tests requires evaluation of the amount of diagnostic uncertainty a test reduces. Statistical measures, such as sensitivity and specificity, currently dominating the evidence-based medicine (EBM) and related fields, cannot explicitly measure this reduction in diagnostic uncertainty. Mutual information (MI), an information theory statistic, explicitly quantifies diagnostic uncertainty by measuring information gain before vs after diagnostic testing. In this paper, we propose the use of MI as a single measure to express diagnostic test performance and demonstrate how it can be used in the meta-analysis of diagnostic test studies. ⋯ We have demonstrated the suitability of MI in assessing the performance of diagnostic tests, which can facilitate easier interpretation of the true utility of diagnostic tests. Similarly, to the guidance for interpretation of effect size of treatment interventions, we also propose the guidelines for interpretation of the utility of diagnostic tests based on the magnitude of reduction in diagnostic uncertainty.