Journal of evaluation in clinical practice
-
The current American Academy of Pediatrics policy calls for universal developmental screening (UDS) at the 18-month well-baby visit (18MWBV). In contrast, different clinical practice guidelines exist in other developed countries where only toddlers of concerned parents are referred for (selective) developmental screening (SDS). This study compares the expected benefit (EB) of these two strategies for monitoring children's behavioural development at the 18MWBV. ⋯ There are many steps involved in the monitoring of children's early behavioural development, but when it comes to decide whether or not to use behavioural screening, there is evidence for adopting the SDS strategy, and screening only if a behavioural concern is being raised by parents.
-
It is well known that tests are not 100% accurate at classifying individuals. The actual condition of an individual(e.g. diseased, or not diseased) does not coincide with her test result (positive, or negative). Nevertheless, it is often presupposed, as a rule of thumb, that individuals with negative results can be "ruled out" if screening test is highly sensitive and "ruled in" if screening test is highly specific. This has led to the mnemonic SNNOUT (sensitive negative out) and SPPIN (specific positive in). ⋯ The correct rules of thumb could be of great help to doctors and patients.
-
Several novel oral anticoagulants (NOACs) are licensed for atrial fibrillation (AF) treatment in the United Kingdom. We describe the incidence and mortality from ischaemic stroke and major bleeding in non-valvular atrial fibrillation (NVAF) patients in England, including treatment patterns before/following introduction of NOACs, healthcare resource utilization (HRU), and costs post-onset of these events. ⋯ These data provide temporal insights into AF treatment patterns and outcomes for NVAF patients in England and highlight the need to review higher stroke risk AF patients not receiving antiplatelet/antithrombotic prescriptions.
-
Observational Study
Dynamic evaluation of the comparative effectiveness of an integrated program for heart failure care.
An integrated care program for heart failure (HF) was developed in the Basque Country in 2013. The objective of this research was to evaluate its effectiveness through the number of hospital admissions in three integrated healthcare organizations (IHOs), taking into account the longitudinal nature of the disease and the intensity of the implementation. ⋯ The extent of program implementation measured by intervention intensity is a main driver of the effectiveness of an educational and monitoring program for HF. The evaluation of HF program effectiveness on readmissions must take into account the entire natural history of the disease. Implementation intensity explains differences between IHOs.