Journal of evaluation in clinical practice
-
The recent sacking of Peter Gøtzsche from the Cochrane Collaboration Board raised strong responses and highlights the neglected issue about priorities-maintaining the reputation of the organization or vigorously debating the merits of scientific approaches to find answers to complex problems? The Cochrane approach hales the randomized trial (RCT) as the gold standard research approach and affirms that meta-analysis provides the ultimate proof (or platinum standard) to settle contentious issues confronting the clinician. However, most published medical research is wrong, and critics coined the acronym GIGO (garbage in, garbage out) as a meme to highlight the risks of blind faith in the hyped-up procedures of the EBM movement. This paper firstly explores the differences between the prevailing scientific method arising from the linear cause-and-effect assumption and the complex adaptive systems science methods arising from observations that most phenomena emerge from nonlinearity in networked systems. ⋯ EBM and Cochrane with their restrictive approaches are the antithesis to a practice of medicine that is responsive to constantly changing patient needs. As such, the EBM/Cochrane crisis opens a window of opportunity to re-examine the nature of health, illness and disease, and the nature of health care and its systems for the benefits of its professionals and their patients. We are at the cusp of a paradigmatic shift towards an understanding a praxis of health care that takes account of its complexities.
-
Valid and reliable instruments for measuring are needed. To add knowledge to the subject of tools of evidence-based practice (EBP) evaluation in mainland China, the present study aims to translate the Quick-EBP-VIK into Chinese, which is an instrument for the assessment of nurses' value, knowledge, and implementation of EBP, and to evaluate the metric characteristics of the Chinese version. ⋯ The Chinese version of the Quick-EBP-VIK has evidence of acceptable reliability and validity and can be used to measure value, knowledge, and implementation of EBP for Chinese nurses.
-
To externally validate the PREDICT tool in a cohort of women participating in a population-based breast cancer screening programme who were diagnosed with breast cancer between 2000 and 2008 in Spain. ⋯ The PREDICT tool does not discriminate well in our population considering only the variables of the original algorithm. More accurate tools are needed to obtain a better discrimination.
-
The risk of cognitive dysfunction is higher in people with diabetes than in the general population, and approximately 50% of those with diabetes will develop cognitive impairments as they age. Screening for cognitive dysfunction in people with diabetes can help identify both pathology and those who are at risk for higher health care utilization, but we do not know how health care providers implement cognitive screening recommendations in this population. In this study, we examined health care providers' knowledge of those recommendations and their application of them, as well as factors associated with guideline use. ⋯ Most respondents believed that there was a good rationale for assessing cognitive function in people with diabetes. However, despite some familiarity with guidelines for cognitive function screening, most respondents did not use standardized assessment tools. The results indicate variability in clinical practice regarding assessment and practices, such that there may be some variability in outcomes for patients.
-
Laboratory information sub-systems play an important role in diagnosis and treatment of patients. This study aimed to determine functional requirements of users and assess the existence of these requirements in the laboratory information system. ⋯ Laboratory information system requirements were designed with 68 items. Evaluation results showed that the systems were moderate in terms of compliance with the requirements.