bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validity of retrospective review of medical records as a means of identifying adverse events: comparison between medical records and accident reports
Authors: Kobayashi Mia , Ikeda Shunya , Kitazawa Naomi , Sakai Hideto 
Published: September 2010

AbstractAims  This study was undertaken to investigate whether the adverse events recorded in accident reports could be properly identified by a retrospective review of medical records.Methods  In an acute‐care hospital, a retrospective review of 200 medical records, consisting of the medical records for the 100 cases for which accident reports were reported and an additional 100 cases extracted at random from the medical records of patients discharged in FY 2002, was conducted. The retrospective review of the medical records consisted of two stages. In the first stage, the medical records were screened by a nurse leader (Review A) and by a group of nurses trained by the nurse leader (Review B). In the second stage, a doctor review team determined the presence of adverse events.Results  Of the 61 accident reports that satisfied at least one of the 18 criteria to screen potential adverse events, 28 were ultimately judged to be adverse events in this study. Of these 28 events, Review A identified 25 (89.3%) and Review B identified 24 (85.7%). One adverse event was overlooked during Review A, and two events were overlooked during Review B. The two adverse events not identified by either Review A or Review B were not adequately described in the medical records.Conclusions  Some adverse events could not be identified by retrospective reviews of medical records, partly because of inadequate descriptions. However, when adequate information was available, adverse events could be identified with a very high degree of accuracy.
Implications of rigid adherence to a protocol of investigation for patients undergoing thyroidectomy
Authors: Hardy Robert , Moss Andrew , Lee David 
Published: September 2010

AbstractRationale, aims and objectives  Protocols may improve patient care by standardizing investigations performed. In pre‐operative surgical patients this should ensure all patients undergo essential investigations while limiting unnecessary tests. Previous studies have shown poor protocol adherence within 6 weeks of implementation unless strictly enforced. With this in mind, we analysed clinical and financial implications of rigid adherence to a protocol of pre‐operative investigation for patients undergoing thyroidectomy in a single centre.Methods  A protocol for investigation of patients undergoing thyroidectomy was introduced, with investigations being performed at the surgical out patient clinic. Where already performed by the referring doctor, they were not to be repeated. Protocol adherence was measured over a 6‐month period and strictly enforced to try to ensure 100% compliance.Results  35 consecutive patients underwent thyroidectomy over the study period. Compliance with the protocol was obtained for between 86% and 100% of tests required by the protocol. In addition, numerous tests specified by the protocol were performed more than once, and additional tests outside the protocol were done, with an average excess cost per patient of £121.38.Conclusions  A protocol for pre‐operative investigation of a common surgical procedure can be achieved. Rigid enforcement of the protocol can lead to over‐investigation because of concerns about test omission, with associated financial implications. Furthermore, a rigid protocol does not always prevent performance of unnecessary investigations.
Models based on value and probability in health improve shared decision making
Authors: Ortendahl Monica 
Published: September 2010

Abstract
Rationale, aims and objectives  Diagnostic reasoning and treatment decisions are a key competence of doctors. A model based on values and probability provides a conceptual framework for clinical judgments and decisions, and also facilitates the integration of clinical and biomedical knowledge into a diagnostic decision.
Method  Both value and probability are usually estimated values in clinical decision making. Therefore, model assumptions and parameter estimates should be continually assessed against data, and models should be revised accordingly. Introducing parameter estimates for both value and probability, which usually pertain in clinical work, gives the model labelled subjective expected utility. Estimated values and probabilities are involved sequentially for every step in the decision‐making process.
Results  Introducing decision‐analytic modelling gives a more complete picture of variables that influence the decisions carried out by the doctor and the patient.
Conclusion  A model revised for perceived values and probabilities by both the doctor and the patient could be used as a tool for engaging in a mutual and shared decision‐making process in clinical work.
Evidence‐based medicine and limits to the literature search
Authors: Nunn Robin 
Published: September 2010

Summary
Rationale, aims and objectives  Searching the literature, a core requirement of evidence‐based medicine has been impossibly oversold. The literature search is supposed to provide evidence independent from expert opinion, which has been deemed to be low on the evidence hierarchy. Yet freedom from expertise is not free. Paradoxically, practitioners are told to search the literature to avoid authority, but because there is too much information and too little time, they are urged to rely on authoritative digests. But the chain of errors inherent in searching literature for decision making, whether in scoping the decision, finding relevant documents, or in the document content, cannot be ignored. This article explores those errors.
Method  With examples from signal theory and decision theory, the literature search is analyzed in light of fundamental limits in the nature of informaiton. You can run from expertise but you cannot hide. Expertise is inevitably required to deal with these errors. So do‐it‐yourself searching is inadequate in the absence of expertise. The best decisions result from collaboration with subject matter experts and decision‐making experts.
Relationships between statistical measures of agreement: sensitivity, specificity and kappa
Authors: Feuerman Martin , Miller Allen R. 
Published: September 2010

Abstract
Objectives  Cohen's kappa coefficient is presently a standard tool for the analysis of agreement on a binary outcome between two tests. In view of the ubiquity of the use of sensitivity, specificity, raw agreement and kappa in clinical studies, clearly it is advantageous to have a useful analytic relation connecting these measures of agreement.
Methods  We elaborate on previous work, comment on other results appearing in the literature and discuss analytic formulas relevant to various problems connecting specificity, sensitivity and kappa.
Results  For selected values of kappa that range from good to excellent, a graph of the curves representing minimal pairs of sensitivity and specificity is provided.
Conclusions  The analytic formulas and graph could be potentially useful to clinicians and biostatisticians in better interpreting the outcomes of an alternative diagnostic test whenever the measures sensitivity, specificity and kappa are employed together.
Bayesian clinical reasoning: does intuitive estimation of likelihood ratios on an ordinal scale outperform estimation of sensitivities and specificities?
Authors: Moreira Juan , Bisoffi Zeno , Narváez Alberto , Van den Ende Jef 
Published: September 2010

Abstract
Rationale:  Bedside use of Bayes' theorem for estimating probabilities of diseases is cumbersome. An alternative approach based on five categories of powers of tests from ‘useless’ to ‘very strong’ has been proposed. The performance of clinicians using it was assessed.
Methods  Fifty clinicians attending a course of tropical medicine estimated powers of tests and post‐test probabilities using the classical vs. the categorical Bayesian approach. The estimation of post‐test probability was assessed for real and dummy diseases in order to avoid the bias of previous knowledge. Accuracy of answers was measured by the difference with reference values obtained from an expert system (Kabisa).
Results  Clinicians estimated positive likelihood ratios (LRs) a median of −1.07 log10 lower than Kabisa [interquartile range (IQR): −1.47; −0.80] when derived classically and −0.17 (IQR: −0.42; +0.04) when estimated categorically (P < 0.001). For negative LRs the median was +0.39 log10 higher (IQR: +0.71; +0.08) when derived classically and −0.18 log10 lower (IQR: +0.03; −0.36) when estimated categorically (P < 0.001).Twenty (40%) disclosed not being able to calculate post‐test probabilities using sensitivities and specificities. Regardless the approach post‐test probabilities were overestimated both for real and dummy diseases [respectively +1.23 log10 (IQR: +0,67; +2.08) and +2.03 log10 (IQR: +0.49; +2.42)] (P = 0277), but the range was wider for the latter (P = 0.001).
Conclusions  Participants were more accurate in estimating powers with a categorical approach than with sensitivities and specificities. Post‐test probabilities were overestimated with both approaches. Knowledge of the disease did not influence the estimation of post‐test probabilities. A categorical approach might be an interesting instructional tool, but the effect of training with this approach needs assessment.
Knowing – in Medicine
Authors: Sturmberg Joachim P. , Martin Carmel M. 
Published: September 2010

AbstractIn this paper we argue that knowledge in health care is a multidimensional dynamic construct, in contrast to the prevailing idea of knowledge being an objective state. Polanyi demonstrated that knowledge is personal, that knowledge is discovered, and that knowledge has explicit and tacit dimensions.Complex adaptive systems science views knowledge simultaneously as a thing and a flow, constructed as well as in constant flux. The Cynefin framework is one model to help our understanding of knowledge as a personal construct achieved through sense making. Specific knowledge aspects temporarily reside in either one of four domains – the known, knowable, complex or chaotic, but new knowledge can only be created by challenging the known by moving it in and looping it through the other domains.Medical knowledge is simultaneously explicit and implicit with certain aspects already well known and easily transferable, and others that are not yet fully known and must still be learned. At the same time certain knowledge aspects are predominantly concerned with content, whereas others deal with context.Though in clinical care we may operate predominately in one knowledge domain, we also will operate some of the time in the others. Medical knowledge is inherently uncertain, and we require a context‐driven flexible approach to knowledge discovery and application, in clinical practice as well as in health service planning.
Protocol‐based care: impact on roles and service delivery*
Authors: Rycroft‐Malone Jo , Fontenla Marina , Bick Debra , Seers Kate 
Published: September 2010

Abstract
Objective  To evaluate the impact of protocol‐based care on nursing roles, practice and service delivery.
Design  Case study evaluation informed by realistic evaluation methodology. Qualitative data collection methods were used including non‐participant observation, post‐observation interviews with nurses and patients, key informant interviews, tracking patient journeys and document review.
Participants  141 participants took part including 73 nurses, midwives and health visitors, 4 allied health professionals, 20 doctors, 5 support staff and 39 patients.
Settings  Five sites were purposively sampled and included acute and primary care service provision.
Findings  As a mechanism for standardization, the use of protocol‐based care approaches such as guidelines, care pathways, protocols and algorithms was patchy and dependent on contextual, professional and individual factors. Protocol‐based care approaches were commonly used as checklists and for reference; nurses and doctors expressed concern that such use could lead to a ‘tick box mentality’ and restricted judgement. By using standardized care approaches nurses were taking on new tasks and developing skills beyond the traditional scope of practice including prescribing, diagnosing, ordering tests and sometimes deciding on treatments. The ability to perform these roles meant that they were able to run clinics or services independently. The extension of roles to incorporate prescribing, for example, meant that nurses were able to provide a more streamlined service for patients because they did not have to refer to doctors. In turn, it was reported that this reduced doctors' workload. Protocol‐based care was viewed as a ‘nurses' thing’; however, some General Practitioners and junior doctors were using available standardized care approaches.
Conclusions  The potential of standardization was mediated by the patchy use of protocol‐based care approaches and negative perceptions about standardization. Use of protocol‐based care has the potential to impact on nurses' roles, increasing their autonomy and subsequently impacting on service delivery.
An evaluation of educational outreach to improve evidence‐based prescribing in Medicaid: a cautionary tale
Authors: Zillich Alan J. , Ackermann Ronald T. , Stump Timothy E. , Ambuehl Roberta J. , Downs Steven M. , Holmes Ann M. , Katz Barry , Inui Thomas S. 
Published: September 2010

Abstract
Rationale, aims and objectives  Evidence suggests that educational outreach (‘academic detailing’) improves evidence‐based prescribing. We evaluated the impact of an academic detailing programme intended to increase new statin prescriptions.
Methods  In a 2 × 2 factorial design we evaluated the effect of an academic detailing programme with/without telephonic care management for patients. Eligible patients were continuously enrolled Medicaid members at high risk for cardiovascular disease utilization who were not receiving statin medication in the 18 months prior to the intervention. All primary care prescribers assigned to these patients were randomized by clinic to academic detailing. Two trained nurses provided the detailing to prescribers, including specific discussion about the use of statins in this high‐risk patient population. Nurses left the prescribers with a summary of clinical practice guidelines, a one‐page detailing sheet and a list of patients under the care of the prescriber who were candidates for statins. The primary outcome was the incidence of a new statin prescription claim during the 6‐month intervention period and the subsequent 6 months. Logistic regression models were used to estimate main effects of the interventions and to adjust for potential confounding variables in the study.
Results  Forty‐eight clinics were randomized, effectively randomizing a total of 284 patients and 128 prescribers. Among the 284 patients, 46 (16%) received a new statin claim during the evaluation period. Controlling for significant bivariate associations, the academic detailing intervention had no significant effect on new statin prescriptions compared with the control group (odds ratio = 0.8, 95% confidence interval: 0.4–1.6, P = 0.5).
Conclusion  Among this Medicaid population at high risk for cardiovascular events, an academic detailing programme to increase statin prescriptions was not effective. To assist others to learn from our failed effort, we identify and discuss critical elements in the design and implementation of the programme that could account for these results.
Do urea breath test (UBT) referrals for Helicobacter pylori testing match the clinical guidelines in primary care practice? A prospective observational study
Authors: Noya Horowitz , Anat Beit‐Or , Moshe Leshno , Gennady Polishchouk , Zamir Halpern , Menachem Moshkowitz 
Published: September 2010

Abstract
Background  Various international guidelines recommend the use of non‐endoscopic tests [such as urea breath test (UBT)] for the evaluation of dyspeptic patients, unless endoscopy is clinically indicated.
Aim  To assess adherence with guidelines for UBT referrals among primary care doctors in Israel.
Methods  Patients referred by primary care doctors to an open‐access UBT service were included in the study. Prior to the test, all patients were administered with a short questionnaire regarding their symptoms, previous and concomitant medications including previous Helicobacter pylori eradication.
Results  The study sample consisted of 209 patients, aged 18–94 years, M/F = 74/135. The UBT was judged to be appropriate in 94 (45%) subjects, inappropriate in 93 (44.5%) subjects and appropriate but avoidable in 22 (10.5%) subjects, most of them asymptomatic patients following anti H. pylori treatment. The inappropriate indications include 38 (18%) patients with suspected gastro‐oesophageal reflux disease symptoms and 21 (10%) dyspeptic patients aged 45 years or more.
Conclusion  Nearly 45% percent of UBT referrals in primary care practice were inappropriate, and a significant number of dyspeptic patients should have been referred to endoscopy. These findings show a substantial non‐compliance with guidelines for H. pylori testing among primary care doctors.
Integrated audit as a means to implement unit protocols: a randomized and controlled study
Authors: Charrier Lorena , Allochis Maria Cristina , Cavallo Maria Rita , Gregori Dario , Cavallo Franco , Zotti Carla Maria 
Published: September 2010

Abstract
Rationale  Great emphasis is placed on the need to base assistance activities on efficacy evidence. Nevertheless, it is demonstrated that the mere knowledge of scientific recommendations is not sufficient to determine changes in practice. Many elements can influence the operators' behaviour, so that comprehensive strategies are needed to change wrong or not evidence‐based practices.
Objectives  The aim was to compare the efficacy of two protocol implementation strategies: clinical–organizational integrated audits with feedback and presence of facilitators in the departments versus standard observation.
Methods  Cluster‐randomized, controlled and open trial methods were used. Implementation was investigated for protocols regarding the prevention of pressure lesions and the management of peripheral and central venous catheters. For both protocols, a checklist with the indicators needed for the evaluation was created. The study was divided into five time points. For the initial and final investigation, evaluators filled‐in the checklists for both study groups; for the three intermediate investigations, the checklists were self‐filled by the operators of the control group, while the operators of the experimental group received the intervention.
Results  For almost all indicators, the data show an increment in the adoption of correct practices. Nevertheless, the last investigation shows a significant (P < 0.05) difference between the two groups in favour of the experimental group: 12 process indicators versus one for catheter management protocol and seven versus one for protocol on pressure lesions.
Conclusions  The main strong point of the study lies in carrying out an intervention aimed at improving the operators' adoption of two protocols as a whole, rather than of single procedures. The audit intervention allowed to highlight some more subjective criticalities important in determining the success or failure of the implementation of effective practices.
EBM: evidence to practice and practice to evidence
Authors: Isaac Carol A. , Franceschi Amy 
Published: September 2010

Abstract
Rationale  The purpose of this paper is to explore new perspectives about difficulties academicians may have communicating with clinicians, obtaining subjects, and gaining compliance for their research.
Aims and Objectives  Evidence‐based medicine (EBM) has been defined as an integration of best research evidence, clinical expertise, and patient values; however, clinical observation and experience are placed last in the evidence hierarchy with the randomized controlled trial held as the standard for clinical intervention. This paper describes how the hierarchical model of power in the research community obstructs new areas of knowledge, and how clinicians create resistance.
Methods  Foucault gave new perspectives describing how power circulates through individuals within organizational discourse. Drawing on literature and experience, and using a framework based on postmodern theoretical concepts, this paper examines patterns of discourse, subjectivity, resistance, and power/knowledge within the physical therapy profession.
Results  The hierarchical discourse of medical knowledge produces opposition rather than collaboration between researcher, clinician, and patient. Alleviating perceptions of dominance and creating connections produces cohesion within medical communities.
Conclusions  Evidence to practice and practice to evidence redefines EBM as a circular integration of best research evidence, clinical expertise, and patient values.
How to run an effective journal club: a systematic review
Authors: Deenadayalan Y. , Grimmer‐Somers K. , Prior M. , Kumar S. 
Published: September 2010

Abstract
Background  Health‐based journal clubs have been in place for over 100 years. Participants meet regularly to critique research articles, to improve their understanding of research design, statistics and critical appraisal. However, there is no standard process of conducting an effective journal club. We conducted a systematic literature review to identify core processes of a successful health journal club.
Method  We searched a range of library databases using established keywords. All research designs were initially considered to establish the body of evidence. Experimental or comparative papers were then critically appraised for methodological quality and information was extracted on effective journal club processes.
Results  We identified 101 articles, of which 21 comprised the body of evidence. Of these, 12 described journal club effectiveness. Methodological quality was moderate. The papers described many processes of effective journal clubs. Over 80% papers reported that journal club intervention was effective in improving knowledge and critical appraisal skills. Few papers reported on the psychometric properties of their outcome instruments. No paper reported on the translation of evidence from journal club into clinical practice.
Conclusion  Characteristics of successful journal clubs included regular and anticipated meetings, mandatory attendance, clear long‐ and short‐term purpose, appropriate meeting timing and incentives, a trained journal club leader to choose papers and lead discussion, circulating papers prior to the meeting, using the internet for wider dissemination and data storage, using established critical appraisal processes and summarizing journal club findings.