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Background Assessing prognosis is challenging for many physicians in various medical fields. Research shows that physicians who perform disability assessments consider six areas when evaluating a prognosis: disease, treatment, course of the disease, external information, patient-related and physician-related aspects. We administered a questionnaire to evaluate how physicians rate the importance of these six prognosis areas during work disability evaluation and to explore what kind of support they would like during prognosis assessment. Methods Seventy-six physicians scored the importance of 23 prognostic aspects distributed over six prognosis areas. Participants scored the importance of each aspect both “in general” and from the perspective of a case vignette of a worker with a severe degenerative disease. The questionnaire also covered needs and suggestions for support during the evaluation of prognoses. Results Medical areas that are related to the disease, or the treatment or course of the disease, appeared important (scores of 7.0–9.0), with less differing opinions among participants (IQR 1.0–3.0). Corresponding verbatim remarks supported the importance of disease and treatment as prognostic aspects. In comparison, patient- and physician-related aspects scored somewhat lower, with more variability (range 4.0–8.0, with IQR 2.0–5.0 for patient- and physician-related considerations). Participants indicated a need for a tool or online database that includes prognostic aspects and prognostic evidence. Conclusions Despite some variation in scores, the physicians rated all six prognosis areas as important for work disability evaluations. This study provides suggested aids to prognosis assessment, including an online support tool based on evidence-based medicine features.

Background Using a standardized approach to describe the sources of uncertainty in cost-effectiveness analyses might bring added value to the local critical assessment procedure of reimbursement submissions in Hungary. The aim of this research is to present a procedural framework to identify, quantify and interpret sources of uncertainty, using the reimbursement dossier of darolutamide as an illustrative example. Methods In the procedural framework designed for the critical assessment of cost-effectiveness analyses, the quantifiability of an identified source of uncertainty is assessed through the input parameters of the originally submitted model, which is followed by the interpretation of its impact on estimates of costs and outcomes compared to the base case cost-effectiveness conclusion. Results Based on our experiences with the recent reimbursement dossier of darolutamide, the significant and quantifiable sources of uncertainty were the time horizon of the economic analysis; the restriction of the efficacy analysis population; long-term relative effectiveness of darolutamide; price discount on subsequent therapies. We identified resource use patterns for comparator and subsequent therapies as a quantifiable, yet non-significant source of uncertainty. The EQ-5D value set used to estimate utility values was identified as a non-quantifiable and potentially not significant source of uncertainty. Conclusions The procedural framework, demonstrated with an example, was sufficiently flexible and coherent to document and structure the sources of uncertainty in cost-effectiveness analyses. The full-scale use of this framework is desirable during the decision-making process for reimbursement in Hungary. The further formalization of identifying sources of uncertainty is a possible subject of methodological development.

Introduction: Over the last decade, and following the publication of an instructional methodological guide for the development of clinical practice guidelines (CPG), the Colombian Ministry of Health and Social Protection (CMHSP) commissioned the development or update of a series of CPGs. However, to date, there is no diagnosis of the characteristics of the recommendations made in such CPGs. Objective: To explore the characteristics of the recommendations included in CPGs commissioned by the CMHSP between 2013 and 2021. Materials and methods: A systematic review of Colombian CPGs published between 2013 and 2021 was conducted. Only CPGs reporting the level of certainty of the supporting evidence and the strength of the recommendation in at least 70% of its recommendations using the GRADE approach were included. Information on the certainty, direction, and strength of each recommendation was extracted. Additionally, the agreement between the language used (wording) in the recommendation and its strength was assessed in a random sample of 20% of the recommendations. Results: Of the 59 CPGs retrieved, 36 met the inclusion criteria, for a total of 1 609 recommendations analyzed. The median number of recommendations per CPG was 41 (IQR: 27-55), 81.4% were in favor, 62.77% were classified as strong, 58.23% were based on low/very low-quality evidence, and 56.06% were intended for treatment. Furthermore, 51.39% and 74.60% of strong and weak recommendations were based on low/very low-quality evidence, respectively. Regarding the analysis of their wording, there was disagreement between the language and the certainty of evidence in 50.31% of the 324 recommendations randomly reviewed. Conclusions: The CPGs evaluated include a relatively high number of recommendations, most of them in favor and rated as strong but based on low-quality evidence, which may be controversial and generate barriers to their understanding and implementation. These results also indicate the need to improve adherence to the CPG development methodology and standards among Colombian CPG development groups.

Previously, we systematically reviewed more than 20 years of influenza vaccine challenge trial research in pigs to answer the question, “does vaccinating sows protect offspring?” Overall, most studies were well designed but clinical heterogeneity made between-study comparisons challenging. Studies varied by samples, outcomes, and assays selected for measurement. Additionally, data essential for inclusion of findings in meta-analyses were often insufficiently reported and as a result, summary effect measures were either not derived or were not meaningful. Clinical heterogeneity and reporting issues complicate and limit what can be learned cumulatively from research and both represent two types of avoidable research waste. Here, we illustrate each concern using data collected tangentially during the systematic review and propose two corrective strategies, both of which have broad applicability across veterinary intervention research; (i) develop a Core Outcome Set (COS) to reduce unnecessary clinical heterogeneity in future research and (ii) encourage funders and journal editors to require submitted research protocols and manuscripts adhere to established reporting guidelines. As a reporting corollary, we developed a supplemental checklist specific to influenza vaccine challenge trial research in swine and propose that it is completed by researchers and included with all study protocol and manuscript submissions. The checklist serves two purposes: as a reminder of details essential to report for inclusion of findings in meta-analyses and sub-group meta-analyses (e.g., antigenic or genomic descriptions of influenza vaccine and challenge viruses), and as an aid to help synthesis researchers fully characterize and comprehensively include studies in reviews.

Background Work capacity evaluations by independent medical experts are widely used to inform insurers whether injured or ill workers are capable of engaging in competitive employment. In many countries, evaluation processes lack a clearly structured approach, standardized instruments, and an explicit focus on claimants’ functional abilities. Evaluation of subjective complaints, such as mental illness, present additional challenges in the determination of work capacity. We have therefore developed a process for functional evaluation of claimants with mental disorders which complements usual psychiatric evaluation. Here we report the design of a study to measure the reliability of our approach in determining work capacity among patients with mental illness applying for disability benefits. Methods/Design We will conduct a multi-center reliability study, in which 20 psychiatrists trained in our functional evaluation process will assess 30 claimants presenting with mental illness for eligibility to receive disability benefits [Reliability of Functional Evaluation in Psychiatry, RELY-study]. The functional evaluation process entails a five-step structured interview and a reporting instrument (Instrument of Functional Assessment in Psychiatry [IFAP]) to document the severity of work-related functional limitations. We will videotape all evaluations which will be viewed by three psychiatrists who will independently rate claimants’ functional limitations. Our primary outcome measure is the evaluation of claimant’s work capacity as a percentage (0 to 100 %), and our secondary outcomes are the 12 mental functions and 13 functional capacities assessed by the IFAP-instrument. Inter-rater reliability of four psychiatric experts will be explored using multilevel models to estimate the intraclass correlation coefficient (ICC). Additional analyses include subgroups according to mental disorder, the typicality of claimants, and claimant perceived fairness of the assessment process. Discussion We hypothesize that a structured functional approach will show moderate reliability (ICC ≥ 0.6) of psychiatric evaluation of work capacity. Enrollment of actual claimants with mental disorders referred for evaluation by disability/accident insurers will increase the external validity of our findings. Finding moderate levels of reliability, we will continue with a randomized trial to test the reliability of a structured functional approach versus evaluation-as-usual.

Background The uptake of evidence in practice by physicians, even if they are trained in the systematic method of evidence-based medicine (EBM), remains difficult to improve. The aim of this study was to explore perceptions and experiences of physicians doing disability evaluations regarding motivators and preconditions for the implementation of EBM in daily practice. Methods This qualitative study was nested in a cluster randomized controlled trial (Trial registration NTR1767; 20-apr-2009) evaluating the effects of training in EBM. The 45 physicians that participated received a comprehensive 6-months training program in EBM of which the last course day included audio-recorded interviews in groups. During these interviews participating physicians discussed perceptions and experiences regarding EBM application in daily practice. In an iterative process we searched for common motivators or preconditions for the implementation of EBM. Results Three main concepts or themes emerged after analyzing the transcriptions of the discussions: 1) improved quality of physicians’ actions, such as clients benefiting from the application of EBM; 2) improved work attractiveness of physicians; and 3) preconditions that have to be met in order to work in an evidence-based manner including professional competence, facilitating material conditions and organizational support and demands. Conclusions Physicians trained in EBM are motivated to use EBM because they perceive it as a factor improving the quality of their work and making their work more attractive. In addition to personal investments and gains, organizational support should further facilitate the uptake of evidence in practice.

The objective of the study was to evaluate all available systematic reviews on the use of prone positional ventilation in adult patients with acute respiratory distress syndrome (ARDS). An umbrella review on the efficacy of prone positional ventilation in adult patients ventilation in adult patients with acute respiratory distress syndrome was conducted. We performed a systematic search in the database of Medline (Pubmed), Scopus, Cochrane Library, Web of Science, and Epistemonikos. The ROBIS tools and GRADE methodology were used to assess the risk of bias and certainty of evidence. We estimated the necessary number of patients to be treated to have benefit. For the synthesis of the result, we selected the review with the lowest risk of bias. Sixteen systematic reviews including 64 randomized clinical trials and evaluating the effect of prone positional ventilation, with or without other ventilation strategies were included. Aoyama 2019 observed prone positioning, without complementary ventilation strategies, leading to a reduction in the 28-day mortality only when compared to high-frequency oscillatory ventilation (RR 0.61; 95% CI 0.39–0.95) and lung-protective ventilation in the supine position (RR 0.69; 95% CI 0.48–0.98), with an ARR of 9.32% and 14.94%, an NNTB of 5.89 and 8.04, and a low and moderate certainty of evidence, respectively. Most reviews had severe methodological flaws that led to results with very low certainty of evidence. The review with the lowest risk of bias presented results in favor of prone positional ventilation compared with high-frequency oscillatory ventilation and lung-protective ventilation. There is a need to update the available reviews to obtain more accurate results.

The Evidence-Based Nursing Series is co-published with Sigma Theta Tau International (STTI). The series focuses on implementing evidence-based practice in nursing and midwifery and mirrors the remit of Worldviews on Evidence-Based Nursing, encompassing clinical practice, administration, research and public policy. Evaluating the Impact of Implementing Evidence-Based Practice considers the importance of approaches to evaluate the implementation of evidence-based practice.  Outcomes of evidence-based practice can be wide ranging and sometimes unexpected.  It is therefore important to evaluate the success of any implementation in terms of clinical outcomes, influence on health status, service users and health policy and long-term sustainability, as well as economic impacts. This, the third and final book in the series, looks at how best to identify, evaluate and assess the outcomes of implementation , reflecting  a wide range of issues to consider and address when planning and measuring outcomes. * An informative, practical resource for an international readership * Providing critical evaluation of models and approaches  to measuring outcomes * Explores the importance of measuring successful implementation * Examines outcomes in terms of long-term sustainability * Addresses economic impacts and influence on health policy  * Provides practice-based examples * Written by a team of internationally respected authors

What do we do if different studies appear to give different answers? When applying research to questions for individual patients or for health policy, one of the challenges is interpreting such apparently conflicting research. A systematic review is a method to systematically identify relevant research, appraise its quality, and synthesize the results. The last two decades have seen increasing interest and developments in methods for doing high quality systematic reviews. Part I of this book provides a clear introduction to the concepts of reviewing, and lucidly describes the difficulties and traps to avoid. A unique feature of the book is its description, in Part II, of the different methods needed for different types of health care questions: frequency of disease, prognosis, diagnosis, risk, and management. As well as illustrative examples, there are exercises for each of the sections. This is essential reading for those interested in synthesizing health care research.

Objectives Specific studies evaluating the effectiveness of the judgement of fitness for work formulated by occupational physicians (OP) are needed. The evaluation consists in investigating OPs’ decisions by measuring their impact on health with specific indicators. This specific study aims at assessing, through outcome indicators, the effectiveness of medical decisions in 61 cases leading to preventive interventions. Methods A 3-step pre-post observational study was carried out in a 4-year period. About 61 clinical cases of health care workers were studied according to the following steps: (1) a medical examination resulting in an evidence-based judgement of fitness for work including prescriptions for an appropriate intervention, (2) the application of the preventive intervention, (3) a second medical examination and completion of a questionnaire by the workers. Two outcome measures were chosen to investigate changes occurred after the intervention: the first measured the perceived and the objective health condition, the second measured satisfaction and working capacity. Results Results show a statistically significant increase in subjects presenting a perceived (36/61; χ 2  = 44.099, P  < 0.001) and an objective (28/61; χ 2  = 12.190, P <  0.01) improvement of health conditions after the intervention, together with an increased satisfaction in working conditions. An overall improvement of health condition was shown in 44/61 workers (72%). Conclusions Decisions made on the basis of a comprehensive process founded on scientific evidence, searched and appraised according to the paradigm of Evidence Based Occupational Health, result in effective outcomes.