Journal of evaluation in clinical practice
-
Use of evidence from systematic research is critical in evidence-based physical therapy, yet this has not been described well in developing countries where its purported benefits are most needed. This study explored research evidence uptake among physical therapists in the Philippines. ⋯ The low research evidence uptake and heavy reliance on potentially biased evidence sources strongly indicate the need for effective professional education for practitioners to address current barriers as well as early intensive undergraduate education for students to ensure adequate preparation on being effective research evidence consumers. Given the profile of Filipino physical therapists, alternatives to 'from scratch' evidence searching and appraisal are required if widespread uptake is envisaged.
-
Existing literature suggests that doctors' poor adherence with guidelines is one of the major contributing factors to suboptimal control of hypertension. This study aims to evaluate doctors' adherence with Malaysian clinical practice guideline (CPG 2008) in a tertiary care hospital, and factors associated with guideline adherence and hypertension control. ⋯ An overall fair level of adherence with guidelines and better control of hypertension was observed. Guidelines compliant practices resulted in better control of hypertension. The gaps between what guidelines recommend and clinical practice were especially seen in the pharmacotherapy of uncomplicated hypertension and hypertension with diabetes mellitus and renal disease.
-
Multicenter Study Clinical Trial
Acute pain management and assessment: are guidelines being implemented in developing countries (Lebanon).
Pain assessment and treatment is influenced by subjective perception of pain. Despite the international efforts to implement guidelines and protocols for pain management, pain continues to be regarded as a complication rather than a primary problem. The literature pertaining to the adequacy of pain management in the Middle East is frail. This study focuses on revealing the implemented practices of initial pain assessment, follow-up and re-evaluation of pain treatment in Lebanese hospitals. ⋯ This study reflects the lack of a well-structured system for pain management in Lebanese hospitals. It underlines the need for pain research in the region. It also highlights the need for implementing the recommendations discussed to minimize risk and optimize pain management.
-
Clinical diversity and methodological heterogeneity exists between studies on chronic care management. This study aimed to examine the effectiveness of chronic care management in chronic obstructive pulmonary disease (COPD) while taking heterogeneity into account, enabling the understanding of and the decision making about such programmes. Three investigated sources of heterogeneity were study quality, length of follow-up, and number of intervention components. ⋯ This study demonstrated that COPD chronic care management has the potential to improve outcomes of care; heterogeneity in outcomes was explained. Further research is needed to elucidate the diversity between COPD chronic care management studies in terms of the effects measured and strengthen the support for chronic care management.
-
Comparative Study
Diagnosis and management of acute coronary syndrome in an outpatient setting: good guideline adherence in Swiss primary care.
Switzerland lacks of national guidelines for the initial treatment of an acute coronary syndrome (ACS). ACS is not as frequent in an outpatient setting as in an emergency department; nevertheless, missing an ACS is associated with high morbidity and mortality. We wanted to observe actual infrastructure and performance based on case vignettes in outpatient general practitioners (GPs) and cardiologists (CAs); as a second outcome, we wanted to compare GPs to CAs. ⋯ We could show that international guideline adherence in ACS of GPs is high and GPs perform as well as CAs. Nevertheless there is room for optimization in the antiplatelet therapy and the use of cardiac stress testing in a low-risk population. National guidelines for treatment of an ACS in an outpatient setting are indicated.