Journal of evaluation in clinical practice
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The Getting It Right First Time programme aims to reduce variation in clinical practice that unduly impacts on outcomes for patients in the National Health Service (NHS) in England; often termed "unwarranted variation." However, there is no "gold standard" method for detecting unwarranted variation. The aim of this study was to describe a method to allow such variation in recorded practice or patient outcomes between NHS trusts to be detected using data over multiple time periods. By looking at variation over time, it was hoped that patterns that could be missed by looking at data at a single time point, or averaged over a longer time period, could be identified. ⋯ The time-series method may complement other methods to help identify unwarranted variation.
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To estimate in-hospital and 30-day outcomes after transcatheter aortic valve replacement (TAVR) in South America through a systematic review and meta-analysis of observational data. ⋯ As compared with published international registries, the overall results of TAVR in South America seemed underrated. Significant heterogeneity was observed in procedural success, pacemaker requirement, and post-procedure moderate or severe aortic regurgitation. This study provides a real-life framework for the analysis of the performance of this technology in the region, intended to be a starting point for quality improvement.
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New therapies are increasingly approved by regulatory agencies such as the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) based on testing in non-randomized clinical trials. These treatments have typically displayed "dramatic effects" (ie, effects that are considered large enough to obviate the combined effects of biases and random errors that may affect the study results). The agencies, however, have not identified how large these effects should be to avoid the need for further testing in randomized controlled trials (RCTs). We investigated the effect size that would circumvent the need for further RCTs testing by the regulatory agencies. We hypothesized that the approval of therapeutic interventions by regulators is based on heuristic decision making whose accuracy can be best characterized by the application of signal detection theory (SDT). ⋯ Drug developers and practitioners alike can use the change in one logarithm of effect size as a benchmark to decide if further testing in RCTs should be pursued, or as a guide to interpreting the results reported in non-randomized studies. However, further research would be useful to better characterize the threshold of effect size above which testing in RCTs is not needed.
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This article aims to identify the factors that affect physicians' experiences of receiving practice data and to use these data to develop a model describing how individuals interact with the data. ⋯ Our novel model depicts the relationship between data feedback systems and individuals' mindsets interact to augment or hinder clinical practice improvement. This model may provide leaders with a framework to examine their academic and administrative structures and how they might interface with performance feedback systems with clinicians.
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To explore rates and factors associated with mandatory vaccination support overall and intentions to get vaccinated specifically for COVID-19 among individuals in Greece. ⋯ The survey revealed that the majority of the Greek citizens favour mandatory vaccination overall and intend to get vaccinated for COVID-19, driven mostly by utilization of preventive services and trust in healthcare authorities. However, intention to get vaccinated for COVID-19 was lower relative to mandatory vaccination support. This suggests a need to intensify evidence-based yet simplified messaging by esteemed healthcare providers to inform the public on the risks and benefits of vaccines.