Journal of evaluation in clinical practice
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Hospitals were mandated to dramatically increase capacity during the Covid-19 crisis in New York City. Conversion of non-clinical space into medical units designated for Covid-19 patients became necessary to accommodate this mandate. ⋯ Converting non-clinical space to a medical unit was accomplished quickly with staffing, workflow for appropriate patients, few patients who returned to a higher level of care, and no respiratory or cardiac arrests or deaths on the unit.
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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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Representation of benefits and harms associated with specific interventions in an understandable and comparable way is crucial for informed decision making that clinical practice guidelines (CPGs) aim to enhance. Therefore, we investigated how statements concerning the effects of interventions considered and described benefits and harms, magnitude of effect and its uncertainty, numeric and non-numeric information, and outcomes in Finnish CPGs. ⋯ In the Finnish CPGs, the statements were rarely framed with both absolute and relative numeric measures of an intervention's effect. Harms were rarely reported with a grade indicating the level of evidence. The users of CPGs would benefit from more consistent and understandable framing of statements considering both benefits and harms of interventions.
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Despite the available evidence to support optimal practices in rehabilitation, significant knowledge practice gaps persist. Opinion leaders (OLs) and knowledge brokers (KBs) can enhance the success of knowledge translation (KT) interventions and improve uptake of best practices among clinicians. However, the literature on the mechanisms underpinning OLs'/KBs' activities, and guidance on the type of support needed for successful implementation of these roles in rehabilitation contexts is scarce. This research aimed to highlight the differences and similarities between OLs and KBs with respect to context, mechanism, and outcomes as well as describe the common patterns of OLs and KBs by creating a context-mechanism-outcomes configuration. ⋯ Findings of this realist review converge to create a context-mechanism-outcomes configuration with suggestions to optimally utilize OLs/KBs in rehabilitation. The configurations suggest desirable features that can lead to a greater potential to achieve targeted goals. It is preferable that OLs/KBs be embedded in the organization and that they are adequately skilful and well-trained. Also, OLs/KBs should perform the required roles using KT interventions adapted to the local context.
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Heart failure (HF) clinics are highly effective, yet not optimally utilized. A realist review was performed to identify contexts (eg, health system characteristics, clinic capacity, and siting) and underlying mechanisms (eg, referring provider knowledge of clinics and referral criteria, barriers in disadvantaged patients) that influence utilization (provider referral [ie, of all appropriate and no inappropriate patients] and access [ie, patient attends ≥1 visit]) of HF clinics. ⋯ Given the burden of HF and benefit of HF clinics, more research is needed to understand, and hence overcome sub-optimal use of HF clinics. In particular, an understanding from the perspective of referring providers is needed.