IRG Pre-Conference Workshop – HTAi13

Check this advertisement out! I have to say that I am feeling very chuffed. Who knew that an event our group organised would have an advertisement like this! Many thanks go to Sally Wood of EAHIL.

Doctor’s Toolbag

Doctor’s Toolbag is a new product from CEBMi – http://www.cebmi.net/doctors-toolbag

The Doctor’s Toolbag iPhone app developed by the BMJ Group and CEBMi Limited provides a fast and simple way to use the most effective rules in a busy clinical setting. Some rules help with diagnosis, others are useful for screening or assessing risk factors. Combining these rules with the latest evidence from Best Practice and Clinical Evidence from the BMJ Evidence Centre, provides a succinct and up-to-date tool that can be incorporated into everyday clinical practice to help improve patient care.

Key features

• Contains 74 of the most useful clinical prediction tools for prognosis and diagnosis. Each prediction tool tells you what clinical features to look for, and what they mean for your patient
• Evidence summaries supporting each tool, with links to abstracts from key publications
• Regular updates to evidence summaries and prediction rules reflecting the latest clinical evidence
• Up-to-date information from Best Practice and Clinical Evidence about additional tests that may be required, treatment and relevant guidelines
• Rules searchable by title, specialist area & condition
• Hide/reveal supplementary information, including useful pictures and sounds
• Customisation of your homepage for one click access to your favourite tools
• Embedded article references, including links to sources, for convenient mobile browsing
• In-app web browsing of related content
• Adjustable font size

Clinical prediction tools include:

• ABCD2 stroke risk score – Prediction of stroke risk in patients with TIA
• AUDIT C – Detection of the early signs of hazardous and harmful drinking
• CURB 65 – Criteria for severity of community acquired pneumonia
• MiniCog – Screening for cognitive impairment
• Wells DVT Score – Assessment of deep vein thrombosis
• Ottawa ankle, knee and foot rules – Does the patient need an ankle, knee or foot x-ray?
• PHQ9 depression score – Assessment of depression in primary care
• Centor criteria – Diagnosis of acute bacterial tonsillitis in adults and in children

 

Livestream

The Livestream channel is a great resource for streaming your events live. And it’s free. You just need to create an account and you’re away. To see, go to http://www.livestream.com/

 

Instruments for Evaluating Education in Evidence-Based Practice

Shaneyfelt et al. Instruments for Evaluating Education in Evidence-Based Practice: A Systematic Review.  JAMA. 2006;296(9):1116-1127. doi:

Abstract

Context  Evidence-based practice (EBP) is the integration of the best research evidence with patients’ values and clinical circumstances in clinical decision making. Teaching of EBP should be evaluated and guided by evidence of its own effectiveness.

Objective  To appraise, summarize, and describe currently available EBP teaching evaluation instruments.

Data Sources and Study Selection  We searched the MEDLINE, EMBASE, CINAHL, HAPI, and ERIC databases; reference lists of retrieved articles; EBP Internet sites; and 8 education journals from 1980 through April 2006. For inclusion, studies had to report an instrument evaluating EBP, contain sufficient description to permit analysis, and present quantitative results of administering the instrument.

Data Extraction  Two raters independently abstracted information on the development, format, learner levels, evaluation domains, feasibility, reliability, and validity of the EBP evaluation instruments from each article. We defined 3 levels of instruments based on the type, extent, methods, and results of psychometric testing and suitability for different evaluation purposes.

Data Synthesis  Of 347 articles identified, 115 were included, representing 104 unique instruments. The instruments were most commonly administered to medical students and postgraduate trainees and evaluated EBP skills. Among EBP skills, acquiring evidence and appraising evidence were most commonly evaluated, but newer instruments evaluated asking answerable questions and applying evidence to individual patients. Most behavior instruments measured the performance of EBP steps in practice but newer instruments documented the performance of evidence-based clinical maneuvers or patient-level outcomes. At least 1 type of validity evidence was demonstrated for 53% of instruments, but 3 or more types of validity evidence were established for only 10%. High-quality instruments were identified for evaluating the EBP competence of individual trainees, determining the effectiveness of EBP curricula, and assessing EBP behaviors with objective outcome measures.

Conclusions  Instruments with reasonable validity are available for evaluating some domains of EBP and may be targeted to different evaluation needs. Further development and testing is required to evaluate EBP attitudes, behaviors, and more recently articulated EBP skills.

Evaluation tools: EBM Fresno Test | Berlin Questionnaire

UpToDate Mobile App

UpToDate has released an app for iPhone. To find out more about the app, click here.  Only private subscribers can download the app at this time.

AHRQ’s Horizon Scanning Manual

The AHRQ Horizon Scanning System Protocol & Operations Manual is now online. Click here to open the PDF document in a new browser window. From the Preface: “Horizon scanning involves two processes. The first is the identification and monitoring of new and evolving health care interventions that are purported to or may hold potential to diagnose, treat, or otherwise manage a particular condition or to improve care delivery for a variety of conditions. The second is the analysis of the relevant health care context in which these new and evolving interventions exist to understand their potential impact on clinical care, the health care system, patient outcomes, and costs. It is NOT the goal of the AHRQ Healthcare Horizon Scanning System to make predictions on the future utilization and costs of any health care technology. Rather, the reports will help to inform and guide the planning and prioritization of research resources.” This document includes daily lead scanning, search and profile development for target topics,  inclusion criteria, tables of resources that ERCI librarians search, PubMed filters etc. If you are involved in horizon scanning or if your organisation is interested in developing HS processes, this is a document to consult.

Number Needed to Treat http://www.thennt.com

There is a way of understanding how much modern medicine has to offer individual patients. It is a simple statistical concept called the “Number-Needed-to-Treat”, or for short the ‘NNT’. The NNT offers a measurement of the impact of a medicine or therapy by estimating the number of patients that need to be treated in order to have an impact on one person. The concept is statistical, but intuitive, for we know that not everyone is helped by a medicine or intervention — some benefit, some are harmed, and some are unaffected. The NNT tells us how many of each. Visit The NNT.

Read David Rothman’s review here.

QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies

Annals of Internal Medicine Oct 2011 vol. 155 no. 8 529-536

In 2003, the QUADAS tool for systematic reviews of diagnostic accuracy studies was developed. Experience, anecdotal reports, and feedback suggested areas for improvement; therefore, QUADAS-2 was developed. This tool comprises 4 domains: patient selection, index test, reference standard, and flow and timing. Each domain is assessed in terms of risk of bias, and the first 3 domains are also assessed in terms of concerns regarding applicability. Signalling questions are included to help judge risk of bias.

The QUADAS-2 tool is applied in 4 phases: summarize the review question, tailor the tool and produce review-specific guidance, construct a flow diagram for the primary study, and judge bias and applicability. This tool will allow for more transparent rating of bias and applicability of primary diagnostic accuracy studies.

The Centre for Health Informatics at UNSW has recently successfully completed the ANDS-funded project: “An International Antibiotic-Resistance Gene Cassette Database”

The key achievements this project produced are:
•    Published a free on-line repository of the hundreds of known
antibiotic resistance gene cassettes.
•    Established  a web service through which microbiologists can submit
cassette array sequences and receive an accurate cassette names based on predictions made by our (existing) computational system and knowledge base.
•    Allow people to submit new cassettes to be reviewed by staff at the
Centre for Infectious Diseases and Microbiology and for inclusion in the knowledge base.
•    Created tools to keep track of submission status, update submission,
and publish them.
•    Users in 6 countries in less than 6 months since launch.
This is a link to the Repository of Antibiotic resistance Cassettes database online here

A description of the MPPDA data collection can be seen on Research Data
Australia here

This project was jointly led by Dr. Guy Tsafnat and Dr. Sally Partridge at the Centre for Infectious Diseases and Microbiology at Westmead Hospital.
The software development was carried out by Intersect Australia Limited

News from BMJ’s Best Practice

The Clinical Evidence systematic reviews are now available for you to access within Best Practice.