This article provides an evaluation and overview of the Personal Digital Assistant (PDA) version of the evidence-based medicine database, InfoRetriever. Both the Pocket PC and Palm OS version are evaluated in this article. Topics covered are the access and installation of InfoRetriever for both PDA operating systems, the design and interface of InfoRetriever, the ease of access of the database contents, and its importance as a tool for point-of-care medicine.

Evidence-based practices and comparative effectiveness research are salient topics in public policy. Empirical validation of agency operating processes provides agencies and policy-makers the opportunity to address uncertainty surrounding effectiveness. While this is an increasingly accepted rational approach to public policy, the exact mechanism for how this operates is less known. In order to evaluate several theoretical assumptions and normative rational expectations inherent in this approach, the implementation of a state legislative mandate stating policy expectations for behavioral health evidence-based practices is assessed. This study sought to assess whether implementation patterns and associated outcomes reflect "rational mechanism" policy expectations. While the premise of this research surrounds a state behavioral health legal mandate, results inform broader health policy efforts. Study results identify some evidence that the policy yielded "rational mechanism" processes and outcomes, but also indicated that other mechanisms may have influenced implementation patterns. In addition, evidence of a link between policy and outcomes is at best inconsistent. Further research on evidence-based policies using definitional and measurement frameworks applied in this study is clearly warranted.

Rising collection costs sometimes necessitate tough decisions regarding cancellation of popular products. In 2015–2016, the East Tennessee State University Medical Library subscribed to UpToDate and DynaMed Plus, both clinical point-of-care products, with the understanding that one product would be canceled at the fiscal year end. The librarian team undertook a year-long community engagement campaign to inform library users about the pending product cancellation decision. Ultimately, DynaMed Plus was selected and UpToDate was cancelled. The campaign generated user engagement with the decision making, along with perceived benefits including increased awareness of the library's budget constraints, increased discussion of scholarly publishing, and greater faculty/student knowledge of evaluating evidence-based products.

This dissertation presents a body of research consisting of 5 scientific papers with an overarching objective to develop and test interventions that can enhance the dissemination, access and use of current best evidence at the point of care. Questions constantly arise from clinicians’ interactions with their patients, but more than 60% remain unanswered. The first 4 papers therefore focused on evidence dissemination to clinicians and trainees looking for answers and trying to stay alert to new evidence. We used as our “laboratory” an online tool developed at McMaster University’s Health Information Research Unit, the MacPLUS Federated Search (MacPLUS FS), which allows busy clinicians to search multiple top high quality resources simultaneously and display a 1-page output with the most clinically useful results at the top. Guided by effective models for the teaching of clinical skills at the point of care, we designed 3 web-based interventions addressing logistical and educational barriers to increase the quantity and quality of searching for current best evidence. These interventions were: (A) a web-based Clinical Questions Recorder and Reminder; (B) an Evidence Retrieval Coach composed of 8 short videos embedded in MacPLUS; (C) and a Gamified Audit & Feedback based on the allocation of “badges” and “reputation scores” for evidence searching. We tested these interventions in 4 factorial randomized-controlled trials among 1,868 heath care professionals and students currently registered in MacPLUS FS, namely: 477 medical faculty members, 431 postgraduate medical trainees, 725 nursing students and 235 medical students. Results showed that these target populations substantially differed both in their baseline frequency of search and access to alerts, as in their responsiveness to the 3 web-based interventions on evidence utilization. Evidence summaries have traditionally been tailored to meet the educational needs of clinicians, but are seldom provided in a format that supports shared decision-making. Our fifth paper explored a potential solution, which constitutes another route for evidence dissemination and use. In a project called SHARE-IT, we developed a new framework and online prototype for the generic production of decision aids, which allow physicians and patients to discuss the evidence together in the clinical encounter. We present the framework, design methods and early testing of this generic approach, which showed promising results for the translation of evidence summaries into useful tools for shared decision-making. / Thesis / Doctor of Philosophy (PhD)

Abstract not available

L’information est un des besoins les plus importants des patients atteints de cancer. Leurs attentes fortes, variables et hétérogènes, en matière d’informations sur les différents aspects de la prise en charge de la maladie, soulèvent la question de la qualité de ces informations mises à disposition des patients. L’élaboration d’outils d’information et d’aide à la décision de qualité, qu’ils soient destinés aux cliniciens, tels que les recommandations pour la pratique clinique (RPC), ou aux patients, tels que des documents écrits d’information, implique la prise en compte des trois composantes essentielles de la décision médicale : données actuelles de la science (evidence-based medicine), expertise professionnelle, et préférences et valeurs des patients. Pour pouvoir baser la décision médicale sur ces trois dimensions, l’enjeu est de partager avec les patients les données actuelles de la science, et d’intégrer les préférences des patients dans les RPC. Notre hypothèse est qu’il est possible d’intégrer les préférences des patients à deux niveaux de production des connaissances : l’élaboration de documents écrits d’information des patients dans le cadre du programme SOR SAVOIR Patient d’une part, et l’élaboration de RPC pour les cliniciens d’autre part. Les résultats de ces travaux fournissent une contribution méthodologique pour améliorer la qualité des documents écrits et impliquer les patients atteints de cancer dans le développement de ces informations / Information is one of the most important needs of cancer patients. Their strong, variable and heterogeneous expectations, in terms of information on different aspects of the management of the disease, raise the question of the quality of the information made available to patients. The development of good-quality information materials and decision aids, dedicated to clinicians, such as clinical practice guidelines (CPG), or dedicated to patients, such as patient information leaflets, requires taking into account the three essential components of medical decision: current scientific data (evidence-based medicine), professional expertise and patient values and preferences. To be able to base medical decisions on these three dimensions, the challenge is to share with the patients current scientific data, and incorporate patient preferences in the development process of CPG. Our hypothesis is that it is possible to integrate the preferences of patients at two levels of knowledge production: the development of written patient information in the French SOR SAVOIR Patient program on the one hand, and development of CPG for clinicians on the other hand. The results of this work provide a methodological contribution to improve the quality of written documents and involve cancer patients in the development of this information.

La longévité est un enjeu majeur des prochaines décennies. La conséquence de cette longévité est l’émergence des maladies chroniques. Il est aujourd’hui admis que le vieillissement individuel est fortement influencé par des variables biologiques, psychologiques, environnementales et sociales. La prévention commence à la naissance pour se poursuivre tout au long de la vie. C’est pourquoi, une consultation de prévention à des moments clés du parcours de vie notamment au moment de la retraite est largement conseillée. Notre travail de doctorat a consisté, grâce à la mise en place de plusieurs recherches-actions dans les Centres d’examens de santé de l’Assurance maladie, à documenter par la preuve scientifique, démarche qui rejoint celle de l’Evidence-Based Medecine, la construction d’un examen périodique de santé dédié aux séniors. Les recherches-actions ont concerné trois problématiques de santé publique des personnes âgées que sont la chute, les troubles cognitifs et la dégénérescence maculaire liée à l’âge. Chaque recherche-action a apporté sa contribution à la construction de cet examen de santé senior : une meilleure connaissance des caractéristiques des chuteurs avec élaboration d’un score prédictif de chute et de stratégies de prise en charge de ce risque, des outils simples de repérage des troubles cognitifs légers, un dépistage de la dégénérescence maculaire liée à l’âge via la télémédecine. D’autres thématiques de santé seront à explorer mais les Centres d’examens de santé se positionnent d’ores et déjà, comme des acteurs déterminants de la prise en charge des populations vieillissantes / The increase of life expectancy is a major issue to face in the decades to come. A consequence of this increasing life expectancy is the emergence of chronic diseases. It is now acknowledged that individual ageing is strongly influence by biological, psychological, environmental and social variables. Prevention begins at birth and continues throughout life. It is for this reason, that a prevention consultation at certain key moments in life, such as at retirement, is strongly advised. Our doctorate work consisted of documenting the setup of periodic health examinations dedicated to seniors. This was supported by scientific proof provided by carrying out many action researches in the Health Examination centres of French Health Insurance, an approach similar to ‘Evidence Based Medicine’. The action researches were directed towards three main public health issues amongst the elderly which include falling, memory cognitive impairment and macular degeneration related to age. Each action research contributed to the establishment of this health examination for seniors. Indeed, now there is a better recognition of characteristics amongst seniors who have suffered falls thanks to the development of a tool which gives a predictive score a falling, and in turn action strategies. In addition, there is a tool to spot and identify mild cognitive impairment and screening for macular degeneration related to age through the use of telemedicine. Other health topics will need to be explored but French Health Examination Centres already position themselves as responsible decisive actors for the ageing population

Thesis (MScPhysio)--Stellenbosch University, 2012. / Background: Evidence for the effectiveness of physiotherapeutic interventions in the management of knee osteoarthritis (OA) is synthesised in the current clinical guidelines (CGs), providing clinicians with readily accessible and interpretable practice guidelines. However, CGs are often not specific to the local context of the target users, therefore hindering successful implementation of evidence into clinical practice. Formulating succinct and composite recommendations by synthesising the current CGs reporting on the evidence-based (EB) management of knee OA may assure contextual relevance and facilitate implementation of evidence into clinical practice. In addition, multifaceted interventions, such as evidence-based practice (EBP) workshops, are also postulated to promote the implementation of guideline recommendations, thereby enhancing clinical outcomes. Objectives: The primary objectives of this study were to: 1) describe the range of EB physiotherapeutic interventions in the management of knee OA as documented in the current CGs; and 2) develop composite clinical recommendations for a specific group of users working in Jerusalem. A secondary study objective was to ascertain the effect of translating the knowledge through a specifically-designed EBP workshop on the uptake of knowledge and implementation of EBP into clinical practice by physiotherapists working in Jerusalem. The EBP workshop was aimed at educating physiotherapists about the EB physiotherapeutic techniques for knee OA management. Study design: Two studies were conducted. A systematic review (SR) into EB clinical guidelines was conducted to describe and synthesise the available evidence and formulate composite recommendations for knee OA. The results of the SR were used to design an EBP workshop aimed at educating physiotherapists about EB physiotherapeutic techniques for treating knee OA patients. A pre-post quasi-experimental design was then conducted to assess the effect of this EBP workshop on the uptake and implementation of EBP into clinical practice amongst public sector physiotherapists working in Jerusalem. Methodology for quasi experimental study: Physiotherapists who regularly treat knee OA patients were recruited from a list of members registered with the Palestinian Physiotherapy Association Jerusalem. A three-month retrospective audit (initial audit) of knee OA patients’ physiotherapy records kept by the participating physiotherapists was conducted to establish current management patterns. EB strategies for knee OA was presented to the participating physiotherapists during a one-day workshop. A second audit of physiotherapy records was conducted three months after the EBP workshop to establish changes in the selection of physiotherapeutic management techniques for knee OA. Results: The initial audit revealed that the participating physiotherapists utilized one high EB modality namely, exercises, as a core management strategy in knee OA, but did not frequently implement other high EB modalities such as self-management and weight-loss programs. Following the EBP workshop, a statistically significant increase (p=0.008) in the implementation of weight-loss and self-management strategies in the management of knee OA was noted. Conversely, a statistically significant decrease was noticed in using patellar taping (low EB modality) in the management of knee OA (p=0.04). No significant changes were noticed in the utilization of other physiotherapy modalities supported by weak or modest EB recommendations. Conclusion: The study concluded that physiotherapists inherently prescribed exercise as a core management strategy for knee OA. Modalities supported by modest levels of evidence were used as adjunct treatments. The EBP workshop facilitated the increased application of high EB modalities such as weight-loss and self-management programs. The results of this study illustrate that an EBP workshop may be effective in promoting the implementation of EB physiotherapeutic modalities in the management of knee OA. However, larger studies with longer follow-up periods are required. / No Afrikaans abstract available

Hypotheses on the efficiency of evidence-based printed materials can be directed by health communication concepts. These concepts can provide a general framework that goes beyond the traditional vulgarization point of view: instead, it points towards a strategy to obtain health outcomes and provoke behavior change, from a disease prevention, management and health promotion perspective. The present study proposes a comprehensive framework based on concepts from health risk communication, Tarde's theory of social values, usability, readability and plain language. Using the mapping approach, an evaluation grid was applied to printed evidence-based materials with proven effectiveness, in order to reveal the underlying strategy and isolate the characteristics of effective materials. The results allowed us to define two types of printed evidence-based materials, according to the robustness of the evidence they contain and the target audience. It was also possible to identify indicators of notions that are translated into operationalized items, frequent in those materials that might be responsible for their efficiency: clear purpose of the documents, limited scope, learning motivation and correspondence to the logic, experience and language of readers. Effectiveness of printed evidence-based materials could also be correlated to numeracy, objectiveness, standard definitions, constant timeframes and denominators, risks enumerated in order of importance, effective response, and high degree of threat, urgency, novelty and visibility of the disease. It was also possible to identify some missing communication concepts: cultural diversity, narrative, increased easiness of procedures and aesthetic advantage for the patient. In the process of work, the theory of social values emerged as a dynamic component that can bring together and explain many concepts, as well as physician’s acceptance of the guidelines. Value in terms of usefulness and truth plays a major role in cognitive appreciation of the documents. This concept gives a strategic meaning to the whole work and allows us to better understand attitude and behavior change.

Advertising on complementary, alternative medicines and over the counter medicines (OTC) published in the printed journals for lay people from the view of Evidence Based Medicine Student: Schirlová. Z Tutor: Matoulková, P. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Czech Republic INTRODUCTION: Advertisements are important means of communicating information to public. The quality of the pharmaceutical advertising has been continuously discused. METHODS: The objective of the study was to assess availability of supporting scientific information for health claims stated in the food supplements and OTC (Over-the- Counter) medicines ads that were published during period September 2012 and June 2013 in the mostly read life style journals for women. For each advertisement, the emphasized claim/-s was compared to available scientific unbiased evidence. The literature search was conducted by using Pubmed database (mainly meta-analysis and randomized clinical trials). Further information was searched in the Scholar Google, Natural Medicines Comprehensive Database (Consumer version) and Micromedex. Different keywords and their appropriate combinations were used to identify relevant information. Frequency analysis was used to assess frequency...