Patient preference for falls prevention in hospitals revealed through willingness-to-pay, contingent valuation survey.
J Eval Clin Pract. 2011 Apr;17(2):304-10
Authors: Haines TP, McPhail S
Patient preference for inter…

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Are therapeutic decisions made on the medical admissions unit any more evidence-based than they used to be?

J Eval Clin Pract. 2009 Dec;15(6):1180-6

Authors: Ayre S, Walters G

RATIONALE, AIMS AND OBJECTIVES: To determine whether inpatients in a medical admissions unit in a UK district general hospital received evidence-based therapies in 2008. METHODS: The diagnoses of and therapies received by inpatients at the George Eliot Hospital National Health Service Trust in Nuneaton were recorded. A clinical librarian searched the literature (Clinical Knowledge Summaries, Cochrane Library, Medline and Embase) for the best evidence for each diagnosis-therapy pair. Evidence was graded on the following scale: systematic review, randomized controlled trial, non-experimental evidence and no or contrary evidence. RESULTS: One hundred and two patients generated 150 diagnosis-therapy pairs. Of these 61 (41%) had systematic review level evidence supporting them, 17 (11%) randomized controlled trial evidence, 48 (32%) non-experimental evidence and 24 (16%) no evidence. CONCLUSIONS: Results were comparable with previous studies. Care in a medical admissions unit in 2008 is still evidence-based, but, despite the vast growth in medical literature, no more than it was. The process was a useful collaboration between medical and library staff to audit the quality of patient care.

PMID: 20367724 [PubMed - indexed for MEDLINE]

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Inhospital management of COPD exacerbations: a systematic review of the literature with regard to adherence to international guidelines.

J Eval Clin Pract. 2009 Dec;15(6):1101-10

Authors: Lodewijckx C, Sermeus W, Vanhaecht K, Panella M, Deneckere S, Leigheb F, Decramer M

Rationale Chronic obstructive pulmonary disease (COPD) exacerbations are a leading cause of hospitalization. Suboptimal inhospital management is expected to lead to more frequent exacerbations and recurrent hospital admission, and is associated with increased mortality. Aims To explore inhospital management of COPD and to compare the results with recommendations from international guidelines. Methods A literature search was carried out for relevant articles published 2000-2009 in the databases Medline, Cochrane Library, Cumulative Index for Nursing and Allied Health Literature and Invert. In addition, the reference lists of the selected articles were examined. Main inclusion criteria were as follows: COPD, exacerbation, hospitalization, description of inpatient management, and clinical trials. Assessment and treatment strategies in different studies were analysed and compared with American Thoracic Society-European Respiratory Society and Global Initiative for Chronic Obstructive Lung Disease guidelines. Outcomes were analysed. Results Seven eligible studies were selected. Non-pharmacological treatment was infrequently explored. When compared with international guidelines, diagnostic assessment and therapy were suboptimal, especially non-pharmacological treatment. Respiratory physicians were more likely to perform recommended interventions than non-respiratory physicians. Conclusions Adherence to international guidelines is low for inhospital management of COPD exacerbations, especially in terms of non-pharmacological treatment. Further investigation is recommended to explore strategies like care pathways that improve performance of recommended interventions.

PMID: 20367712 [PubMed - indexed for MEDLINE]

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Misleading one detail: a preventable mode of diagnostic error?

J Eval Clin Pract. 2009 Oct;15(5):804-6

Authors: Arzy S, Brezis M, Khoury S, Simon SR, Ben-Hur T

RATIONALE, AIMS AND OBJECTIVES: Despite advances in our understanding of cognitive biases in clinical practice, little is known about correction or prevention of diagnostic errors. The presence of a single misleading detail may lead clinicians down a cognitive and actual path toward an incorrect diagnosis. METHODS: In a large teaching hospital, we surveyed 51 attending doctors in internal medicine, presenting each with 10 clinical vignettes and soliciting their diagnosis of the condition leading to the presentation. Each of the 10 clinical cases included a single misleading detail. RESULTS: This survey elicited a wrong diagnosis in 90% of cases, which was reduced to 30% when omitting the misleading detail from the vignette. Diagnostic accuracy did not improve by warning doctors about potentially misleading information. Asking doctors to identify a leading diagnostic detail and then to formulate an alternative diagnosis after omission of the detail, significantly reduced diagnostic error rate by nearly 50%. CONCLUSION: Systematic re-examination of leading diagnostic clues may help to reduce errors in diagnosis.

PMID: 19811592 [PubMed - indexed for MEDLINE]

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