Abstract Objective to provide guidance for guideline developers on how to consider health equity at key stages of the guideline development process. Study Design and Setting literature review ...followed by group discussions and consensus building. Results The key stages at which guideline developers could consider equity include setting priorities, guideline group membership, identifying the target audience(s), generating the guideline questions, considering the importance of outcomes and interventions, deciding what evidence to include and searching for evidence, summarising the evidence and considering additional information, wording of recommendations, and evaluation and use. We provide examples of how guidelines have actually considered equity at each of these stages. Conclusion Guideline projects should consider the above suggestions for recommendations that are equity-sensitive.
Post-test Probability According to Prevalence Agoritsas, Thomas; Courvoisier, Delphine S.; Combescure, Christophe ...
Journal of general internal medicine : JGIM,
10/2011, Letnik:
26, Številka:
10
Journal Article
Introduction Symptomatic hip osteoarthritis (OA) is a disabling condition with up to a 25% cumulative lifetime risk. Total hip arthroplasty (THA) is effective in relieving patients’ symptoms and ...improving function. It is, however, associated with substantial risk of complications, pain and major functional limitation before patients can return to full function. In contrast, hip arthroscopy (HA) is less invasive and can postpone THA. However, there is no evidence regarding the delay in the need for THA that patients would find acceptable to undergoing HA. Knowing patients’ values and preferences (VP) on this expected delay is critical when making recommendations regarding the advisability of HA. Furthermore, little is known on the optimal amount of information regarding interventions and outcomes needed to present in order to optimally elicit patients’ VP. Methods and analysis We will perform a multinational, structured interview-based survey of preference in delay time for THA among patients with non-advanced OA who failed to respond to conservative therapy. We will combine these interviews with a randomised trial addressing the optimal amount of information regarding the interventions and outcomes required to elicit preferences. Eligible patients will be randomly assigned (1 : 1) to either a short or a long format of health scenarios of THA and HA. We will determine each patient's VP using a trade-off and anticipated regret exercises. Our primary outcomes for the combined surveys will be: (1) the minimal delay time in the need for THA surgery that patients would find acceptable to undertaking HA, (2) patients’ satisfaction with the amount of information provided in the health scenarios used to elicit their VPs. Ethics and dissemination The protocol has been approved by the Hamilton Integrated Research Ethics Board (HIREB13-506). We will disseminate our study findings through peer-reviewed publications and conference presentations, and make them available to guideline makers issuing recommendations addressing HA and THA.
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)
We investigate the stationary-state fluctuations of a growing one-dimensional interface described by the Kardar-Parisi-Zhang (KPZ) dynamics with a noise featuring smooth spatial correlations of ...characteristic range ξ. We employ nonperturbative functional renormalization group methods to resolve the properties of the system at all scales. We show that the physics of the standard (uncorrelated) KPZ equation emerges on large scales independently of ξ. Moreover, the renormalization group flow is followed from the initial condition to the fixed point, that is, from the microscopic dynamics to the large-distance properties. This provides access to the small-scale features (and their dependence on the details of the noise correlations) as well as to the universal large-scale physics. In particular, we compute the kinetic energy spectrum of the stationary state as well as its nonuniversal amplitude. The latter is experimentally accessible by measurements at large scales and retains a signature of the microscopic noise correlations. Our results are compared to previous analytical and numerical results from independent approaches. They are in agreement with direct numerical simulations for the kinetic energy spectrum as well as with the prediction, obtained with the replica trick by Gaussian variational method, of a crossover in ξ of the nonuniversal amplitude of this spectrum.
We investigate the stationary-state fluctuations of a growing one-dimensional interface described by the KPZ dynamics with a noise featuring smooth spatial correlations of characteristic range ...\(\xi\). We employ Non-perturbative Functional Renormalization Group methods in order to resolve the properties of the system at all scales. We show that the physics of the standard (uncorrelated) KPZ equation emerges on large scales independently of \(\xi\). Moreover, the Renormalization Group flow is followed from the initial condition to the fixed point, that is from the microscopic dynamics to the large-distance properties. This provides access to the small-scale features (and their dependence on the details of the noise correlations) as well as to the universal large-scale physics. In particular, we compute the kinetic energy spectrum of the stationary state as well as its non-universal amplitude. The latter is experimentally accessible by measurements at large scales and retains a signature of the microscopic noise correlations. Our results are compared to previous analytical and numerical results from independent approaches. They are in agreement with direct numerical simulations for the kinetic energy spectrum as well as with the prediction, obtained with the replica trick by Gaussian variational method, of a crossover in \(\xi\) of the non-universal amplitude of this spectrum.
Adjustment of patient satisfaction scores for case-mix variables such as age and sex may lead to overadjustment. The patient's tendency to rate healthcare positively or negatively may be the only ...variable that should be adjusted to improve the comparability of satisfaction scores between healthcare providers.
To develop a measure of "rating tendency", assess its stability over time, explore its distribution across subgroups of patients and its association with patient opinion scores.
A scale based on 10 hypothetical scenarios describing hospital care episodes was developed. It was administered both before and after hospitalisation to 203 patients programmed for elective orthopaedic surgery in a Swiss teaching hospital. A problem score regarding the actual hospitalisation was obtained at follow-up.
The rating tendency scale had good internal consistency (Cronbach alpha 0.85), and factor analysis confirmed that it measured a single underlying concept. However, the correlation between prehospitalisation and posthospitalisation measures was moderate (intraclass correlation coefficient 0.55, p<0.001), as was the correlation with the hospitalisation problem score (Spearman r = -0.22, p = 0.002). The pattern of rating tendency across subgroups of respondents mirrored the pattern of problem scores. Adjusting for the rating tendency had little effect on comparisons of problem scores between subgroups of patients, all of whom were treated at the same hospital.
A patient's "rating tendency" can be measured using a reliable 10-item scale. The utility of adjusting satisfaction scores for rating tendency when comparing hospitals remains to be tested.
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