Attitudes towards, and patterns of use, of published research evidence in clinical decision making amongst intensive care clinicians.

An evidence-practice gap is defined as the difference between what we know from the best available research evidence and what actually happens in current practice. The highly respected ARDSNet low-tidal-volume ventilation trial was published in 2000, however, in 2016 an observational study conducted in over 50 countries documented that up to one third of eligible patients failed to receive the ARDSNet low-tidal-volume ventilation strategy. In this thesis, we undertook a sequence of studies to better understand research evidence use in intensive care, with the intention of developing a tool that may help close evidence-practice gaps. To better understand research evidence use, we conducted a self-administered mail-out survey of intensive care specialists in Australia and New Zealand, and a self-administered online survey of a multinational group of intensive care clinicians. Based on knowledge gained from these surveys, we developed a concise evidence summary tool designed to overcome 27 explicit barriers to the use of research evidence. To evaluate the evidence summary tool, we developed a clinical case-based scenario. Ninety-three multinational intensive care clinicians were invited to review the casebased scenario and then read the evidence summary tool. Reading the evidence summary tool led to a significant increase in the belief that the intervention described in the tool would benefit the realistic patient in our case-based scenario (mean score change 0.32, 95% CI 0.19 to 0.46, P<0.001). Interestingly, the group most influenced by the evidence summary tool were those who appeared to be less up to date. Whilst it is not known whether this success in increasing intensive care clinicians’ belief in the benefit of a treatment would translate into a change in clinical practice behaviours, these promising results clearly indicate a need for further investigation into the use of evidence summary tools as an intervention to help close evidence-practice gaps

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

How to Practice Academic Medicine and Publish from Developing Countries?

This is an open access book. The book provides an overview of the state of research in developing countries – Africa, Latin America, and Asia (especially India) and why research and publications are important in these regions. It addresses budding but struggling academics in low and middle-income countries. It is written mainly by senior colleagues who have experienced and recognized the challenges with design, documentation, and publication of health research in the developing world. The book includes short chapters providing insight into planning research at the undergraduate or postgraduate level, issues related to research ethics, and conduct of clinical trials. It also serves as a guide towards establishing a research question and research methodology. It covers important concepts such as writing a paper, the submission process, dealing with rejection and revisions, and covers additional topics such as planning lectures and presentations. The book will be useful for graduates, postgraduates, teachers as well as physicians and practitioners all over the developing world who are interested in academic medicine and wish to do medical research

Assessing Pain-related Factors as Predictors of Distress during Transitional Musculoskeletal Pain Experience

During peopleâs pain experience, certain difficulties may emerge within individualsâ psychological and social domains that can confound and exacerbate the frequency of their pain-related distress episodes. Previous research has consistently found psychosocial factors evident during the first months of unresolved pain are reliable predictors of pain chronicity and disability at 12 months. This exploratory descriptive quantitative multivariate study included 2 nationwide online surveys that examined the frequency of moderate-to-severe symptoms of distress within the anxiety-depression spectrum, and the extent that 8 pain-related factors influenced and predicted episodes of anxiety and depressed mood, which included 2 demographic risk factors (age range and gender), 3 medical protocol-related factors (general musculoskeletal diagnosis, pain intensity, and pain interference), and 3 psychosocial issues (perceived rejection, quality of life, and satisfaction with life). Respondents were recruited online and screened for eligibility to participate in each survey. Participants were 18 years of age or older with either a recent musculoskeletal injury or recently diagnosed musculoskeletal condition lasting no more than 4 months since onset. The study found perceived rejection was the most reliable predictor and had the greatest effect on anxiety episodes, and that pain interference reliably predicted and had the greatest effect upon episodes of depressed mood. The findings from the present study suggest that to properly prevent chronic pain and minimize pain-related disability, greater attention needs to be directed toward the psychosocial issues that emerge during the course of individualsâ transitional pain experience

The feasibility and potential effectiveness of a conventional and exergame intervention to alter balance-related outcomes including fall risk: a mixed methods study

Introduction: Fall risk, occurrence and injury is increasing as the world ages, and Africa and other emerging regions will not be spared. Similarly, the rise of noncommunicable diseases, compressed morbidity and lack of physical activity present major challenges. This novel feasibility study explored the use of an exergaming technology compared with a conventional, evidence-based exercise programme (Otago Exercise Programme) to reduce fall risk by improving balance, and to inform a large-scale randomised control trial. Methodology: Mixed methods study in independent older adults with established fall risk. The quantitative component employed feasibility RCT methodology. Cluster randomisation assigned interventions to sites. Single blinding was used. Both interventions were offered for six months. A variety of balance-related endpoints (e.g., Timed Up and Go, Dynamic Gait Index, Mini-BESTest) were used to find the most applicable. Patient-centred variables included questionnaires regarding depression, physical activity levels, quality of life and estimates of self-efficacy for exercise. Qualitative focus groups explored participants' experiences of falls and the exergaming intervention using a phenomenology lens. Results: Site and participant recruitment was simple and readily achievable, with low numbers need to screen required. Eligibility criteria were confirmed and more added. Adherence and attrition were major challenges. Cluster randomisation appeared to exacerbate between-group differences at baseline. The exergaming intervention produced preliminary evidence in its favour, with results approaching Minimal Clinically Important Difference compared with the evidence-based intervention. The experience of the exergaming intervention was regarded as positive by focus group participants. Barriers and facilitators are reported. Discussion: Methodological issues in the literature have prevented firm consensus on the use of exergaming in falls prevention, although studies are abundant. The current study used rigorous methodology in the novel context of a developing region, which offers numerous challenges for older adults. Implications for a large-scale, fully funded RCT are discussed. Lessons learned can be used to scale up service delivery for an under-served population; and promote the aim of well-being for all at all ages