Evidence Based Practice: Assessing the educational outcome

Healthcare providers and patients strive for optimal outcomes with a growing trend to embed the principles of evidence-based practice (EBP) into mainstream care delivery by practicing dentists. The foundations of future best practice are built at dental school. How do we evaluate the outcome of an EBP syllabus? This study describes the use of the KACE assessment tool to assess the learning outcomes of final year DDS students who had completed an EBP program. The use of a validated instrument to measure four dimensions, knowledge, attitudes about it, familiarity with sources for accessing evidence and confidence in critical appraisal skills can be an important outcomes assessment tool. 90 dental students from the final year completed the questionnaire in 2016. 84% demonstrated good knowledge of evidence hierarchy. 92% agreed of the value to future practice and improvement in quality of patient care with 88% agreeing with the value of it as an integral part of a dental school curriculum. Students demonstrate confidence in appraising study design, recognizing bias, generalizability and value of the research report. However, even with electronic access to databases, when it came to accessing evidence over 75% would ask a friend with less than 25% consulting the Cochrane Database. The outcome of the training had been positive in providing the skills for EBP. The use of a validated tool ensured the graduating students received a good foundation to provide their future patients with the best clinical evidence for optimal and cost-effective dental care

The effectiveness of home versus community-based weight control programmes initiated soon after breast cancer diagnosis: a randomised controlled trial

BackgroundBreast cancer diagnosis may be a teachable moment for lifestyle behaviour change and to prevent adjuvant therapy associated weight gain. We assessed the acceptability and effectiveness of two weight control programmes initiated soon after breast cancer diagnosis to reduce weight amongst overweight or obese women and prevent gains in normal-weight women.MethodsOverweight or obese (n?=?243) and normal weight (n?=?166) women were randomised to a three-month unsupervised home (home), a supervised community weight control programme (community) or to standard written advice (control). Primary end points were change in weight and body fat at 12 months. Secondary end points included change in insulin, cardiovascular risk markers, quality of life and cost-effectiveness of the programmes.ResultsForty-three percent of eligible women were recruited. Both programmes reduced weight and body fat: home vs. control mean (95% CI); weight ?2.3 (?3.5, ?1.0) kg, body fat ?1.6 (?2.6, ?0.7) kg, community vs. control; weight ?2.4 (?3.6, ?1.1) kg, body fat ?1.4 (?2.4, ?0.5) kg (all p?<?0.001). The community group increased physical activity, reduced insulin, cardiovascular disease risk markers, increased QOL and was cost-effective.ConclusionsThe programmes were equally effective for weight control, but the community programme had additional benefits.Clinical trial registrationISRCTN6857614

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Evidence Based Practice: Assessing the educational outcome

Healthcare providers and patients strive for optimal outcomes with a growing trend to embed the principles of evidence-based practice (EBP) into mainstream care delivery by practicing dentists. The foundations of future best practice are built at dental school. How do we evaluate the outcome of an EBP syllabus? This study describes the use of the KACE assessment tool to assess the learning outcomes of final year DDS students who had completed an EBP program. The use of a validated instrument to measure four dimensions, knowledge, attitudes about it, familiarity with sources for accessing evidence and confidence in critical appraisal skills can be an important outcomes assessment tool. 90 dental students from the final year completed the questionnaire in 2016. 84% demonstrated good knowledge of evidence hierarchy. 92% agreed of the value to future practice and improvement in quality of patient care with 88% agreeing with the value of it as an integral part of a dental school curriculum. Students demonstrate confidence in appraising study design, recognizing bias, generalizability and value of the research report. However, even with electronic access to databases, when it came to accessing evidence over 75% would ask a friend with less than 25% consulting the Cochrane Database. The outcome of the training had been positive in providing the skills for EBP. The use of a validated tool ensured the graduating students received a good foundation to provide their future patients with the best clinical evidence for optimal and cost-effective dental care