Une étude pilote d’un programme cursus longitudinal de méditation pleine conscience durant le doctorat en médecine

Background: To support student well-being, a mindfulness curriculum in undergraduate medical education was launched at our university in 2014. We describe the program and report 3-year results. Methods: Medical students responded to online questionnaires on mindfulness (Freiburg Mindfulness Inventory), empathy (Jefferson Scale of Physician Empathy), resilience (Connor-Davidson Resilience Scale) and perceived stress (Perceived Stress Scale) and were surveyed for demographics, home practice, and subjective experience at curriculum launch and yearly for 3 years. Results: In respondents, high stress (19.2 (SD=6)) and low resilience (71.2 (SD=12.5)) scores were seen throughout training. Scores for mindfulness correlated positively with those for empathy (r=.217 p<0.01) and resilience (r=.539, p<0.01), and negatively with stress scores (r=-.380, p<0.01). While overall scale scores did not statistically change after curriculum implementation, statistically significant increases were seen in mindfulness (12%, p=0.008), empathy (5%, p=0.045), and resilience scores (12%, p=0.002) with a trend toward lower stress scores (8%, p=0.080) in respondents who felt they applied the curriculum principles. Two hours of reported home practice per week was associated with statistically significant changes (14% increased mindfulness scores p<0.001; 6% increased empathy scores p<0.001, 10% increased resilience scores p=0.003; 11% decreased stress scores p= 0.008). Despite positive program evaluations for both mandatory and elective sessions, student attendance at elective sessions was low. Conclusion: A mindfulness curriculum integrated into formal undergraduate medical education is feasible. Benefits may be confined to those students who apply curriculum principles and practice regularly. Further study is needed.Contexte : Pour soutenir le bien-être des étudiants, un cursus de méditation pleine conscience dans le cadre du programme de doctorat en médecine a été lancé à notre université en 2014. Nous décrivons le programme et communiquons les résultats après trois ans. Méthodes :  Des étudiants en médecine ont répondu à des questionnaires en ligne sur la pleine conscience (inventaire de pleine conscience de Freiburg), l’empathie (Échelle de Jefferson sur l’empathie du médecin), la résilience (échelle de résilience de Connor-Davidson) et le stress perçu (échelle du stress perçu) et ont été interrogés pour les caractéristiques démographiques, la pratique de la méditation pleine conscience à domicile et l’expérience subjective au moment du lancement du cursus et, ensuite, annuellement pendant trois ans. Résultats : Chez les répondants, un degré de stress élevé (19,2 (ET = 6)) et une faible résilience (71,2 (ET = 12,5)) ont été observés tout au long de la formation. Il y avait une corrélation positive entre les la pleine conscience et l’empathie (r = 0,17, p < 0,01) et de la résilience (r = 0,539, p < 0,01), et négative avec le stress (r = -0,380, p < 0,01). Alors que les résultats globaux ne changent pas statistiquement après la mise en œuvre du cursus, des augmentations statistiquement significatives ont été observées pour la pleine conscience (12 %, p = 0,008), l’empathie (5 %, p = 0,045) et la résilience (12 %, p = 0,002) avec une tendance vers des résultats inférieurs pour le stress (8 %, p = 0,080) chez les répondants qui estimaient avoir appliqué les principes du programme. On retrouvait des changements significatifs chez les répondants qui rapportaient avoir pratiqué deux heures par semaine à domicile (résultats accrus de 14 % pour la pleine conscience (p < 0,001), de 6 % pour l’empathie (p < 0,001) et de 10 % pour la résilience (p = 0,003), et réduits de 11 % pour le stress (p = 0,008)). Malgré des évaluations de programme positives pour les sessions obligatoires et optionnelles, l’assiduité des étudiants aux sessions optionnelles était faible. Conclusion : Un cursus de méditation pleine conscience intégré dans des études formelles de doctorat en médecine est faisable. Les avantages peuvent être confinés aux étudiants qui appliquent les principes du programme et qui le pratiquent sur une base régulière. D’autres études sont requises

Are potentially clinically meaningful benefits misinterpreted in cardiovascular randomized trials? A systematic examination of statistical significance, clinical significance, and authors’ conclusions

Background: While journals and reporting guidelines recommend the presentation of confidence intervals, many authors adhere strictly to statistically significant testing. Our objective was to determine what proportions of not statistically significant (NSS) cardiovascular trials include potentially clinically meaningful effects in primary outcomes and if these are associated with authors’ conclusions. Methods: Cardiovascular studies published in six high-impact journals between 1 January 2010 and 31 December 2014 were identified via PubMed. Two independent reviewers selected trials with major adverse cardiovascular events (stroke, myocardial infarction, or cardiovascular death) as primary outcomes and extracted data on trial characteristics, quality, and primary outcome. Potentially clinically meaningful effects were defined broadly as a relative risk point estimate ≤0.94 (based on the effects of ezetimibe) and/or a lower confidence interval ≤0.75 (based on the effects of statins). Results: We identified 127 randomized trial comparisons from 3200 articles. The primary outcomes were statistically significant (SS) favoring treatment in 21% (27/127), NSS in 72% (92/127), and SS favoring control in 6% (8/127). In 61% of NSS trials (56/92), the point estimate and/or lower confidence interval included potentially meaningful effects. Both point estimate and confidence interval included potentially meaningful effects in 67% of trials (12/18) in which authors’ concluded that treatment was superior, in 28% (16/58) with a neutral conclusion, and in 6% (1/16) in which authors’ concluded that control was superior. In a sensitivity analysis, 26% of NSS trials would include potential meaningful effects with relative risk thresholds of point estimate ≤0.85 and/or a lower confidence interval ≤0.65. Conclusions: Point estimates and/or confidence intervals included potentially clinically meaningful effects in up to 61% of NSS cardiovascular trials. Authors’ conclusions often reflect potentially meaningful results of NSS cardiovascular trials. Given the frequency of potentially clinical meaningful effects in NSS trials, authors should be encouraged to continue to look beyond significance testing to a broader interpretation of trial results.Pharmaceutical Sciences, Faculty ofNon UBCReviewedFacult

Evidence reversals in primary care research: a study of randomized controlled trials.

BACKGROUND: Evidence-Based Medicine is built on the premise that clinicians can be more confident when their decisions are grounded in high-quality evidence. Furthermore, evidence from studies involving patient-oriented outcomes is preferred when making decisions about tests or treatments. Ideally, the findings of relevant and valid trials should be stable over time, that is, unlikely to be reversed in subsequent research. OBJECTIVE: To evaluate the stability of evidence from trials relevant to primary healthcare and to identify study characteristics associated with their reversal. METHODS: We studied synopses of randomized controlled trials (RCTs) published from 2002 to 2005 as Daily POEMs (Patient Oriented Evidence that Matters). The initial evidence (E1) from these POEMs (2002-2005) was compared with the updated evidence (E2) on that same topic in a summary resource (DynaMed 2019). Two physician-raters independently categorized each POEM-RCT as (i) reversed when E1 ≠ E2, or as (ii) not reversed, when E1 = E2. For all Evidence Reversals (E1 ≠ E2), we assessed the direction of change in the evidence. RESULTS: We evaluated 408 POEMs on RCTs. Of those, 35 (9%; 95% confidence interval [6-12]) were identified as reversed, 359 (88%) were identified as not reversed, and 14 (3%) were indeterminate. On average, this represents about 2 evidence reversals per annum for POEMs about RCTs. CONCLUSIONS: Over 12-17 years, 9% of RCTs summarized as POEMs are reversed. Information alerting services that apply strict criteria for relevance and validity of clinical information are likely to identify RCTs whose findings are stable over time