41 research outputs found
A new challenge for meteorological measurements: The meteoMet project-Metrology for meteorology
Climate change and its consequences require immediate actions in order to safeguard the environment and economy in Europe and in the rest of world. Aiming to enhance data reliability and reduce uncertainties in climate observations, a joint research project called MeteoMet-Metrology for Meteorology started in October 2011 coordinated by the Italian Istituto Nazionale di Ricerca Metrologica (INRiM). The project is focused on the traceability of measurements involved in climate change: surface and upper air measurements of temperature, pressure, humidity, wind speed and direction, solar irradiance and reciprocal influences between measurands. This project will provide the first definition at the European level of validated climate parameters with associated uncertainty budgets and novel criteria for interpretation of historical data series. The big challenge is the propagation of a metrological measurement perspective to meteorological observations. When such an approach will be adopted the requirement of reliable data and robust datasets over wide scales and long terms could be better met. © 2013 AIP Publishing LLC
A theory-based process evaluation alongside a randomised controlled trial of printed educational messages to increase primary care physicians' prescription of thiazide diuretics for hypertension [ISRCTN72772651]
Background
Pragmatic trials of implementation interventions focus on evaluating whether an intervention changes professional behaviour under real-world conditions rather than investigating the mechanism through which change occurs. Theory-based process evaluations conducted alongside pragmatic randomised trials address this by assessing whether the intervention changes theoretical constructs proposed to mediate change. The Ontario Printed Educational Materials (PEM) cluster trial was designed to increase family physicians’ guideline-recommended prescription of thiazide diuretics. The trial found no intervention effect. Using the theory of planned behaviour (TPB), we hypothesised that changes in thiazide prescribing would be reflected in changes in intention, consistent with changes in attitude and subjective norm, with no change to their perceived behavioural control (PBC), and tested this alongside the RCT.
Methods
We developed and sent TPB postal questionnaires to a random sub-sample of family physicians in each trial arm 2 months before and 6 months after dissemination of the PEMs. We used analysis of covariance to test for group differences using a 2 × 3 factorial design. We content-analysed an open-ended question about perceived barriers to thiazide prescription. Using control group data, we tested whether baseline measures of TPB constructs predicted self-reported thiazide prescribing at follow-up.
Results
Four hundred twenty-six physicians completed pre- and post-intervention questionnaires. Baseline scores on measures of TPB constructs were high: intention mean = 5.9 out of 7 (SD = 1.4), attitude mean = 5.8 (SD = 1.1), subjective norm mean = 5.8 (SD = 1.1) and PBC mean = 6.2 (SD = 1.0). The arms did not significantly differ post-intervention on any of the theory-based constructs, suggesting a possible ceiling effect. Content analysis of perceived barriers suggested post-intentional barriers to prescribing thiazides most often focused on specific patient clinical characteristics and potential side effects. Baseline intention (β = 0.63, p < 0.01) but not PBC (β = 0.04, p = 0.78) predicted 42.6 % of the variance in self-reported behaviour at follow-up in the control group.
Conclusions
Congruent with the Ontario Printed Educational Messages trial results and aligned with the TPB, we saw no impact of the intervention on any TPB constructs. The theoretical basis of this evaluation suggests possible explanations for the failure of the PEM intervention to change professional behaviour, which can directly inform the design and content of future theory-based PEM interventions to change professional behaviour
Application of discrete choice experiments to enhance stakeholder engagement as a strategy for advancing implementation: a systematic review
Redesigning printed educational materials for primary care physicians: design improvements increase usability
Abstract
Background
Printed educational materials (PEMs) are a frequently used tool to disseminate clinical information and attempt to change behavior within primary care. However, their effect on clinician behavior is limited. In this study, we explored how PEMs can be redesigned to better meet the needs of primary care physicians (PCPs) and whether usability and selection can be increased when design principles and user preferences are used.
Methods
We redesigned a publicly available PEM using physician preferences, design principles, and graphic designer support. We invited PCPs to select their preferred document between the redesigned and original versions in a discrete choice experiment, followed by an assessment of usability with the System Usability Scale and a think aloud process. We conducted this study in both a controlled and opportunistic setting to determine whether usability testing results vary by study location. Think aloud data was thematically analyzed, and results were interpreted using the Technology Acceptance Model.
Results
One hundred and eighty four PCPs participated in the discrete choice experiment at the 2014 Family Medicine Forum, a large Canadian conference for family physicians. Of these, 87.7 % preferred the redesigned version. Follow-up interviews were held with a randomly selected group of seven participants. We repeated this in a controlled setting in Toronto, Canada, with a set of 14 participants. Using the System Usability Scale, we found that usability scores were significantly increased with the redesign (p < 0.001). We also found that when PCPs were given the choice between the two versions, they selected the redesigned version as their preferred PEM more often than the original (p < 0.001). Results did not appear to differ between the opportunistic and controlled setting. We used the results of the think aloud process to add to a list of end user preferences developed in a previous study.
Conclusions
We found that redesigning a PEM with user preferences and design principles can improve its usability and result in the PEM being selected more often than the original. We feel this finding supports the involvement of the user, application of design principles, and the assistance of a graphic designer in the development of PEMs
Metrology for pressure, temperature, humidity and airspeed in the atmosphere
The Joint Research Project METEOMET - "Metrology for Meteorology" realized in the frame of the European Metrology Research Programme (EMRP) is described in the paper. The project is focused on the traceability of measurements involved in the climate changes: surface and upper air measurements of temperature, pressure, humidity, wind speed and direction, solar irradiance and reciprocal influences between measurands. It includes development and testing of novel instruments as well as improved calibration procedures and facilities for ground based observations, including in-situ practical calibrations and best practice dissemination. The project consortium is based on 18 National Metrology Institutes (NMIs), three un-funded partners and several collaborators, such as universities, research centers, meteorological organization and institutions, from Europe and other non-European countries. Istituto Nazionale di Ricerca Metrologica (INRiM) in Italy is the project coordinator. Three Polish organizations participate in the project: the Central Office of Measure (MG-GUM), the Institute of Low Temperature and Structure Research (INTiBS) and the Wrocław University (UWr)
What are family physicians' perceptions of guideline implementation and uptake? A qualitative study
What is the effectiveness of printed educational materials on primary care physician knowledge, behaviour, and patient outcomes: a systematic review and meta-analyses
Abstract
Background
Printed educational materials (PEMs) are commonly used simple interventions that can be used alone or with other interventions to disseminate clinical evidence. They have been shown to have a small effect on health professional behaviour. However, we do not know whether they are effective in primary care. We investigated whether PEMs improve primary care physician (PCP) knowledge, behaviour, and patient outcomes.
Methods
We conducted a systematic review of PEMs developed for PCPs. Electronic databases were searched for randomized controlled trials, quasi randomized controlled trials, controlled before and after studies, and interrupted time series. We combined studies using meta-analyses when possible. Statistical heterogeneity was examined, and meta-analysis was performed using a random effects model when significant statistical heterogeneity was present and a fixed effects model otherwise. The template for intervention description and replication (TIDieR) checklist was used to assess the quality of intervention description.
Results
Our search identified 12,439 studies and 40 studies met our inclusion criteria. We combined outcomes from 26 studies in eight meta-analyses. No significant effect was found on clinically important patient outcomes, physician behaviour, or physician cognition when PEMs were compared to usual care. In the 14 studies that could not be included in the meta-analyses, 14 of 71 outcomes were significantly improved following receipt of PEMs compared to usual care. Most studies lacked details needed to replicate the intervention.
Conclusions
PEMs were not effective at improving patient outcomes, knowledge, or behaviour of PCPs. Further trials should explore ways to optimize the intervention and provide detailed information on the design of the materials.
Protocol registration
PROSPERO, CRD4201300435
Projekt EMRP JRP ENV07 Metrologia dla meteorologii zakończony
W związku z obserwowanymi zmianami klimatu Światowa Organizacja Meteorologiczna (WMO) podjęła decyzję o przystąpieniu w 2010 r. do międzynarodowego porozumienia CIPM MRA. Spodziewanym efektem tego porozumienia jest poprawa oceny parametrów klimatu poprzez poprawę wiarygodności wyników pomiaru i związanych z nimi niepewności. Projekt JRP ENV07 MeteoMet, realizowany w ramach Europejskiego Programu Badawczo-Rozwojowego w Dziedzinie Metrologii, jest odpowiedzią na to wyzwanie. Projekt koncentruje się na spójności pomiarów parametrów klimatu. W artykule przedstawiono genezę projektu, główne zagadnienia, jakim był on poświęcony oraz omówiono udział polskich instytucji zaangażowanych w realizację projektu.The observed changes in climate led to the participation of the World Meteorological Organization (WMO) in an international agreement of the CIPM MRA. The expected result of an agreement, signed by the WMO in 2010, is to improve the assessment of climate parameters by improving the reliability of the measurement results and associated uncertainties. The project JRP ENV07 MeteoMet, implemented within the European Metrology Research Programme, is the answer to this challenge. The project is focused on the measurement traceability of climate parameters. The paper presents the genesis of the project, the main issues dedicated to the project as well as is discussed the participation of Polish institutions involved in the project
Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis
Abstract Background Elective surgeries can be associated with significant harm to older adults. The present study aimed to identify the prognostic factors associated with the development of postoperative complications among older adults undergoing elective surgery. Methods Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and AgeLine were searched for articles published between inception and April 21, 2016. Prospective studies reporting prognostic factors associated with postoperative complications (composite outcome of medical and surgical complications), functional decline, mortality, post-hospitalization discharge destination, and prolonged hospitalization among older adults undergoing elective surgery were included. Study characteristics and prognostic factors associated with the outcomes of interest were extracted independently by two reviewers. Random effects meta-analysis models were used to derive pooled effect estimates for prognostic factors and incidences of adverse outcomes. Results Of the 5692 titles and abstracts that were screened for inclusion, 44 studies (12,281 patients) reported on the following adverse postoperative outcomes: postoperative complications (n =28), postoperative mortality (n = 11), length of hospitalization (n = 21), functional decline (n = 6), and destination at discharge from hospital (n = 13). The pooled incidence of postoperative complications was 25.17% (95% confidence interval (CI) 18.03–33.98%, number needed to follow = 4). The geriatric syndromes of frailty (odds ratio (OR) 2.16, 95% CI 1.29–3.62) and cognitive impairment (OR 2.01, 95% CI 1.44–2.81) were associated with developing postoperative complications; however, there was no association with traditionally assessed prognostic factors such as age (OR 1.07, 95% CI 1.00–1.14) or American Society of Anesthesiologists status (OR 2.62, 95% CI 0.78–8.79). Besides frailty, other potentially modifiable prognostic factors, including depressive symptoms (OR 1.77, 95% CI 1.22–2.56) and smoking (OR 2.43, 95% CI 1.32–4.46), were also associated with developing postoperative complications. Conclusion Geriatric syndromes are important prognostic factors for postoperative complications. We identified potentially modifiable prognostic factors (e.g., frailty, depressive symptoms, and smoking) associated with developing postoperative complications that can be targeted preoperatively to optimize care