The road to health care.

BMJ (online) (Impact Factor: 16.38). 08/2004; 329(7456):1-2. DOI: 10.1136/bmj.329.7456.1
Source: PubMed

ABSTRACT Balancing benefits and harms of interventions is essential

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    ABSTRACT: Early education on the foundations of evidence based practice (EBP) is advocated as a potent intervention toward enhancing EBP uptake among physical therapists. Little is known about the extent to which EBP is integrated in educational curricula in developing countries where the benefits of EBP are more acutely needed. This study sought to describe EBP education in Philippine physical therapy schools, including the challenges encountered by educators in teaching EBP. A national survey of higher education institutions offering an undergraduate degree program in physical therapy was conducted from August 2011 through January 2012. A 35-item questionnaire was developed to gather data on whether or not EBP was taught, specific EBP content covered and courses in which content was covered, teaching and evaluation methods, and challenges in teaching EBP. Data were analyzed descriptively. The study had a response rate of 55.7% (34/61). Majority of the participating educational institutions (82%, 28/34) reported teaching EBP by incorporating EBP content in the professional courses. Among those that did not teach EBP, inadequate educator competence was the leading barrier. Courses commonly used to teach EBP were those on research (78.6%, 22/28), therapy planning (71.4%, 20/28), treatment skills (57.1-64.3%, 16-18/28), and undergraduate thesis (60.7%, 17/28). Various EBP contents were covered, with statistical concepts more frequently taught compared with critical EBP content. Lectures and journal reports were the usual teaching methods (96.4%, 27/28 and 89.3%, 25/28, respectively) while written examinations, completion of an undergraduate thesis, and oral reports (82.1%, 23/28, 78.6%, 22/28, and 78.6%, 22/28, respectively) were often used in evaluation. Students' inadequate knowledge of statistics and lack of curricular structure for EBP were identified as leading challenges to teaching (75%, 21/28 and 50%, 14/28, respectively). Many physical therapy faculties across the Philippines are incorporating EBP content in teaching. However, there is arbitrary and fragmented coverage of EBP content and inadequate emphasis on clinically oriented teaching-learning and assessment methods. These findings suggest the need to design appropriate entry-level educational programs on EBP. Effective 'educating the educators' strategies are urgently needed and can have far-reaching positive repercussions on EBP uptake in physical therapist practice.
    BMC Medical Education 11/2013; 13(1):154. · 1.41 Impact Factor
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    ABSTRACT: Objectifs L’objectif de cette étude est l’analyse des indications médicales et de l’état de santé des patients transférés d’un centre hospitalier de réadaptation vers un service des urgences (SU). Existe-t-il des différences chez les patients qui vont aux urgences au cours d’un séjour en réadaptation ? Et concrètement, quel type de patient sera plus fréquemment transféré ? Méthodes Une étude rétrospective fut réalisée à un centre hospitalier de traumatologie pour adultes et enfants situé dans une grande ville américaine et qui accueille 40 000 patients chaque année. Cette étude a comparé deux groupes de patients choisis de façon aléatoire : un groupe de 534 patients ayant été transférés au SU depuis un centre hospitalier de réadaptation et un groupe de 500 patients admis aux urgences directement de la communauté. Les variables évaluées sont : les paramètres démographiques, le diagnostic du SU et le niveau de soins, la durée d’hospitalisation, le coût du séjour, l’état de santé à la sortie de l’hôpital et un éventuel retour aux urgences dans les 60 jours. Résultats Les patients transférés depuis un centre de réadaptation étaient plus âgés (p < 0,01), ils différaient de par leur origine ethnique (83 % afro-américains ; p < 0,01), la raison de l’hospitalisation (p < 0,01 ; en majorité pour des maladies cardiovasculaires, respiratoires ou une altération de l’état mental), leur hospitalisation est plus longue et plus coûteuse (durée moyenne : 4 à 8 jours, p < 0,01), et leur niveau de soins plus élevé (p < 0,01). Ces patients étaient plus souvent admis en chirurgie ou en réanimation sous monitorage et, enfin, leur état de santé à la sortie de l’hôpital était souvent fragile ou médiocre (p < 0,01). Conclusion Les patients transférés d’un centre hospitalier de réadaptation souffraient de problèmes médicaux (et souvent psychologiques) complexes et graves. Les besoins médicaux de ces patients nécessitaient la mobilisation d’un niveau élevé de ressources au sein du SU. Leur état de santé à la sortie de l’hôpital était souvent non optimal, ce qui suggère une probabilité de retour à l’hôpital par le biais des urgences avant la fin de leur traitement au centre de réadaptation.
    Annals of physical and rehabilitation medicine 04/2014; 57(3).
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    ABSTRACT: To assess the prevalence, morphology and distribution of retinal hemorrhages in healthy newborns and their relationship to neonatal, maternal and obstetrical factors, and to determine their natural history. The present study prospectively included 2,031 consecutive healthy newborns. Indirect ophthalmoscopy was performed within 24hours after birth in all newborns. Infants with retinal hemorrhages were reexamined weekly until the hemorrhage resolved. Annual ophthalmologic follow-up was also scheduled in these children. Neonatal, maternal and obstetric parameters were analyzed in all newborns and compared between newborns with retinal hemorrhages and those without retinal hemorrhages. 31.8 % of newborns exhibited retinal hemorrhages. 72.6 % of hemorrhages were bilateral. They tended to be localized around the optic discs and in the posterior pole, but their distribution was variable. Retinal hemorrhages were of variable shapes. The prevalence of retinal hemorrhages was higher in newborns delivered with vacuum-assisted extraction (38 %, P<0.001), intermediate during normal vaginal delivery (32.6 %, P<0.001) and lower with cesarean section (20.8 %). Comparative analysis between elective cesarean section and emergency cesarean showed a higher incidence of retinal hemorrhages in the emergency cesarean group (P=0.006). On multivariate analysis, vacuum-assisted delivery was the only factor associated with a higher prevalence of retinal hemorrhages in newborns (P=0.045). Two thirds of hemorrhages had disappeared by one week after birth. Retinal hemorrhages had resolved in all newborns within four weeks. Birth-related retinal hemorrhages are common (1/3 of our newborns). Vacuum-assisted delivery is the main risk factor in this study. All hemorrhages resolved by one month of age. These findings may help in differential diagnosis with shaken baby syndrome.
    Journal francais d'ophtalmologie 02/2014; · 0.51 Impact Factor


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