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Biomedical subjects

Gordon Guyatt

Publications and source records attributed to Gordon Guyatt.

At least 73 records · Page 4Linked to original sources
PubMed2003

Measuring parental perceptions of child oral health-related quality of life.

OBJECTIVES: The aim of this study was to develop and evaluate the P-CPQ, a measure of parental/caregiver perceptions of the oral health-related quality of life of children. This forms one component of the Child Oral Health Quality of Life Questionnaire (COHQOL). METHODS: An item pool was developed through a review of existing child health questionnaires and interviews with parents/caregivers of children with pedodontic, orthodontic, and orofacial conditions. The resulting 47 items were used in a study in which 208 parents/caregivers provided data on their frequency and importance. The 31 items rated the most frequent and important were selected for the final questionnaire (P-CPQ). The P-CPQ validity and reliability were assessed by a new sample of 231 parents, 79 of whom completed two copies for the assessment of test-retest reliability. RESULTS: The P-CPQ discriminated among the three clinical groups included in the expected direction. Within-group analyses using clinical data provided some evidence that scores were associated with the severity of the condition. The P-CPQ also showed good construct validity. It had excellent internal consistency reliability with a Cronbach's alpha of 0.94 and demonstrated perfect test-retest reliability (ICC=0.85). CONCLUSION: The study provides data to indicate that the P-CPQ is valid and reliable.

Adolescent↗
PubMed2002

Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials.

OBJECTIVE: To review the effectiveness of primary prevention strategies aimed at delaying sexual intercourse, improving use of birth control, and reducing incidence of unintended pregnancy in adolescents. DATA SOURCES: 12 electronic bibliographic databases, 10 key journals, citations of relevant articles, and contact with authors. STUDY SELECTION: 26 trials described in 22 published and unpublished reports that randomised adolescents to an intervention or a control group (alternate intervention or nothing). DATA EXTRACTION: Two independent reviewers assessed methodological quality and abstracted data. DATA SYNTHESIS: The interventions did not delay initiation of sexual intercourse in young women (pooled odds ratio 1.12; 95% confidence interval 0.96 to 1.30) or young men (0.99; 0.84 to 1.16); did not improve use of birth control by young women at every intercourse (0.95; 0.69 to 1.30) or at last intercourse (1.05; 0.50 to 2.19) or by young men at every intercourse (0.90; 0.70 to 1.16) or at last intercourse (1.25; 0.99 to 1.59); and did not reduce pregnancy rates in young women (1.04; 0.78 to 1.40). Four abstinence programmes and one school based sex education programme were associated with an increase in number of pregnancies among partners of young male participants (1.54; 1.03 to 2.29). There were significantly fewer pregnancies in young women who received a multifaceted programme (0.41; 0.20 to 0.83), though baseline differences in this study favoured the intervention. CONCLUSIONS: Primary prevention strategies evaluated to date do not delay the initiation of sexual intercourse, improve use of birth control among young men and women, or reduce the number of pregnancies in young women.

Adolescent↗
PubMed2002

Assessing the quality of drug detailing.

This study measured the validity of a new instrument, the Assessment Instrument for Drug Detailing (AIDD), used by doctors to score the quality of drug detailing provided by pharmaceutical representatives in their offices. Five pharmaceutical representatives provided "good, medium, and poor" details to 135 family doctors in their offices, who were blinded to the quality of the details. A "reference standard group" constructed the details and trained the representatives. An "assessment group" trained family physicians to use the AIDD to score the details. Physicians discriminated between different quality details in all but one domain, nomenclature (P </=.001). Physicians scored good quality presentations 2.3 points higher than poor quality details, and reported that they learned more from good than poor quality details. Approximately 71% of the variability in physicians' global ratings (R(2) = 0.71) was explained by assigned detail quality, F(2, 118) = 54.64, P <.0001, presentation time, F(2, 118) = 9.98, P <.0001, pharmaceutical representative, F(4, 118) = 9.58, P <.0001, and physician rating the detail, F(109, 118) = 1.94, P <.0001.

Analysis of Variance↗
PubMed2002

Family impact of child oral and oro-facial conditions.

OBJECTIVES: The aim of this study was to develop and evaluate the Family Impact Scale, a measure of the family impact of child oral and oro-facial disorders. This formed one component of the Child Oral Health Quality of Life Instrument. METHODS: The scale was developed using a process described by Guyatt et al. (1987) and Juniper et al. (1996). An item pool was developed using a review of existing child health status and family impact questionnaires, interviews with 41 parents-caregivers of children with paedodontic, orthodontic and oro-facial conditions and discussions with dental specialists. The resulting pool of 21 items was used in an item impact study in which 93 parents-caregivers provided data on the frequency and importance of these items. The 14 items identified most frequently or rated the most important were selected for the final questionnaire. The discriminant and construct validity and internal consistency reliability of this 14-item scale were assessed in a study of 266 parents-caregivers from the three clinical groups. Seventy-nine of these participants completed a second copy of the questionnaire to facilitate assessment of test-retest reliability. RESULTS: Family Impact Scale scores ranged from 0 to 33, indicating that the measure was sensitive to variations in family impact. Floor effects were minimal with only 10.2% of subjects having a score of zero and there were no ceiling effects, that is, subjects with maximum scores. Almost three-quarters of parents-caregivers reported some family impact 'sometimes' or 'often/everyday' over the previous 3 months. Impact on parental or family activities of this frequency was reported by 53.0%, impact on parental emotions by 44.0%, conflict in the family by 31.6% and financial difficulties by 31.2%. The measure and its component items were reasonably good at discriminating between the three clinical groups included in the study and showed good construct validity. It had excellent internal consistency reliability with a Cronbach's alpha of 0.83 and was reproducible for parent-caregivers who reported that their child's condition was stable (ICC = 0.80). CONCLUSIONS: The study provides some data to suggest that child oral and oro-facial conditions have a pervasive impact on the family. The Family Impact Scale had good technical properties. Its evaluative properties need to be tested in longitudinal studies.

Adolescent↗
PubMed2002

Teaching evidence-based complementary and alternative medicine: 1. A learning structure for clinical decision changes.

Complementary and alternative medicine (CAM) education is at a crossroads and has been an area of increasing debate. Public use of CAM has risen dramatically since 1997, with initial reports ranging from 30% to a possible 60% in the United States. Much attention has been directed to the education of the public regarding CAM, with respect to efficacy, potential harm, and integration. Far less attention has been paid to the education of CAM practitioners. In the current climate of integrative health settings, CAM practitioners should be trained to interact with conventional physicians, the public, and policy makers in an evidence-based format. In order to create communication effectively, an evidence-based approach may provide the common ground required for all schools of thought.

Clinical Competence↗
PubMed2002

Teaching evidence-based complementary and alternative medicine: 4. Appraising the evidence for papers on therapy.

Practicing evidence-based complementary and alternative medicine (CAM) requires practitioners to develop an ability to appraise the quality of published studies addressing questions related to their clinical practice. This paper describes a process by which CAM practitioners can determine the validity of studies evaluating therapeutic interventions. The process requires asking two broad questions: (1). Do the treatment and control group begin with the same prognosis? and (2). Do the treatment and control group remain the same with respect to important prognostic factors? Answering these questions requires determining whether studies used effective randomization, preserved randomization through intention-to-treat analyses, used blinding, and had adequate follow-up of trial participants.

Child↗
PubMed2002

Teaching evidence-based complementary and alternative medicine: 2. A conceptual approach to causation-part 1.

One of the most common questions that arise in clinical practice is whether a causal relationship exists between two factors. In order to answer this question three steps need to be taken: First an association needs to be demonstrated between treatment/exposure and effect. Next, the possibility of this association being the result of error needs to be determined. Finally additional evidence to support a cause-and-effect relationship needs to be identified. Part 1 of this two-part paper describes how a complementary and alternative medicine provider goes through the first two steps when confronted with the question of whether silicone breast implants cause arthritis to develop. Also covered are the need for a control group when attempting to establish whether an association exists, the potential for systematic error (bias) or unsystematic error (chance) to distort an association, and the susceptibility of different study designs to systematic error.

Arthritis↗
PubMed2002

Teaching evidence-based complementary and alternative medicine: 2. A conceptual approach to causation-part 2.

As noted in Part 1, of this two-part paper, one of the most common questions that arise in clinical practice is whether a causal relationship exists between two factors. In order to answer this question we noted in Part 1 that three steps need to be taken: First an association needs to be demonstrated between treatment/exposure and effect. Next, the possibility of this association being the result of error needs to be determined. Finally, additional evidence to support a cause-and-effect relationship needs to be identified. Part 1 covered the first two steps and now Part 2 describes how a complementary and alternative medicine provider goes through the last step of this process when confronted with the question of whether silicone breast implants cause the development of arthritis. Part 3 examines the importance of answering the following questions: Did the cause precede the effect? How strong was the association observed? Is increasing exposure more likely to lead to disease? Is there evidence from several different studies showing the same association? Does withdrawal of the cause result in loss of the effect? Is there a biologic model that can explain the causal relationship?

Arthritis↗
PubMed2002

Teaching evidence-based complementary and alternative medicine: 5. Interpreting the results of a study on therapy and applying them to a patient.

Practicing evidence-based complementary and alternative medicine (CAM) requires that practitioners develop an ability to understand and appropriately apply the results of published studies addressing questions related to their clinical practice. This paper describes a process by which CAM practitioners can interpret the results of studies evaluating therapeutic interventions and then determine if they can apply these results to their patients. We describe a process for interpreting the results of a study on therapy that involves determining the estimate of the magnitude of the therapy's effect and determining the precision of this estimate. We then describe a process for determining whether the results of a study on therapy can be applied to a given patient that involves determining the extent to which patients in the study differ from the patient being treated and determining if the study addressed all outcomes of interest.

Child↗
PubMed2002

Teaching evidence-based complementary and alternative medicine: 3. Asking the questions and identifying the information.

Practicing evidence-based complementary and alternative medicine (EBCAM) requires skills in accessing current valid literature on clinical queries. This requires searching a variety of sources within a broad scope of scientific disciplines. This daunting task requires effective skills for accessing information from both print and electronic sources. This paper identifies the progression from question formulation through to searching and acquiring the valid information. In the evolving information age, complementary and alternative medicine (CAM) practitioners require informational databases and knowledge of search terminology. This paper suggests practical strategies for successful database searches in support of EBCAM.

Child↗
PubMed2002

Education, ethics, and end-of-life decisions in the intensive care unit.

OBJECTIVE: To examine the influence of education and clinical experience on residents' attitudes toward withdrawal of life support. DESIGN: Self-administered survey. SETTING: Four Canadian teaching hospitals. SUBJECTS: Residents rotating through four intensive care units. MEASUREMENTS AND MAIN RESULTS: The survey examined ethics education and experience regarding end-of-life care, importance of factors influencing withdrawal of life support, confidence in decisions, and recommendations for enhancing end-of-life education. The response rate was 83.9% (52 of 62). A minority of residents reported an appropriate amount of formal teaching on ethical principles (17.3%), patient-centered education (28.8%), and informal discussion (28.8%) before their intensive care unit rotation. During their rotation, most residents cared for patients in whom withdrawal of life support was considered. Although they usually attended family meetings, residents were never (34.6%) or rarely (42.3%) the primary discussant. Before the intensive care unit rotation, confidence in withdrawal decisions was related to male sex (p =.001) and previous patient-centered ethics education (p =.02). At the end of the intensive care unit rotation, only resident involvement in family meetings (p =.02) and being the primary discussant at such meetings (p =.01) were associated with confidence. After we adjusted for pre-rotation confidence in withdrawal of life support decision-making, the only predictor of post-rotation confidence was family meeting involvement (p <.001). Residents recommended more patient-centered discussion, observation of attending physicians discussing end-of-life issues, and opportunity to lead family meetings. CONCLUSIONS: Experiential, case-based, patient-centered curricula are associated with resident confidence in withdrawal of life support decisions in the intensive care unit.

Adult↗