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Biomedical subjects

Regina Kunz

Publications and source records attributed to Regina Kunz.

14 recordsLinked to original sources
PubMed2006

Quality of reporting of randomized, controlled trials in cerebral palsy.

OBJECTIVES: In conducting reviews on the effectiveness of physiotherapy interventions on children with cerebral palsy, the assessment of trials can be hampered by problems in reporting. Therefore, we set out to evaluate trial reporting by using the Consolidated Standards of Reporting Trials (CONSORT) statement recommendations. METHODS: Randomized, controlled trials published in 1990 or later were identified in literature searches for reviews on the effectiveness of physiotherapy interventions on children with cerebral palsy. Two independent reviewers evaluated the trial reporting by using a modified 33-item Consolidated Standards of Reporting Trials checklist. RESULTS: We identified 15 randomized, controlled trials. Almost half (48%) of the applicable items were reported adequately. Inadequate reporting was found in the following items: outcome measures, sample-size determination, details of the sequence generation, allocation concealment and implementation of the randomization, success of assessor blinding, recruitment and follow-up dates, intention-to-treat analysis, precision of the effect size, co-interventions, and adverse events. CONCLUSIONS: Only a small number of sufficiently reported trials were found. Because nearly all items had been described in at least 1 article, high-quality reporting seems feasible. Assessment of trials depends on appropriate reporting, and poor reporting jeopardizes judgments on the clinical implications. Authors of randomized, controlled trials are encouraged to follow the Consolidated Standards of Reporting Trials criteria. There is a clear need to improve the quality of reporting of trials in this field.

Cerebral Palsy↗
PubMed2006

[The implementation of evidence-based medicine in general practice-acceptance and use of external information services].

BACKGROUND: The demand for, and the potential of, evidence-based medicine (EBM) in everyday general practice have not been studied systematically yet. METHODS: For six months we offered all general practitioners (n = 190) practising in one of Berlin's city districts to conduct a systematic search for, and critical assessment of, the medical literature on any patient-related questions that participating physicians might have had. The primary aim of the study was to motivate general practitioners to ask patient-related questions and, in the long run, to integrate EBM into their medical practice. At the end of the project, attitudes towards EBM were assessed using standardized questionnaires. RESULTS: Only four questions, all referring to the field of therapy/prevention, were asked by the general practitioners in the district in which we offered our services. The average time required to supply an answer was 6.25 hours. For the subsequent evaluation of the service, the response rate was 34%. Reasons for not taking advantage of the service included lack of time, doubts about how the questioner would benefit from the service, and "being unaware" of the offering. CONCLUSIONS: Only rarely did general practitioners make use of the research service offered. The reasons included lack of time and the general practitioners' doubts that the service would be of benefit to their patients. In addition, we cannot exclude the possibility that the project may not have been adequately integrated into physicians' everyday practice. Nevertheless, the participants indicated that they were interested in EBM and that they considered scientific or evidence-based information to be relevant to the care of patients. This is why it is important to develop some type of continuing medical education model that can be effectively integrated into everyday medical practice.

Evidence-Based Medicine↗
PubMed2004

Integrating an evidence-based medicine rotation into an internal medicine residency program.

PURPOSE: To measure the impact of a resident focused evidence-based medicine (EBM) educational intervention on EBM knowledge of residents and students, to assess its feasibility, and to evaluate residents' attitudes regarding this rotation. METHOD: In 2002, based on the EBM user and EBM practitioner model, the authors designed the EBM elective rotation and conducted a controlled trial of its implementation in the internal medicine residency program in three teaching hospitals affiliated with the University at Buffalo, New York. The intervention group (one hospital, 17 medical students and residents) received a multifaceted intervention. In the control group (two hospitals, 23 medical students and residents), there was no curriculum change. The effectiveness in a pre- and post-test was assessed using the English version of the Berlin Questionnaire. A survey of all internal medicine residents (n = 119) was conducted to evaluate their attitudes toward the EBM elective rotation. RESULTS: In the intervention group, knowledge improved slightly, but not significantly (.71 on a scale ranging from 0-15 on the Berlin questionnaire, p =.3). The mean score in the control group decreased significantly (1.65, p =.005). The difference in change scores between the two groups was significant even after adjustment for covariates (2.52, p =.006). Residents (response rate 83%) had positive attitudes regarding the rotation. CONCLUSION: An EBM elective rotation was successfully integrated into a residency program. This multifaceted educational approach with an "on-the-ward" EBM resident, may improve the EBM knowledge and skills of targeted students and residents.

Adult↗
PubMed2004

[Last but not least--the German Network EbM has got its glossary on EbM terms].

Evidence-based medicine is not self-explaining. But due to the use of methodological, technical and statistical terms beginners might find it difficult to get access to EbM. To overcome this hurdle, a working group of practising physicians and methodologists have developed a glossary for the German Network Evidence-based Medicine covering the most important terms and providing explanations by giving practical examples. Access is also possible through www.ebm-netzwerk.de/glossar.htm. The present glossary is just a start, though. Over the coming years more terms will have to be added according to the needs and suggestions of our readership. We thus call on active participation of its users.

Evidence-Based Medicine↗
PubMed2003

[How many standards can variety take?].

The recently published "Curriculum Evidence-based Medicine" of the German Network Evidence-based Medicine and the German Agency for Quality in Medicine has been criticised for shortcomings in teaching methods and the teaching process. In this article, authors of the curriculum provide a replique to the criticisms.

Curriculum↗
PubMed2002

[Evidence-based guidelines--what is the present situation?].

Guidelines have proven to be an important tool for improving quality of health care. Evidence-based guidelines are particularly well accepted and have a high degree of credibility based on the transparent process of their development and the explicit use of clinical patient-oriented research, on which the recommendations are based. The goal of the guidelines "Management of early rheumatoid arthritis", currently developed by an interdisciplinary working group, is to minimize out existing deficiencies in the provision of health care.

Arthritis, Rheumatoid↗
PubMed2002

When small degrees of bias in randomized trials can mislead clinical decisions: an example of individualizing preventive treatment of upper gastrointestinal bleeding.

OBJECTIVE: Although randomized trials yield less biased estimates of treatment effects than other study designs, unconcealed randomization and lack of blinding can lead to overestimates of the treatment benefit on the order of 15% to 40% on average. In applying the results of clinical trials to patient care, clinicians need to be concerned about bias of this order when it would change patient management. The aim of this study is to assess under which circumstances clinicians need to be concerned about bias in clinical trials. DESIGN: Sensitivity analysis. SETTING: Recently published meta-analysis of RCTs on the benefit of H2-blockers on the prevention of gastrointestinal bleeding in critically ill patients. INTERVENTIONS: Assessment of the effect of different degrees of bias on clinical decision making in various clinical scenarios. RESULTS: Bias of even a modest degree (15% to 40% overestimation of effect) changed clinical decisions more frequently when treatment benefits were small and when the patients' risk to suffer an adverse outcome was low. When the benefit was large and the patients were at high risk, clinical decisions remained unchanged, despite bias in the estimation of effect. CONCLUSIONS: When treatments of moderate benefit are applied to patients of low to moderate risk, even small biases in the estimation of effects carry a high risk of erroneous decisions. When the treatment benefit is large and the patients are at high risk, clinicians need to be less concerned about bias in RCTs.

Bias↗
PubMed2002

[Implementation of evidence-based medicine in clinical practice--external offers to search for and critically assess medical literature].

UNLABELLED: Evidence-based medicine (EBM) is considered complicated and its realization in everyday medical practice causes difficulties. Therefore, in the course of the present study we made each physician of a university hospital the offer that we would undertake for them a systematic search for and critical assessment of the medical literature on a particular patient-related question they might have. One to two weeks after we had supplied our answers, the influence our answers had had on the medical decisions taken and the overall satisfaction with our offer were evaluated using standardized questionnaires. RESULTS: A total of 34 EBM questions were asked, 31 (91%) of which had a shape that permitted an answer to be obtained. The median time required for supplying an answer was 7 hours (within a range of 3 to 32). In the course of the subsequent evaluation process it was possible to analyze 19 questionnaires (the equivalent of a response rate of 61%). In general our EBM answers were considered good, comprehensible and transparent. For 2/3 of the participants the answers supplied by us satisfied their informational requirements and could be applied satisfactorily in clinical practice. CONCLUSIONS: The offer of external high-quality search-and-assessment of medical literature is useful, but the process is time consuming. Easier access to medical information and knowledge of how to search for and assess literature are important preconditions for the successful implementation of EBM. To achieve the latter evidence-based secondary literature and the development of evidence-based guidelines appear to be reasonable alternatives.

Evidence-Based Medicine↗