Biomedical subjects

David Feldstein

Publications and source records attributed to David Feldstein.

4 recordsLinked to original sources

PubMed2006

Instruments for evaluating education in evidence-based practice: a systematic review.

CONTEXT: Evidence-based practice (EBP) is the integration of the best research evidence with patients' values and clinical circumstances in clinical decision making. Teaching of EBP should be evaluated and guided by evidence of its own effectiveness. OBJECTIVE: To appraise, summarize, and describe currently available EBP teaching evaluation instruments. DATA SOURCES AND STUDY SELECTION: We searched the MEDLINE, EMBASE, CINAHL, HAPI, and ERIC databases; reference lists of retrieved articles; EBP Internet sites; and 8 education journals from 1980 through April 2006. For inclusion, studies had to report an instrument evaluating EBP, contain sufficient description to permit analysis, and present quantitative results of administering the instrument. DATA EXTRACTION: Two raters independently abstracted information on the development, format, learner levels, evaluation domains, feasibility, reliability, and validity of the EBP evaluation instruments from each article. We defined 3 levels of instruments based on the type, extent, methods, and results of psychometric testing and suitability for different evaluation purposes. DATA SYNTHESIS: Of 347 articles identified, 115 were included, representing 104 unique instruments. The instruments were most commonly administered to medical students and postgraduate trainees and evaluated EBP skills. Among EBP skills, acquiring evidence and appraising evidence were most commonly evaluated, but newer instruments evaluated asking answerable questions and applying evidence to individual patients. Most behavior instruments measured the performance of EBP steps in practice but newer instruments documented the performance of evidence-based clinical maneuvers or patient-level outcomes. At least 1 type of validity evidence was demonstrated for 53% of instruments, but 3 or more types of validity evidence were established for only 10%. High-quality instruments were identified for evaluating the EBP competence of individual trainees, determining the effectiveness of EBP curricula, and assessing EBP behaviors with objective outcome measures. CONCLUSIONS: Instruments with reasonable validity are available for evaluating some domains of EBP and may be targeted to different evaluation needs. Further development and testing is required to evaluate EBP attitudes, behaviors, and more recently articulated EBP skills.

Educational Measurement↗

PubMed2006

Clinical use of evidence-based medicine--clinical questions: Acetylcysteine, a new treatment for an old foe?

This is a small, good quality, randomized controlled trial that shows a modest slowing in the deterioration of VC and DLco with the addition of high dose N-acetylcysteine to standard therapy in IPF. Overall the study should be interpreted with caution given its high drop out rate, which may have biased the results towards a more dramatic slowing of the disease progression. There were no differences in dyspnea score or functional status. There was no increase in the adverse events in the N-acetylcysteine group and the medication is inexpensive. Given only modest effects of N-acetylcysteine on VC and DLco, no change in functional scores, and the flaws of the study we would hesitate to use N-acetylcysteine as standard therapy in all patients with IPF.

Acetylcysteine↗

PubMed2005

Finding the best available evidence: what's new?

The voluminous growth of the health literature paired with time constraints of practitioners can make it difficult to implement evidence-based medicine (EBM). New and better resources that summarize and/or synthesize the literature are available to facilitate the integration of evidence into practice. Understanding how such resources work and how to use them is an important step in finding evidence for patient care. By using a clinical scenario concerning abdominal aortic aneurysm screening, this article describes 3 types of EBM resources from the "4S" model: systems, synopses, and syntheses. The common features of each resource type are discussed and comparisons of selected examples are provided.

Evidence-Based Medicine↗

PubMed2005

Do prophylactic anticonvulsants in patients with brain tumors decrease the incidence of seizures?

The well-done systematic review included a moderate number of patients from randomized controlled trials with an objective diagnosis of a brain tumor. There were mild differences between the 5 studies used in the systematic review with patients in 3 of the studies undergoing surgical resection or debulking of their disease. There was no evidence of seizure prevention overall or in the subgroup analysis. Given the small number of patients in each subgroup, these results should be interpreted with caution. Known adverse effects with anticonvulsant therapy include severe rash (including Stevens-Johnson syndrome), hematologic effects, and drug-drug interactions. Therefore, we should be hesitant to place patients on these medications without a proven benefit. The relatively small number of patients in this meta-analysis means that larger scale studies could show a small clinical benefit from anticonvulsants.

Anticonvulsants↗