PubMed Health⌕ Search

Biomedical subjects

Jeremy M Grimshaw

Publications and source records attributed to Jeremy M Grimshaw.

At least 19 recordsLinked to original sources
PubMed2006

Lead editorial: trials - using the opportunities of electronic publishing to improve the reporting of randomised trials.

This editorial introduces the new online, open access, peer-reviewed journal Trials. The journal considers manuscripts on any aspect of the design, performance, and findings of randomised controlled trials in any discipline related to health care, and also encourages the publication of protocols. Trialists will be able to provide the necessary detail for a true and complete scientific record. They will be able to communicate not only all outcome measures, as well as varying analyses and interpretations, but also in-depth descriptions of what they did and honest reflections about what they learnt. Trials also encourages articles covering generic issues related to trials, for example focussing on the design, conduct, analysis, interpretation, or reporting.

Editorial↗
PubMed2006

Knowledge for knowledge translation: the role of the Cochrane Collaboration.

Knowledge-translation (KT) activities, including continuing education, should be informed by the totality of available research evidence. Systematic reviews are a generic methodology used to synthesize evidence from a broad range of research methods addressing different questions. Over the past decade, there has been a dramatic increase in the availability of systematic reviews that could support KT activities. However, the conduct of systematic reviews is technically challenging, and it is not surprising that the quality of available reviews is variable. In addition, unless attempts are made to update systematic reviews, they rapidly become out of date. The Cochrane Collaboration is a unique, worldwide, not-for-profit organization that aims to help people make well-informed decisions about all forms of health care by preparing, maintaining, and promoting the accessibility of systematic reviews of the effects of health care interventions. Globally, over 13, 000 consumers, clinicians, policymakers, and researchers are involved with The Cochrane Collaboration and have to date produced over 2, 500 systematic reviews that can be used to inform KT activities. The Cochrane Collaboration publishes its reviews quarterly in The Cochrane Library. Cochrane reviews have been used to develop a number of KT-derivative products for professionals, consumers, and policymakers. Whereas most Cochrane Review groups focus on specific clinical areas, the Cochrane Effective Practice and Organisation of Care Group undertakes reviews of interventions to improve health care delivery and health care systems, including reviews of different KT activities. We summarize the activities of The Cochrane Collaboration and how these can contribute to KT activities.

Canada↗
PubMed2005

Scope for improvement in the quality of reporting of systematic reviews. From the Cochrane Musculoskeletal Group.

OBJECTIVE: To assess the quality of reporting in Cochrane musculoskeletal systematic reviews (excluding back and injury reviews). METHODS: This study assessed all the Cochrane Musculoskeletal Group's systematic reviews from Issue 4, 2002, of the Cochrane Library Database of Systematic Reviews. Two reviewers independently extracted data and assessed quality. Two assessment tools were used, including an 18 item checklist and flow chart developed by the Quality of Reporting of Meta-analysis (QUOROM) consensus group, and a 10 item scale, the Oxman-Guyatt Overview Quality Assessment Questionnaire (OQAQ). One question on the latter scale (item 10) scores overall quality on a 7 point scale, with high scores indicating superior quality. Data were analyzed using univariate approaches. RESULTS: The 57 systematic reviews assessed were found to have good overall quality, with scores on individual items revealing only minor flaws. Documenting the flow of included and excluded studies and summarizing the results are 2 areas needing improvement in reporting. According to the Oxman-Guyatt scale the overall scientific quality of the Cochrane musculoskeletal reviews was good [mean 5.02 (95% CI 3.71-6.32)]. CONCLUSION: Our study found that the reporting quality of Cochrane musculoskeletal systematic reviews was generally good, although there was room for improvement. For example, it might be feasible to develop specific guidelines for reporting protocols. Certainly more work is needed in reporting search results, documentation of the flow of studies, identification of the type of studies, and summarization of the key findings.

Evidence-Based Medicine↗
PubMed2005

Determinants of the intracluster correlation coefficient in cluster randomized trials: the case of implementation research.

The objective of this research was to identify determinants of the magnitude of intracluster correlation coefficients (ICCs) in cluster randomized trials from the field of implementation research. A survey of experts was conducted to generate a priori hypotheses of factors that might affect ICC size. Hypotheses were tested on empirical estimates of ICCs calculated from 21 implementation research datasets, mainly from the UK. Effects of setting (primary or secondary care), type of variable (process or outcome), type of measurement (objective or subjective), prevalence of outcome and size of cluster were tested. In total, 220 ICCs were available (range 0 to 0.415). Significant differences in ICC magnitude were found. The ICCs were significantly higher for process than for outcome variables, and for secondary care outcomes compared with primary care outcomes. The effects of prevalence and size were less clear cut. There was no evidence to suggest that type of measurement affected ICC size. In conclusion, accurate estimates of ICCs are essential for sample size calculations for cluster randomized trials of professional behaviour change interventions. This study demonstrates that ICCs are sensitive to a number of trial factors, particularly setting and outcome type. These factors must be considered when planning such cluster randomized trials.

Biomedical Research↗
PubMed2005

Improving management of hypertension in general practice: a randomised controlled trial of feedback derived from electronic patient data.

BACKGROUND: Although absolute risk of death associated with raised blood pressure increases with age, the benefits of treatment are greater in older patients. However, fewer patients in this group are identified, treated, and controlled. AIM: To evaluate the impact of the provision of different levels of feedback on identification, treatment, and control of older patients with hypertension. DESIGN OF STUDY: Randomised controlled trial. SETTING: Fifty-two Scottish general practices. METHOD: Practices were randomly allocated to either control (n = 19), audit only feedback (n = 16), or audit plus risk feedback, prioritising patients by absolute risk (n = 17). Electronic data were extracted from practice computer systems annually from 1999 to 2001 and used to develop feedback. Data were collected for 30 345 patients aged 65-79 years. RESULTS: The majority of known patients with hypertension in each group had an initial blood pressure recorded (control = 89.6%; audit = 80.4%; risk = 96.1%) and this increased over the study period (control = 92.3%; audit = 86.0%; risk = 96.6%). Initially, more than 80% of patients in each group were treated but many were uncontrolled (blood pressure >/=160/ >/=90 mmHg) (control = 41.5%; audit = 41.3%; risk = 36.1%). The numbers of untreated and uncontrolled patients in each group reduced (control = 32.3%; audit = 38.3%; risk = 32.6%). There was some evidence of a significant difference in mean systolic pressure between the audit plus risk and audit only groups: (149.6 versus 152.7 mmHg; P = 0.019) and of significantly greater control in the audit plus risk group compared with the other groups 49.4% (versus audit only = 35.4%; versus control = 46.5%; odds ratio = 1.72 [95% confidence interval = 1.09 to 2.70]; P = 0.019). CONCLUSIONS: Levels of identification, treatment, and control improved in each group. Although there were still significant numbers of patients with uncontrolled hypertension, there is some evidence to suggest that providing patient-specific feedback may have a positive impact on identification and management of hypertension in older people and produce an increase in control.

Aged↗
PubMed2004

Intracluster correlation coefficients in cluster randomized trials: empirical insights into how should they be reported.

BACKGROUND: Increasingly, researchers are recognizing that there are many situations where the use of a cluster randomized trial may be more appropriate than an individually randomized trial. Similarly, the need for appropriate standards of reporting of cluster trials is more widely acknowledged. METHODS: In this paper, we describe the results of a survey to inform the appropriate reporting of the intracluster correlation coefficient (ICC)--the statistical measure of the clustering effect associated with a cluster randomized trial. RESULTS: We identified three dimensions that should be considered when reporting an ICC--a description of the dataset (including characteristics of the outcome and the intervention), information on how the ICC was calculated, and information on the precision of the ICC. CONCLUSIONS: This paper demonstrates the development of a framework for the reporting of ICCs. If adopted into routine practice, it has the potential to facilitate the interpretation of the cluster trial being reported and should help the development of new trials in the area.

Cluster Analysis↗
PubMed2004

Is evidence-based implementation of evidence-based care possible?

Traditional approaches to disseminating research findings have failed to achieve optimal healthcare. In a systematic review of 235 studies of guideline dissemination and implementation strategies, we observed the following: there was a median 10% improvement across studies, suggesting that it is possible to change healthcare provider behaviour and improve quality of care; most dissemination and implementation strategies resulted in small to moderate improvements in care; multifaceted interventions did not appear more effective than single interventions. The interpretation of our systematic review is hindered by the lack of a robust theoretical base for understanding healthcare provider and organisational behaviour. Future research is required to develop a better theoretical base and to evaluate further guideline dissemination and implementation strategies.

Australia↗
PubMed2004

Selecting, presenting and delivering clinical guidelines: are there any "magic bullets"?

There are internationally agreed optimal methods for developing clinical practice guidelines. The quality of published guidelines varies. A validated assessment instrument should be used to identify well developed guidelines that can be used with confidence. There are multiple ways of presenting guidelines, including computerised systems. Computerisation of guidelines can cover a range of formats, from brief prompts through to complex decision-support systems. Integrating guidelines into computerised reminder systems has been shown to be effective in improving patient care, but there is less evidence to support the effectiveness of guidelines integrated into computerised decision-support systems.

Australia↗
PubMed2004

Sample size calculator for cluster randomized trials.

Cluster randomized trials, where individuals are randomized in groups are increasingly being used in healthcare evaluation. The adoption of a clustered design has implications for design, conduct and analysis of studies. In particular, standard sample sizes have to be inflated for cluster designs, as outcomes for individuals within clusters may be correlated; inflation can be achieved either by increasing the cluster size or by increasing the number of clusters in the study. A sample size calculator is presented for calculating appropriate sample sizes for cluster trials, whilst allowing the implications of both methods of inflation to be considered.

Algorithms↗
PubMed2004

Simulated patients in the community pharmacy setting. Using simulated patients to measure practice in the community pharmacy setting.

BACKGROUND: Performance measurement and quality of care in community pharmacy settings is problematic because of the lack of formal patient registration and the resultant risk of selection bias. Although simulated patients have been used for teaching and education purposes, particularly in medical settings, their use as a research tool requires exploration in other health settings. The purpose of this paper is to describe how we used simulated patients to measure professional performance of community pharmacy staff. METHOD: Sixty pharmacies participated in a randomised controlled trial (RCT) to evaluate the effectiveness and efficiency of two guideline implementation strategies in the community pharmacy setting. The primary outcome measure for the study was derived from assessment forms completed by simulated patients following covert visits to participating pharmacies. RESULTS: Of the 420 simulated patient visits scheduled, 384 (91%) were completed. Nine visits were reported by pharmacy staff using reply-paid postcards, four of which concurred with known SP visits. Each detected visit was made by a different SP. In a post-intervention survey, 26 (52%) pharmacists stated they had been apprehensive about the use of simulated patients as part of the study, however, 41 (82%) pharmacists agreed that SP visits were an acceptable research method to use in a community pharmacy setting. DISCUSSION: Simulated patients are a feasible method of assessing professional performance in community pharmacy settings and overcome the methodological problems of other measurement methods. Further research is needed to assess the reliability and validity of simulated patients.

Adult↗
PubMed2004

Implementation strategies for a Scottish national epilepsy guideline in primary care: results of the Tayside Implementation of Guidelines in Epilepsy Randomized (TIGER) trial.

PURPOSE: To determine the effectiveness of two dissemination and implementation strategies to implement a national guideline for epilepsy management in primary care settings. METHODS: Three-arm cluster-randomized controlled trial. The participants were general practitioners from 68 practices in Tayside, Scotland, and 1,133 of their patients with self-reported epilepsy treated with antiepileptic medications (AEDs). Practices were randomized blind to a control, intermediate, or intensive intervention. CONTROL: Postal dissemination of a nationally developed clinical guideline. Intermediate intervention: Postal dissemination of the guideline supported by interactive, accredited workshops, and dedicated, structured protocol documents. Intensive intervention: Intermediate intervention plus a nurse specialist who supported and educated practices in the establishment of epilepsy review clinics. The primary outcome was the SF-36 health-related quality-of-life instrument. Secondary measures were a battery of prevalidated epilepsy-specific quality-of-life instruments. These were administered at baseline and after the intervention phase. Process of care was assessed by case-note review on number of review meetings and counseling sessions for epilepsy before and after the interventions. RESULTS: None of the intervention groups showed any change in the primary or secondary outcome measures or process-of-care measures. CONCLUSIONS: None of the intervention strategies led to improvements in patient quality of life or quality of epilepsy care. Further research is needed to discover why the interventions failed, to identify barriers to adoption of guidelines, and to develop strategies that might improve implementation and uptake in the future.

Adult↗
PubMed2004

The impact of guidelines on mild hypertension in pregnancy: time series analysis.

OBJECTIVE: To determine the impact of a national strategy to promote implementation of a guideline on the management of mild, non-proteinuric hypertension in pregnancy. DESIGN: Simple, interrupted time series analysis. SETTING: Four maternity units in Scotland. POPULATION: Women delivering a live or stillborn baby. METHODS: Dissemination of the guideline under the auspices of a national clinical effectiveness programme, supported by a national launch meeting and feedback from a survey of obstetricians highlighting aspects of care that could be improved. MAIN OUTCOME MEASURES: Appropriateness of initial investigation and subsequent clinical management, and costs of guideline development and implementation activities. DATA COLLECTION: Twenty-four months pre-intervention and 12 months post-intervention data were abstracted from a random sample of case notes. RESULTS: Initial investigation was consistent with recommendations for 59.9% out of 1263 women and subsequent clinical management for 67.6% out of 1081 in whom a diagnosis could be made from available data. There were no significant changes in the appropriateness of initial investigation (10.6%; 95% confidence interval [CI] -0.1% to 19.3%; decreasing by 1.2% per month post-implementation, 95% CI -2.5% to 0.1%) or clinical management (-0.3%; 95% CI -8.7% to 11.2%). Guideline development and implementation cost an estimated pound 2784 per maternity unit in Scotland. CONCLUSIONS: Clinical care of mild hypertension in pregnancy remains highly inconsistent. The lack of the intervention effect may be related to the complexity of the guideline recommendations and the nature of the implementation strategy.

Adult↗
PubMed2004

Using electronic patient records to inform strategic decision making in primary care.

Although absolute risk of death associated with raised blood pressure increases with age, the benefits of treatment are greater in elderly patients. Despite this, the 'rule of halves' particularly applies to this group. We conducted a randomised controlled trial to evaluate different levels of feedback designed to improve identification, treatment and control of elderly hypertensives. Fifty-two general practices were randomly allocated to either: Control (n=19), Audit only feedback (n=16) or Audit plus Strategic feedback, prioritising patients by absolute risk (n=17). Feedback was based on electronic data, annually extracted from practice computer systems. Data were collected for 265,572 patients, 30,345 aged 65-79. The proportion of known hypertensives in each group with BP recorded increased over the study period and the numbers of untreated and uncontrolled patients reduced. There was a significant difference in mean systolic pressure between the Audit plus Strategic and Audit only groups and significantly greater control in the Audit plus Strategic group. Providing patient-specific practice feedback can impact on identification and management of hypertension in the elderly and produce a significant increase in control.

Aged↗