PubMed · 11718190
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2001. Liposuction.. https://pubmed.ncbi.nlm.nih.gov/11718190/
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OBJECTIVE: To determine whether preoperative assessments carried out by appropriately trained nurses are inferior in quality to those carried out by preregistration house officers. DESIGN: Randomised controlled equivalence/non-inferiority trial. SETTING: Four NHS hospitals in three trusts. Three of the four were teaching hospitals. PARTICIPANTS: All patients attending for assessment before general anaesthesia for general, vascular, urological, or breast surgery between April 1998 and March 1999. INTERVENTION: Assessment by one of three appropriately trained nurses or by one of several preregistration house officers. MAIN OUTCOME MEASURES: History taken, physical examination, and investigations ordered. Measures evaluated by a specialist registrar in anaesthetics and placed in four categories: correct, overassessment, underassessment not affecting management, and underassessment possibly affecting management (primary outcome). RESULTS: 1907 patients were randomised, and 1874 completed the study; 926 were assessed by house officers and 948 by nurses. Overall 121/948 (13%) assessments carried out by nurses were judged to have possibly affected management compared with 138/926 (15%) of those performed by house officers. Nurses were judged to be non-inferior to house officers in assessment, although there was variation among them in terms of the quality of history taking. The house officers ordered considerably more unnecessary tests than the nurses (218/926 (24%) v 129/948 (14%). CONCLUSIONS: There is no reason to inhibit the development of nurse led preoperative assessment provided that the nurses involved receive adequate training. However, house officers will continue to require experience in preoperative assessment.
OBJECTIVE: To develop and validate an instrument for measuring knowledge and skills in evidence based medicine and to investigate whether short courses in evidence based medicine lead to a meaningful increase in knowledge and skills. DESIGN: Development and validation of an assessment instrument and before and after study. SETTING: Various postgraduate short courses in evidence based medicine in Germany. PARTICIPANTS: The instrument was validated with experts in evidence based medicine, postgraduate doctors, and medical students. The effect of courses was assessed by postgraduate doctors from medical and surgical backgrounds. INTERVENTION: Intensive 3 day courses in evidence based medicine delivered through tutor facilitated small groups. MAIN OUTCOME MEASURE: Increase in knowledge and skills. RESULTS: The questionnaire distinguished reliably between groups with different expertise in evidence based medicine. Experts attained a threefold higher average score than students. Postgraduates who had not attended a course performed better than students but significantly worse than experts. Knowledge and skills in evidence based medicine increased after the course by 57% (mean score before course 6.3 (SD 2.9) v 9.9 (SD 2.8), P<0.001). No difference was found among experts or students in absence of an intervention. CONCLUSIONS: The instrument reliably assessed knowledge and skills in evidence based medicine. An intensive 3 day course in evidence based medicine led to a significant increase in knowledge and skills.