Educational strategies for teaching evidence-based practice to undergraduate health students: systematic review / 보건의료교육평가

PURPOSE: The aim of this systematic review was to find best teaching strategies for teaching evidence-based practice (EBP) to undergraduate health students that have been adopted over the last years in healthcare institutions worldwide. METHODS: The authors carried out a systematic, comprehensive bibliographic search using Medline database for the years 2005 to March 2015 (updated in March 2016). Search terms used were chosen from the USNLM Institutes of Health list of MeSH (Medical Subject Headings) and free text key terms were used as well. Selected articles were measured based on the inclusion criteria of this study and initially compared in terms of titles or abstracts. Finally, articles relevant to the subject of this review were retrieved in full text. Critical appraisal was done to determine the effects of strategy of teaching evidence-based medicine (EBM). RESULTS: Twenty articles were included in the review. The majority of the studies sampled medical students (n=13) and only few conducted among nursing (n=2), pharmacy (n=2), physiotherapy/therapy (n=1), dentistry (n=1), or mixed disciplines (n=1) students. Studies evaluated a variety of educational interventions of varying duration, frequency and format (lectures, tutorials, workshops, conferences, journal clubs, and online sessions), or combination of these to teach EBP. We categorized interventions into single interventions covering a workshop, conference, lecture, journal club, or e-learning and multifaceted interventions where a combination of strategies had been assessed. Seven studies reported an overall increase to all EBP domains indicating a higher EBP competence and two studies focused on the searching databases skill. CONCLUSION: Followings were deduced from above analysis: multifaceted approach may be best suited when teaching EBM to health students; the use of technology to promote EBP through mobile devices, simulation, and the web is on the rise; and the duration of the interventions varying form some hours to even months was not related to the students' EBP competence.

Incidence and predictors of readmission to the cardiac surgery intensive care unit: a retrospective cohort study in Greece

Readmission in the intensive care unit [CU] is a significant morbidity index, which has been related to poor patient outcomes. To identify the preoperative and intraoperative risk factors for readmission in the cardiac surgery ICU. We conducted a retrospective cohort study of 595 consecutive patients who were admitted to the cardiac surgery ICU of a tertiary hospital of Athens - Greece during the one-year period [September 2011-September 2012]. Data collection was carried out, retrospectively, by the use of a short questionnaire and based on the review of medical and nursing patient records at December 2012. The incidence of ICU readmission was 3.7% [22/595]. Respiratory disorders were the main reason for readmission [45.4%]. Readmitted patients had a significantly higher in-hospital mortality compared to those requiring no readmission [P< 0.001]. Multivariate analysis revealed that female gender [for males odds ratio [OR] 0.37, 95% confidence interval [Cl] 0.15-0.89], high logistic EuroSCORE [OR 1.02, 95% Cl 1.00-1.04], prolonged cardiopulmonary [CPB] duration [OR 1.01, 95% Cl 1.00-1.02] and preoperative renal failure [OR 1.02, 95% Cl 1.00-1.05] were the independent risk factors for readmission to the cardiac surgery ICU. One intraoperative and three preoperative variables are associated strongly with higher probability for ICU readmission. Shorter CPB duration could contribute to lower ICU readmission incidence. In addition, the early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both the more efficient healthcare planning and resources allocation