Barriers and facilitators to answering clinical questions in the Americas: a cross-sectional study of surgical trauma care providers.
Barriers and facilitators to answering clinical questions in the Americas: a cross-sectional study of surgical trauma care providers.
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DOI：
10.1136/tsaco-2021-000774
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发表时间：
2021
影响因子：
2
通讯作者：
LaGrone L
中科院分区：
文献类型：
--
作者：
Noble HE;Vega Rivera F;LaGrone L
我们的目的是了解美洲的外科创伤提供者如何获得临床问题的答案，以及他们在根据常见手术病例的建议进行实践时面临的障碍和促进因素。我们假设，提高英语水平和国家收入改善供应商的收购和临床知识的应用。一项包含23个问题的调查评估了报告对证据解释的信心、感知的语言流畅性以及获得和应用有关败血症和阑尾炎的建议。向泛美创伤协会成员分发了美洲各地的电子调查表。来自21个国家的108名参与者完成了这项调查。59%有≥21年的供应商经验。38%的人报告他们的英语阅读理解能力低于或等于“有限的工作熟练程度”。44%的人支持使用谷歌翻译; 35%的人表示他们不需要翻译工具来评估医学文献。59%的人至少每周对临床护理感到不确定。65%的人报告每月至少一次无法回答临床问题。86%的人对自己解释和应用证据的能力充满信心。为了回答临床问题，参与者列出指南（76%），全文同行评审期刊文章（61%）和荟萃分析（49%）作为他们最常用的资源。25%的人正确回答了所有五个临床问题，而43%的人正确回答了三个或更少。79%的人认为他们有足够的资源来回答这五个临床问题。当控制个人人口统计学特征时，年龄的降低（p<0.01）和国家收入水平的提高（p=0.03）对问题的正确答案产生了积极影响。在临床护理中不可避免的。语言、年龄和国家收入水平影响提供者获取和应用与选定临床场景相关的知识。这些发现突出了在获取和培训方面的差距，并增加了改善循证手术实践传播和实施方法的紧迫性。四.
We aimed to understand how surgical trauma providers in the Americas acquire answers to clinical questions and what barriers and facilitators they face in efforts to practice according to recommendations for common surgical cases. We hypothesized that increased English proficiency and country income improved providers’ acquisition and application of clinical knowledge. A 23-question survey evaluated reported confidence in interpretation of evidence, perceived language fluency, and access to and application of recommendations on sepsis and appendicitis. Electronic surveys were distributed across the Americas to Pan American Trauma Society members. 108 participants from 21 countries completed this survey. 59% had ≥21 years of provider experience. 38% reported their English reading comprehension as less than or equal to “limited working proficiency.” 44% endorsed using Google Translate; 35% reported they did not need translation tools to evaluate medical literature. 59% felt uncertainty regarding clinical care at least weekly. 65% reported inability to answer their clinical questions at least once per month. 86% felt confident in their ability to interpret and apply evidence for their practice. To answer clinical questions, participants listed guidelines (76%), full-text peer-reviewed journal articles (61%), and meta-analyses (49%) as their most used resources. 25% answered all five clinical questions correctly, whereas 43% answered three or fewer correctly. 79% felt they had adequate access to resources to answer the five clinical questions. When controlling for individual demographic characteristics, decreased age (p<0.01) and increased country income level (p=0.03) positively impacted correct answers to questions. Uncertainties in clinical care are unavoidable. Language, age, and country income level impacted provider acquisition and application of knowledge relevant to select clinical scenarios. These findings highlight disparities in access and training and add urgency to the movement for improved dissemination and implementation approaches for evidence-based practice in surgery. IV.