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Background Decision aids arc intended to help people participate in decisions that involve weighing the benefits and harms of treatment options often with scientific uncertainty. Objectives To assess the effects of decision aids for people facing treatment or screening decisions. Search methods For this update, we searched from 2009 to June 2012 in MEDLINE; CENTRAL; EMBASE; PsycINFO; and grey literature. Cumulatively, we have searched each database since its start date including CINAHL (to September 2008).Selection criteria We included published randomized controlled rrials of decision aids, which are interventions designed to support patients' decision making by making explicit the decision, providing information about treatment or screening options and their associated outcomes, compared to usual care and/or alternative interventions. We excluded studies of participants making hypothetical decisions. [ABSTRACT FROM AUTHOR]

Background: Uncertainty exists regarding the best treatment for acute Achilles tendon ruptures. Simultaneous comparison of the multiple treatment options using traditional study designs is problematic; multiarm clinical trials often are logistically constrained to small sample sizes, and traditional meta-analyses are limited to comparisons of only two treatments that have been compared in head-to-head trials. Network meta-analyses allow for simultaneous comparison of all existing treatments utilizing both direct (head-to-head comparison) and indirect (not previously compared head-to-head) evidence.Questions/purposes: We performed a network meta-analysis of randomized controlled trials (RCTs) to answer the following questions: Considering open repair, minimally invasive surgery (MIS) repair, functional rehabilitation, or primary immobilization for acute Achilles tendon ruptures, (1) which intervention is associated with the lowest risk of rerupture? (2) Which intervention is associated with the lowest risk of complications resulting in surgery?Methods: This study was conducted with methods guided by the Cochrane Handbook for Systematic Reviews of Interventions and is reported in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension statement for incorporating network meta-analysis. Five databases and grey literature sources (such as major orthopaedic meeting presentation lists) were searched from inception to September 30, 2019. Included studies were RCTs comparing treatment of acute Achilles tendon ruptures using two or more of the following interventions: primary immobilization, functional rehabilitation, open surgical repair, or MIS repair. We excluded studies enrolling patients with chronic ruptures, reruptures, and preexisting Achilles tendinopathy as well as studies with more than 20% loss to follow-up or less than 6 months of follow-up. Nineteen RCTs (1316 patients) were included in the final analysis. The mean number of patients per study treatment arm was 35 ± 16, mean age was 41 ± 5 years, mean sex composition was 80% ± 10% males, and mean follow-up was 22 ± 12 months. The four treatment groups were compared for the main outcomes of rerupture and complications resulting in operation. The analysis was conducted using random-effects Bayesian network meta-analysis with vague priors. Evidence quality was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation methodology. We found risk of selection, attrition, and reporting bias to be low across treatments, and we found the risk of performance and detection bias to be high. Overall risk of bias between treatments appeared similar.Results: We found that treatment with primary immobilization had a greater risk of rerupture than open surgery (odds ratio 4.06 [95% credible interval {CrI} 1.47 to 11.88]; p < 0.05). There were no other differences between treatments for risk of rerupture. Minimally invasive surgery was ranked first for fewest complications resulting in surgery and was associated with a lower risk of complications resulting in surgery than functional rehabilitation (OR 0.16 [95% CrI 0.02 to 0.90]; p < 0.05), open surgery (OR 0.22 [95% CrI 0.04 to 0.93]; p < 0.05), and primary immobilization (OR < 0.01 [95% CrI < 0.01 to 0.01]; p < 0.05). Risk of complications resulting in surgery was no different between primary immobilization and open surgery (OR 1.46 [95% CrI 0.35 to 5.36]). Data for patient-reported outcome scores and return to activity were inappropriate for pooling secondary to considerable clinical heterogeneity and imprecision associated with small sample sizes.Conclusion: Faced with acute Achilles tendon rupture, patients should be counseled that, based on the best-available evidence, the risk of rerupture likely is no different across contemporary treatments. Considering the possibly lower risk of complications resulting in surgery associated with MIS repair, patients and surgeons must balance any benefit with the potential risks of MIS techniques. As treatments continue to evolve, consistent reporting of validated patient-reported outcome measures is critically important to facilitate analysis with existing RCT evidence. Infrequent but serious complications such as rerupture and deep infection should be further explored to determine whether meaningful differences exist in specific patient populations.Level Of Evidence: Level I, therapeutic study. [ABSTRACT FROM AUTHOR]

Introduction: Train-the-trainer (TTT) programs are frequently used to facilitate knowledge dissemination. However, little is known about the effectiveness of these programs. Therefore, we sought to assess the impact of TTT programs on learning and behavior of trainers for educating health and social professionals (trainees). Methods: Guided by the Cochrane Effective Practice and Organisation of Care, we conducted a systematic review. We searched 12 databases until April 2018 and extracted data according to the Population, Intervention, Comparison, Outcome model. Population was defined as trainers delivering training program to health care professionals, and the intervention consists in any organized activity provided by a trainer. There were no restrictive comparators, and outcomes were knowledge, attitude, skill, confidence, commitment, and behavior of trainers. We estimated the pooled effect size and its 95% confidence interval using a random-effect model. We performed a narrative synthesis when meta-analysis was not possible. Results: Of 11,202 potentially eligible references, we identified 16 unique studies. Studies were mostly controlled before-and-after studies and covered a unique training intervention. Targeted trainers were mostly nurses (n = 10) and physicians (n = 5). The most frequent measured outcome was knowledge (n = 12). TTT programs demonstrated significant effect on knowledge (Standardized mean deviation = 0.58; 95% CI = 0.11-1.06; I2 = 90%; P < .01; 10 studies). No studies measured trainers' ability to deliver the training program. Discussion: TTT programs may improve the knowledge of trainers. However, the heterogeneity and small number of studies hamper our ability to draw conclusions that are more robust. [ABSTRACT FROM AUTHOR]

Objectives: In many jurisdictions, ethical concerns require surrogate humane endpoints to replace death in small animal models of acute lung injury. Heterogenous selection and reporting of surrogate endpoints render interpretation and generalizability of findings between studies difficult. We aimed to establish expert-guided consensus among preclinical scientists and laboratory animal veterinarians on selection and reporting of surrogate endpoints, monitoring of these models, and the use of analgesia.Design: A three-round consensus process, using modified Delphi methodology, with researchers who use small animal models of acute lung injury and laboratory animal veterinarians who provide care for these animals. Statements on the selection and reporting of surrogate endpoints, monitoring, and analgesia were generated through a systematic search of MEDLINE and Embase. Participants were asked to suggest any additional potential statements for evaluation.Setting: A web-based survey of participants representing the two stakeholder groups (researchers, laboratory animal veterinarians). Statements were rated on level of evidence and strength of support by participants. A final face-to-face meeting was then held to discuss results.Subjects: None.Interventions: None.Measurements and Main Results: Forty-two statements were evaluated, and 29 were rated as important, with varying strength of evidence. The majority of evidence was based on rodent models of acute lung injury. Endpoints with strong support and evidence included temperature changes and body weight loss. Behavioral signs and respiratory distress also received support but were associated with lower levels of evidence. Participants strongly agreed that analgesia affects outcomes in these models and that none may be necessary following nonsurgical induction of acute lung injury. Finally, participants strongly supported transparent reporting of surrogate endpoints. A prototype composite score was also developed based on participant feedback.Conclusions: We provide a preliminary framework that researchers and animal welfare committees may adapt for their needs. We have identified knowledge gaps that future research should address. [ABSTRACT FROM AUTHOR]

Shared decision making is now making inroads in health care professionals' continuing education curriculum, but there is no consensus on what core competencies are required by clinicians for effectively involving patients in health-related decisions. Ready-made programs for training clinicians in shared decision making are in high demand, but existing programs vary widely in their theoretical foundations, length, and content. An international, interdisciplinary group of 25 individuals met in 2012 to discuss theoretical approaches to making health-related decisions, compare notes on existing programs, take stock of stakeholders concerns, and deliberate on core competencies. This article summarizes the results of those discussions. Some participants believed that existing models already provide a sufficient conceptual basis for developing and implementing shared decision making competency-based training programs on a wide scale. Others argued that this would be premature as there is still no consensus on the definition of shared decision making or sufficient evidence to recommend specific competencies for implementing shared decision making. However, all participants agreed that there were 2 broad types of competencies that clinicians need for implementing shared decision making: relational competencies and risk communication competencies. Further multidisciplinary research could broaden and deepen our understanding of core competencies for shared decision making training. [ABSTRACT FROM AUTHOR]

The article focuses on a study conducted to evaluate a surgical screening clinic for patients with knee osteoarthritis (OA) referred for total knee arthroplasty (TKA), which found that the number of surgical consultations have been halved through othopedic surgical screening by trained physicians using standardized tools. It is noted that an orthopedic surgical screening was referred to all patients with knee OA.

Knowledge translation (KT) interventions can facilitate the successful implementation of best practices by engaging and actively involving various stakeholders in the change process. However, for novices, the design of KT interventions can be overwhelming. In this article, we describe our experience as participants in a problem-based case study on planning a KT intervention and reflect on the use of problem-based learning (PBL) to develop knowledge and skills relevant to the KT process. Participants were six fellows and two faculty members attending the 2009 Canadian Institutes of Health Research KT Summer Institute. Participants received a case study asking them to develop a KT intervention with the goal of implementing a stroke response protocol for hospital inpatients. The group was given 5 hours spread over 2 days to complete the learning task. As the members of the small group reflected on their experience with the case study, 4 themes emerged: (1) balancing engaging stakeholders with moving forward; (2) exploring the research gaps and role of the Knowledge-to-Action Framework; (3) investigating methodological approaches for KT research; and (4) experiencing a supportive training environment. Participation in the problem-based case study allowed participants to expand their individual understanding of KT, while fostering the learning experiences of other group members. In a supportive learning environment, participants were able to identify influential stakeholders for the stroke response protocol implementation, discuss potential barriers by stakeholder group, and consider effective KT interventions. Future training initiatives focusing on strengthening KT capacity and knowledge should consider using small-group problem-based case study to facilitate learning. [ABSTRACT FROM AUTHOR]