Publications by authors named "Sandra E Zwolsman"

17 Publications

  • Page 1 of 1

The effects of oestrogen on vaginal wound healing: A systematic review and meta-analysis.

Neurourol Urodyn 2021 Oct 13. Epub 2021 Oct 13.

Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC-Location AMC, University of Amsterdam, Amsterdam, The Netherlands.

Aims: To determine the effects of oestrogen or oestrogen deprivation on vaginal wound healing. Impaired wound healing following prolapse surgery may increase the risk of recurrent prolapse in the future. Vaginal oestrogen therapy may improve wound healing, hereby possibly improving surgical outcomes.

Methods: A systematic search of OVID MEDLINE, OVID Embase, and Web of Science was conducted up to January 28, 2020. We included original studies comparing wound healing-related outcomes of oestrogen exposed subjects (female animals and women) to hypo-oestrogenic subjects after vaginal surgery. Data on wound healing-related outcome measures were extracted. For each individual comparison, the standardised mean difference (Hedges' g; SMD) and 95% confidence interval (CI) were calculated.

Results: Of the 1474 studies reviewed, 14 studies were included for review, and 11 provided data for meta-analysis. Oestrogen improves neovascularisation (SMD: 1.13, 95% CI: 0.67-1.60), microscopic wound closure (SMD: 0.98, 95% CI: 0.66-1.29), collagen synthesis (SMD: 1.08, 95% CI: 0.42-1.74), and tissue strength (SMD: 1.26, 95% CI: 0.53-1.99) in animals. Oestrogen increases granulation (SMD: 1.67, 95% CI: 0.54-2.79) and accelerates macroscopic wound closure (SMD: 1.82, 95% CI: 1.22-2.42) in women and animals. Oestrogen decreases the inflammatory response (SMD: -0.58, 95% CI: -1.14 to -0.02) in women and animals and reduces levels of transforming growth factor (TGF)-β1 (SMD: -1.68, 95% CI: -2.52 to -0.83) in animals. All results were statistically significant.

Conclusions: Oestrogen therapy has a positive effect on vaginal wound healing. Future studies should determine whether oestrogen therapy has the potential to improve surgical outcomes.
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http://dx.doi.org/10.1002/nau.24819DOI Listing
October 2021

Efficacy of surgical revision of mesh complications in prolapse and urinary incontinence surgery.

Int Urogynecol J 2021 Aug 9;32(8):2257-2264. Epub 2020 Oct 9.

Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, Room H4-262, PO Box 22660, 1100, DD, Amsterdam, The Netherlands.

Introduction And Hypothesis: Women with mesh-related complications in prolapse (POP) and stress-urinary incontinence (SUI) surgery may benefit from operative mesh resection to alleviate symptoms. We hypothesized that mesh resection would alleviate symptoms and aimed to evaluate risks and benefits in these women.

Methods: We carried out a cross-sectional study. Primary outcome was improvement specified as better, unchanged or worsened symptoms after mesh revision surgery. Secondary outcomes were health-related quality of life (HrQol) scores of validated questionnaires, surgical characteristics and physical findings at follow-up visits. Descriptive data were reported with mean and medians. Associations were calculated with Spearman correlation coefficient and chi-square test to determine statistical differences between groups.

Results: Fifty-nine women who underwent mesh revision surgery between 2009 and 2016 were included. After a median follow-up of 1.7 (IQR: 1.1-2.4) years, 44 women (75%) reported improvement of symptoms. No significant surgical or patient characteristics were identified that could differentiate which patients did or did not experience cure or complications.A trend was observed to better HrQol scores in women who reported overall improvement after mesh revision surgery. Seventeen (29%) women needed a subsequent operation after mesh removal.

Conclusions: This cross-sectional study shows that mesh revision surgery alleviates symptoms in 75% of women with mesh-related complications. Type of revision surgery and individual characteristics did not seem to matter to the individual chance of cure or complications. These data can facilitate the counseling of women considering mesh revision surgery.
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http://dx.doi.org/10.1007/s00192-020-04543-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8346427PMC
August 2021

Patients' satisfaction and safety of bulk injection therapy Urolastic for treatment of stress urinary incontinence: A cross-sectional study.

Neurourol Urodyn 2020 08 11;39(6):1753-1763. Epub 2020 Jun 11.

Department of Urology, Langeland Hospital, Zoetermeer, The Netherlands.

Aims: Primary outcome was to evaluate patients' satisfaction after being treated with bulk injection therapy polydimethylsiloxane Urolastic (PDMS-U) for stress urinary incontinence (SUI). Secondary outcomes were: subjective cure, objective cure, severity of SUI symptoms, complications, reintervention rate, and disease-specific quality of life. Furthermore, to determine if outcomes worsened during time-after-treatment (time-frames: 0-12, 13-24, and ≥25 months).

Methods: In a cross-sectional design, patients treated with PDMS-U were recruited for hospital revisit. The primary outcome, patients' satisfaction, was assessed by the surgical satisfaction questionnaire. Subjective cure, objective cure, and severity of symptoms were assessed by the patients global impression of improvement, standardized cough stress test, and Sandvik severity scale, respectively. Medical charts and face-to-face interviews were used to determine complications and reinterventions.

Results: About 110 patients participated, 87 revisited the hospital. Median follow-up was 25 months (interquartile range: 14;35 months). Patients' satisfaction rate was 51%. Subjective and objective cure were respectively 46% and 47%. Most prevalent complications were: urinary retention (22%), pain (15%), and dyspareunia (15%). Exposure and erosion occurred in 7% and 5%, respectively. Reintervention rate of reinjection and excision of bulk material was 6% and 18.0%, respectively. Objective cure significantly worsened during time-after-treatment (P = < .05).

Conclusions: About half of the patients being treated with PDMS-U were satisfied and subjectively cured 2 years after treatment, although the majority still experienced symptoms of SUI. Most complications were mild and transient, however, in 18% excision of bulk material was indicated for severe or persistent complications such as pain, exposure, or erosion.
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http://dx.doi.org/10.1002/nau.24417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7497040PMC
August 2020

Validation of noninvasive focal depth measurements to determine epithelial thickness of the vaginal wall.

Menopause 2019 10;26(10):1160-1165

Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Objective: This study investigates whether noninvasive focal depth (FD) measurements correlate with vaginal wall epithelial thickness (ET). If FD accurately reflects ET of the vaginal wall, this would allow noninvasive longitudinal assessment of (newly developed) treatment modalities aiming to increase ET, without the need for invasive biopsies.

Methods: Fourteen women, median age 62 years (inter quartile ranges: 57-65), undergoing vaginal prolapse surgery because of anterior and/or posterior compartment pelvic organ prolapse were included. We used the CytoCam, a handheld video microscope based on incident dark field imaging, and performed FD measurements of the vaginal wall before surgery. Histology was performed on tissue that was removed during the surgical procedure, and ET was measured in stained sections. We compared ET with FD interindividually, and determined the expected linear correlation and agreement between the two measurements.

Results: Seventeen ET measurements (mean 125 μm ± 38.7, range 48-181 μm) were compared with 17 FD measurements (mean 128 μm ± 34.3, range 68-182 μm). The lineair correlation between the two measurements was strong (r = 0.902, P < 0.01). Bland-Altman analysis demonstrated a mean difference of 13.5 μm when comparing ET to FD.

Conclusions: The results demonstrate good agreement between ET and FD measurements. We consider the mean difference demonstrated with Bland-Altman analysis acceptable for these measurements. This suggests that FD accurately reflects ET, which further supports the use of FD to measure ET of the vaginal wall. For a complete assessment of the vaginal wall, FD measurements are preferably combined with the assessment of vaginal angioarchitecture.
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http://dx.doi.org/10.1097/GME.0000000000001369DOI Listing
October 2019

How cure rates drive patients' preference for urethral bulking agent or mid-urethral sling surgery as therapy for stress urinary incontinence.

Neurourol Urodyn 2019 06 15;38(5):1384-1391. Epub 2019 Apr 15.

Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Aims: To assess the patients' median-accepted threshold of cure rate for urethral bulking agent (UBA) treatment compared to mid-urethral sling (MUS) surgery for treatment of female stress urinary incontinence (SUI). Secondly, to determine the correlation between treatment trade-off point and patient characteristics.

Methods: Women older than 18 years, with predominant SUI, seeking treatment, underwent a structured interview. The treatment trade-off point was determined in scenario one: UBA vs transobturator standard MUS surgery (SMUS) performed under general/spinal anesthesia with one-night hospital stay, and scenario 2: UBA compared to single-incision MUS surgery (SIMS) performed under local analgesia (with sedation) in a daycare setting. The treatment trade-off point was assessed by decreasing the cure rate of UBA from 85% to 10% with steps of 2% until the patient's treatment preference switched to SMUS/SIMS.

Results: One hundred and five patients were interviewed. Mean age was 52 years (SD, ±13.4). The median trade-off point for scenarios 1 and 2 was 79% (interquartile range [IQR]: 69, 85) and 85% (IQR: 71, 85), respectively. Patients with longer duration of SUI symptoms were willing to trade more efficacy to prefer UBA treatment.

Conclusions: Patients with SUI are willing to trade a lower cure rate to prefer UBA over SMUS to avoid hospitalization and general anesthesia. When SIMS is performed in a daycare setting under local analgesia, the majority of patients with SUI are of the opinion that cure rates of UBA should be at least as high as SIMS to be worth considering. The treatment preference is not strongly correlated with the patients' characteristics.
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http://dx.doi.org/10.1002/nau.23997DOI Listing
June 2019

Stress urinary incontinence after vaginal prolapse repair: development and internal validation of a prediction model with and without the stress test.

Neurourol Urodyn 2019 04 7;38(4):1086-1092. Epub 2019 Mar 7.

Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

Objective: To develop a prediction model for stress urinary incontinence (SUI) after vaginal prolapse repair (postoperative stress urinary incontinence [POSUI]) and assess the value of a preoperative stress test.

Patients And Methods: Secondary analysis of two trials in which women were randomised for prolapse repair with or without a midurethral sling (MUS). The trials included women with (CUPIDO-1, n = 134) and without (CUPIDO-2, n = 225) coexisting SUI. POSUI was defined as bothersome SUI one year after surgery and/or treatment of SUI in the first postoperative year. Logistic regression analysis was used to define a reference model, which was extended with the preoperative stress test. The stress test was performed with and without reduction of the prolapse. Missing values were imputed 20 times, with bootstrap resampling for internal validation of discriminatory ability.

Results: Three hundred fifty-six women could be included. POSUI occurred in 17% of the women (n = 61). The reference model included age (<55 years), point Ba of the pelvic organ prolapse quantification system (<-1), vaginal parity (≤3), subjective urinary incontinence, and MUS. The stress test had an odds ratio of 2.4 (95% confidence interval [CI], 1.2-4.6) in the extended model, which increased the optimism-corrected area under the receiver-operating curve from 0.74 to 0.76. The stress test was especially valuable in women with a 10% to 30% POSUI risk, where a stress test substantially impacted the POSUI risk. In more than 50% of the women, the stress test had no additional value in predicting POSUI.

Conclusion: A preoperative stress test is not valuable for women at low risk of SUI after vaginal prolapse repair.
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http://dx.doi.org/10.1002/nau.23958DOI Listing
April 2019

Patient Preferences and Experiences in Hyperemesis Gravidarum Treatment: A Qualitative Study.

J Pregnancy 2018 30;2018:5378502. Epub 2018 Oct 30.

Department of Obstetrics and Gynaecology, University Medical Centers Amsterdam, University of Amsterdam, Amsterdam, Netherlands.

Introduction: Hyperemesis gravidarum (HG) medical therapies are currently of limited effect, which creates a larger role for patient preferences in the way HG care is arranged. This is the first study using in-depth interviews to investigate patients' preferences and experiences of HG treatment.

Materials And Methods: We conducted individual in-depth interviews among women who had been hospitalized for HG in North Holland at least once in the past 4 years. We asked them about their experiences, preferences, and suggestions for improvement regarding the HG treatment they received. The sample size was determined by reaching data saturation. Themes were identified from analysis of the interview transcripts.

Results And Discussion: 13 women were interviewed. Interviewees emphasized the importance of early recognition of the severity of HG, increasing caregivers' knowledge on HG, early medical intervention, and nasogastric tube feeding. They valued a single room in hospital, discussion of treatment options, more possibilities of home-treatment, psychological support during HG and after childbirth, and more uniform information and policies regarding HG treatment.

Conclusion: Further research is needed to establish whether the suggestions can lead to more (cost) effective care and improve the course of HG and outcomes for HG patients and their children.
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http://dx.doi.org/10.1155/2018/5378502DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234451PMC
April 2019

Patients' perspectives on urethral bulk injection therapy and mid-urethral sling surgery for stress urinary incontinence.

Int Urogynecol J 2018 09 19;29(9):1249-1257. Epub 2018 Apr 19.

Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.

Introduction And Hypothesis: The aim of this study was to identify all treatment decision factors that determined the preference for peri-urethral bulk injection therapy (PBI) or mid-urethral sling (MUS) surgery in patients with primary stress urinary incontinence (SUI). Second, we explored what patients expect from treatment for SUI and whether patients would consider PBI as a primary treatment option.

Methods: In a qualitative design, 20 semi-structured, face-to-face interviews were conducted in women with primary SUI. Exclusion criteria were: previous PBI or MUS surgery; predominating urgency. Interviews were guided by three open-ended questions and a topic list. PBI treatment and MUS surgery were described in detail, and the efficacy was stated as 70% and 90%, respectively. Data saturation was reached when no new treatment decision factors were identified in three consecutive interviews. Interviews were audiotaped and fully transcribed. Thematic analysis by a coding process was done independently by two researchers.

Results: Sixteen procedural, personal, professional, social and external treatment decision factors were identified. Regarding expectations about treatment for SUI, women believed 'becoming dry' was wishful thinking. The majority of patients accepted a small degree of persistent urinary incontinence after treatment. Regardless of their treatment preference, patients indicated that women should be informed about PBI as a primary treatment option.

Conclusion: Patients with primary SUI are open to PBI as an alternative treatment option even with lower cure rates compared with MUS surgery performed under general or spinal anesthesia. Patients indicated that women with primary SUI seeking treatment should be informed about PBI as a treatment option.
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http://dx.doi.org/10.1007/s00192-018-3644-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132683PMC
September 2018

The predictive value of demonstrable stress incontinence during basic office evaluation and urodynamics in women without symptomatic urinary incontinence undergoing vaginal prolapse surgery.

Neurourol Urodyn 2018 03 23;37(3):1011-1018. Epub 2017 Aug 23.

Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Aims: Women with pelvic organ prolapse without symptoms of urinary incontinence (UI) might demonstrate stress urinary incontinence (SUI) with or without prolapse reduction. We aimed to determine the value of demonstrable SUI during basic office evaluation or urodynamics in predicting SUI after vaginal prolapse repair in these women.

Methods: Women included in the CUPIDO trials without bothersome UI or UI more than once a week were eligible if they had undergone prolapse repair without incontinence surgery. The diagnostic and predictive value of demonstrable SUI was studied for postoperative SUI (POSUI). POSUI was defined as bothersome SUI at 1-year follow-up or treatment for SUI in the first postoperative year.

Results: In 45% (77/173) of the included women urodynamics was performed. In 19% (32/172) SUI was demonstrated with basic office evaluation, against 29% (22/77) with urodynamics. Nine percent (16/172) developed POSUI, six women underwent surgery for de novo SUI. Women with demonstrable SUI were more at risk to face POSUI: twenty-eight percent versus five percent (Diagnostic Odds Ratio: 7; 95%CI 3-22). Urodynamics predicted one more woman having POSUI, but all women who underwent treatment for de novo SUI showed SUI during basic office evaluation. Test performance did not improved with the adding of urodynamics.

Conclusions: The predictive value of demonstrable SUI in symptomatically continent women undergoing vaginal prolapse repair is limited. Urodynamics added no value. The twenty-eight percent POSUI risk must be balanced against the increased complication risk if a prophylactic midurethral sling is considered.
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http://dx.doi.org/10.1002/nau.23384DOI Listing
March 2018

A randomized, nonblinded extension study of single-incision versus transobturator midurethral sling in women with stress urinary incontinence.

Int Urogynecol J 2018 Jan 2;29(1):37-44. Epub 2017 Jun 2.

Department of Obstetrics and Gynecology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.

Introduction And Hypothesis: Midurethral sling procedures are the first surgical option in women undergoing surgery for stress urinary incontinence (SUI). Single-incision midurethral-slings (SIMS) were designed to provide similar efficacy to traditional midurethral slings but with reduced morbidity. In this international trial we compared the efficacy of a SIMS (MiniArc) and a transobturator standard midurethral sling (SMUS; Monarc) in the treatment of SUI in terms of subjective and objective cure rates and morbidity over a long-term follow-up.

Methods: This was a randomized controlled nonblinded extended trial with a follow-up period of 36 months. Women with symptomatic SUI were eligible. The primary outcome was subjective cure, defined as an improvement in the Patient Global Impression of Improvement (PGI-I) score. Secondary outcomes were objective cure (negative cough stress test), disease-specific quality of life, surgical parameters and morbidity. An intention to treat analysis was performed. Differences in dichotomous variables were tested using the chi-squared test. Differences in continuous variables were tested using Student's t test or the Mann-Whitney U test. We hypothesized that MiniArc would be noninferior to Monarc concerning subjective cure.

Results: We randomized 97 women to the MiniArc group and 96 to the Monarc group. The attrition rate was 23% in the MiniArc group and 22% in the Monarc group after 3 years. At 36 months, the subjective cure rates were 86% in the MiniArc group and 87% in the Monarc group (risk difference -0.6%, 95% CI -12 to 11%). The objective cure rates were 89% and 88%, respectively (risk difference 1.3%, 95% CI -9 to 11%). Both procedures were associated with low complication rates.

Conclusions: After a follow-up of 36 months, MiniArc (SIMS) is non-inferior to Monarc (SMUS) with respect to subjective and objective cure.
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http://dx.doi.org/10.1007/s00192-017-3362-zDOI Listing
January 2018

Results of an innovative bulking agent in patients with stress urinary incontinence who are not optimal candidates for mid-urethral sling surgery.

Neurourol Urodyn 2018 01 28;37(1):339-345. Epub 2017 Apr 28.

Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.

Aims: To assess the efficacy and safety of peri-urethral bulking injections (PBI) with an innovative bulking material (PDMS-U) in women with stress-urinary incontinence (SUI) who are not optimal candidates for mid-urethral sling surgery.

Methods: A prospective study was performed in women with SUI who, for several reasons, have a relative contraindication for a mid-urethral sling procedure. These reasons include: (i) recurrent SUI after a prior SUI surgical procedure; (ii) a history of oncologic gynaecological surgery; (iii) a history of neurologic disease resulting in voiding problems; (iv) a maximal flow rate of less than 15 mL per second or; (v) women with a contraindication for surgery with general or regional anaesthesia. All women were treated with PBI consisting of PDMS-U, a bulking agent that polymerizes in situ. The primary outcome was subjective improvement, defined as "a little better" to "very much better" on the PGI-I. Secondary outcomes included objective cure, disease specific quality of life and adverse events.

Results: Subjective improvement was reported by 18 (90%) of the 20 included patients. The subjective cure rate was 56% and the objective cure rate was 65%. There was a statistically significant improvement of all domain scores of the UDI-6, IIQ-7, and PISQ-12 at 6 months follow up. Abnormal post voiding residual volume (>150 mL) was the most common adverse event (40%), but persisted in only one patient, based on the patient's preference for a catheter.

Conclusions: PBI with PDMS-U is a viable treatment option in women with a relative contra-indication for mid-urethral sling surgery.
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http://dx.doi.org/10.1002/nau.23299DOI Listing
January 2018

Observations of evidence-based medicine in general practice.

Perspect Med Educ 2013 Sep;2(4):196-208

Department of General Practice/Family Medicine Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.

No objective measures are available for assessing the practice of evidence-based medicine (EBM) in general practitioner (GP) trainees, as there is no description of the EBM behaviour that is expected from trainees. As a first step to do so, we aimed to identify which expressions of EBM (defined as the integration of evidence, clinical experience and patient situation) can be observed in daily GP practice. Secondly, we aimed to identify which considerations GPs had regarding EBM but did not share with the patient during consultations. We performed a qualitative study, in which GPs were observed during and interviewed after clinical consultations, with a focus on expressions and considerations related to EBM during clinical decision-making. We observed 147 consultations by 34 GPs (17 trainers and 17 trainees). EBM behaviour was rarely visible in GPs' decision-making. When interviewing the GPs, we found that aspects of EBM that played a role in decision-making were not discussed with the patient. Explicit consideration of all aspects of EBM would make EBM measurable and GPs more aware of the foundations of their decisions. EBM behaviour is difficult to observe during GP consultations and therefore cannot be assessed through observations alone.
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http://dx.doi.org/10.1007/s40037-013-0078-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792233PMC
September 2013

Barriers to the use of evidence-based medicine: knowledge and skills, attitude, and external factors.

Perspect Med Educ 2013 Feb;2(1):4-13

Department of General Practice, Academic Medical Center, PO Box 22700, 1100, DE, Amsterdam, the Netherlands,

Although efforts are made to integrate evidence-based medicine (EBM) into clinical practice, physicians experience significant barriers to its implementation. The aim of this study is to quantify the barriers that general practice (GP) trainees experience when using EBM in practice. In September 2008, a questionnaire was administered to 140 GP trainees from three Dutch GP Speciality Training Institutes. The questionnaire focused on barriers that GP trainees meet when using EBM in practice. Factor analysis identified components in which barriers exist, and the validity and reliability of the questionnaire were established. After removing four items that did not fit the questionnaire structure, factor analysis identified three relevant components. All three components had similar mean scores, indicating a similar negative influence of these components on the practice of EBM: knowledge/skills (α = 0.72, mean score 2.9 ± 0.8), attitude (α = 0.70, mean score 2.9 ± 0.6), and external factors (α = 0.66, mean score 3.0 ± 0.5). The barrier that trainees experienced most was lack of time to practise EBM. Barriers to the use of EBM were present in three components: knowledge/skills, attitude, and external factors.
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http://dx.doi.org/10.1007/s40037-013-0039-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576485PMC
February 2013

Tools to assess evidence-based practice behaviour among healthcare professionals.

Evid Based Med 2013 Aug 24;18(4):129-38. Epub 2013 Jan 24.

Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.

Objective: To identify and compare tools to assess Evidence-Based Practice (EBP) behaviour among healthcare professionals.

Design: Systematic review.

Data Sources: MEDLINE, EMBASE, Cochrane Library, PsychInfo and CINAHL up to July 2011.

Study Selection: Titles, abstracts and eligible full text articles were screened by two reviewers independently.

Data Extraction: Relevant data were extracted by one reviewer and checked by a second reviewer.

Eligibility Criteria For Selecting Studies: original studies among all healthcare professionals that described the development or use of EBP behaviour assessment tools.

Results: Of 19 310 identified articles, 172 studies were included. We identified 117 questionnaires, 10 interviews or focus groups, nine observational studies, 27 chart evaluations and nine studies used a combination of methods. Psychometric properties of the questionnaires used were reported in about half of the studies, in seven studies that assess a single EBM step and in six studies that assess a combination of EBM steps. One of these assessed all five steps of EBP.

Conclusions: Valid and reliable EBP behaviour assessment tools are available. However, only one questionnaire validly assessed all five EBP steps, covering the entire concept of EBP.
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http://dx.doi.org/10.1136/eb-2012-100969DOI Listing
August 2013

How learning style affects evidence-based medicine: a survey study.

BMC Med Educ 2011 Oct 8;11:81. Epub 2011 Oct 8.

Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, the Netherlands.

Background: Learning styles determine how people manage new information. Evidence-based medicine (EBM) involves the management of information in clinical practice. As a consequence, the way in which a person uses EBM can be related to his or her learning style. In order to tailor EBM education to the individual learner, this study aims to determine whether there is a relationship between an individual's learning style and EBM competence (knowledge/skills, attitude, behaviour).

Methods: In 2008, we conducted a survey among 140 novice GP trainees in order to assess their EBM competence and learning styles (Accommodator, Diverger, Assimilator, Converger, or mixed learning style).

Results: The trainees' EBM knowledge/skills (scale 0-15; mean 6.8; 95%CI 6.4-7.2) were adequate and their attitudes towards EBM (scale 0-100; mean 63; 95%CI 61.3-64.3) were positive. We found no relationship between their knowledge/skills or attitudes and their learning styles (p = 0.21; p = 0.19). Of the trainees, 40% used guidelines to answer clinical questions and 55% agreed that the use of guidelines is the most appropriate way of applying EBM in general practice. Trainees preferred using evidence from summaries to using evidence from single studies. There were no differences in medical decision-making or in EBM use (p = 0.59) for the various learning styles. However, we did find a link between having an Accommodating or Converging learning style and making greater use of intuition. Moreover, trainees with different learning styles expressed different ideas about the optimal use of EBM in primary care.

Conclusions: We found that EBM knowledge/skills and EBM attitudes did not differ with respect to the learning styles of GP trainees. However, we did find differences relating to the use of intuition and the trainees' ideas regarding the use of evidence in decision-making.
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http://dx.doi.org/10.1186/1472-6920-11-81DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3207915PMC
October 2011

Sicily statement on classification and development of evidence-based practice learning assessment tools.

BMC Med Educ 2011 Oct 5;11:78. Epub 2011 Oct 5.

Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.

Background: Teaching the steps of evidence-based practice (EBP) has become standard curriculum for health professions at both student and professional levels. Determining the best methods for evaluating EBP learning is hampered by a dearth of valid and practical assessment tools and by the absence of guidelines for classifying the purpose of those that exist. Conceived and developed by delegates of the Fifth International Conference of Evidence-Based Health Care Teachers and Developers, the aim of this statement is to provide guidance for purposeful classification and development of tools to assess EBP learning.

Discussion: This paper identifies key principles for designing EBP learning assessment tools, recommends a common taxonomy for new and existing tools, and presents the Classification Rubric for EBP Assessment Tools in Education (CREATE) framework for classifying such tools. Recommendations are provided for developers of EBP learning assessments and priorities are suggested for the types of assessments that are needed. Examples place existing EBP assessments into the CREATE framework to demonstrate how a common taxonomy might facilitate purposeful development and use of EBP learning assessment tools.

Summary: The widespread adoption of EBP into professional education requires valid and reliable measures of learning. Limited tools exist with established psychometrics. This international consensus statement strives to provide direction for developers of new EBP learning assessment tools and a framework for classifying the purposes of such tools.
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http://dx.doi.org/10.1186/1472-6920-11-78DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221624PMC
October 2011
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