What Are the Effects of Teaching Evidence-Based Health Care (EBHC)? Overview of Systematic Reviews

Background

An evidence-based approach to health care is recognized internationally as a key competency for healthcare practitioners. This overview systematically evaluated and organized evidence from systematic reviews on teaching evidence-based health care (EBHC).

Methods/Findings

We searched for systematic reviews evaluating interventions for teaching EBHC to health professionals compared to no intervention or different strategies. Outcomes covered EBHC knowledge, skills, attitudes, practices and health outcomes. Comprehensive searches were conducted in April 2013. Two reviewers independently selected eligible reviews, extracted data and evaluated methodological quality. We included 16 systematic reviews, published between 1993 and 2013. There was considerable overlap across reviews. We found that 171 source studies included in the reviews related to 81 separate studies, of which 37 are in more than one review. Studies used various methodologies to evaluate educational interventions of varying content, format and duration in undergraduates, interns, residents and practicing health professionals. The evidence in the reviews showed that multifaceted, clinically integrated interventions, with assessment, led to improvements in knowledge, skills and attitudes. Interventions improved critical appraisal skills and integration of results into decisions, and improved knowledge, skills, attitudes and behaviour amongst practicing health professionals. Considering single interventions, EBHC knowledge and attitude were similar for lecture-based versus online teaching. Journal clubs appeared to increase clinical epidemiology and biostatistics knowledge and reading behavior, but not appraisal skills. EBHC courses improved appraisal skills and knowledge. Amongst practicing health professionals, interactive online courses with guided critical appraisal showed significant increase in knowledge and appraisal skills. A short workshop using problem-based approaches, compared to no intervention, increased knowledge but not appraisal skills.

Conclusions

EBHC teaching and learning strategies should focus on implementing multifaceted, clinically integrated approaches with assessment. Future rigorous research should evaluate minimum components for multifaceted interventions, assessment of medium to long-term outcomes, and implementation of these interventions.

Supported decision making: a review of the international literature

Supported decision making (SDM) refers to the process of supporting people, whose decision making ability may be impaired, to make decisions and so promote autonomy and prevent the need for substitute decision making. There have been developments in SDM but mainly in the areas of intellectual disabilities and end-of-life care rather than in mental health. The main aim of this review was to provide an overview of the available evidence relevant to SDM and so facilitate discussion of how this aspect of law, policy and practice may be further developed in mental health services. The method used for this review was a Rapid Evidence Assessment which involved: developing appropriate search strategies; searching relevant databases and grey literature; then assessing, including and reviewing relevant studies. Included studies were grouped into four main themes: studies reporting stakeholders’ views on SDM; studies identifying barriers to the implementation of SDM; studies highlighting ways to improve implementation; and studies on the impact of SDM. The available evidence on implementation and impact, identified by this review, is limited but there are important rights-based, effectiveness and pragmatic arguments for further developing and researching SDM for people with mental health problems.

Mathematical anxiety is linked to reduced cognitive reflection: A potential road from discomfort in the mathematics classroom to susceptibility to biases

Background
When asked to solve mathematical problems, some people experience anxiety and threat, which can lead to impaired mathematical performance (Curr Dir Psychol Sci 11:181–185, 2002). The present studies investigated the link between mathematical anxiety and performance on the cognitive reflection test (CRT; J Econ Perspect 19:25–42, 2005). The CRT is a measure of a person’s ability to resist intuitive response tendencies, and it correlates strongly with important real-life outcomes, such as time preferences, risk-taking, and rational thinking.

Methods
In Experiments 1 and 2 the relationships between maths anxiety, mathematical knowledge/mathematical achievement, test anxiety and cognitive reflection were analysed using mediation analyses. Experiment 3 included a manipulation of working memory load. The effects of anxiety and working memory load were analysed using ANOVAs.

Results
Our experiments with university students (Experiments 1 and 3) and secondary school students (Experiment 2) demonstrated that mathematical anxiety was a significant predictor of cognitive reflection, even after controlling for the effects of general mathematical knowledge (in Experiment 1), school mathematical achievement (in Experiment 2) and test anxiety (in Experiments 1–3). Furthermore, Experiment 3 showed that mathematical anxiety and burdening working memory resources with a secondary task had similar effects on cognitive reflection.

Conclusions
Given earlier findings that showed a close link between cognitive reflection, unbiased decisions and rationality, our results suggest that mathematical anxiety might be negatively related to individuals’ ability to make advantageous choices and good decisions.

'Sorry I meant the patient's left side': impact of distraction on right/left discrimination

Context Medical students can have difficulty in distinguishing left from right. Many infamous medical errors have occurred when a procedure has been performed on the wrong side, such as in the removal of the wrong kidney. Clinicians encounter many distractions during their work. There is limited information on how these affect performance. 
Objectives Using a neuropsychological paradigm, we aim to elucidate the impacts of different types of distraction on left–right (LR) discrimination ability. 
Methods Medical students were recruited to a study with four arms: (i) control arm (no distraction); (ii) auditory distraction arm (continuous ambient ward noise); (iii) cognitive distraction arm (interruptions with clinical cognitive tasks), and (iv) auditory and cognitive distraction arm. Participants’ LR discrimination ability was measured using the validated Bergen Left–Right Discrimination Test (BLRDT). Multivariate analysis of variance was used to analyse the impacts of the different forms of distraction on participants’ performance on the BLRDT. Additional analyses looked at effects of demographics on performance and correlated participants’ self-perceived LR discrimination ability and their actual performance. 
Results A total of 234 students were recruited. Cognitive distraction had a greater negative impact on BLRDT performance than auditory distraction. Combined auditory and cognitive distraction had a negative impact on performance, but only in the most difficult LR task was this negative impact found to be significantly greater than that of cognitive distraction alone. There was a significant medium-sized correlation between perceived LR discrimination ability and actual overall BLRDT performance. 
Conclusions
Distraction has a significant impact on performance and multifaceted approaches are required to reduce LR errors. Educationally, greater emphasis on the linking of theory and clinical application is required to support patient safety and human factor training in medical school curricula. Distraction has the potential to impair an individual's ability to make accurate LR decisions and students should be trained from undergraduate level to be mindful of this.

The Geography of Revolution: The case of Longford, 1917-1921

Why were some areas of the Ireland more active than others during the War of Independence, and why did the areas of most activity change over the course of the war between 1919 and 1921? In the context of the Irish midlands, County Longford stands out as one of the most violent counties surrounded by areas where there was much less activity by the IRA. Even within the county there was a significant difference in the strength of republican activity between north and south Longford. This article will examine the factors that were responsible for the strength of the IRA campaign in this midland enclave, including socio-economic conditions, administrative decisions and failures, and the contemporary political context.
Much of the evidence upon which the paper is based comes from applications made by Longford Volunteers for military service pensions, granted to veterans of the campaign by the Irish government after 1924. Many of these documents are soon to be released by the Irish government. The paper will also include a discussion of these sources and the way in which they can be used by historians to advance our understanding of Ireland’s revolutionary decade.

Solving Limited Memory Influence Diagrams

We present a new algorithm for exactly solving decision making problems represented as influence diagrams. We do not require the usual assumptions of no forgetting and regularity; this allows us to solve problems with simultaneous decisions and limited information. The algorithm is empirically shown to outperform a state-of-the-art algorithm on randomly generated problems of up to 150 variables and 10^64 solutions. We show that these problems are NP-hard even if the underlying graph structure of the problem has low treewidth and the variables take on a bounded number of states, and that they admit no provably good approximation if variables can take on an arbitrary number of states.

Solving Limited Memory Influence Diagrams

We present a new algorithm for exactly solving decision making problems represented as influence diagrams. We do not require the usual assumptions of no forgetting and regularity; this allows us to solve problems with simultaneous decisions and limited information. The algorithm is empirically shown to outperform a state-of-the-art algorithm on randomly generated problems of up to 150 variables and 10^64 solutions. We show that the problem is NP-hard even if the underlying graph structure of the problem has small treewidth and the variables take on a bounded number of states, but that a fully polynomial time approximation scheme exists for these cases. Moreover, we show that the bound on the number of states is a necessary condition for any efficient approximation scheme.

Making randomised trials more efficient: report of the first meeting to discuss the Trial Forge platform

Randomised trials are at the heart of evidence-based healthcare, but the methods and infrastructure for conducting these sometimes complex studies are largely evidence free. Trial Forge (www.trialforge.org) is an initiative that aims to increase the evidence base for trial decision making and, in doing so, to improve trial efficiency.

This paper summarises a one-day workshop held in Edinburgh on 10 July 2014 to discuss Trial Forge and how to advance this initiative. We first outline the problem of inefficiency in randomised trials and go on to describe Trial Forge. We present participants' views on the processes in the life of a randomised trial that should be covered by Trial Forge.

General support existed at the workshop for the Trial Forge approach to increase the evidence base for making randomised trial decisions and for improving trial efficiency. Agreed upon key processes included choosing the right research question; logistical planning for delivery, training of staff, recruitment, and retention; data management and dissemination; and close down. The process of linking to existing initiatives where possible was considered crucial. Trial Forge will not be a guideline or a checklist but a 'go to' website for research on randomised trials methods, with a linked programme of applied methodology research, coupled to an effective evidence-dissemination process. Moreover, it will support an informal network of interested trialists who meet virtually (online) and occasionally in person to build capacity and knowledge in the design and conduct of efficient randomised trials.

Some of the resources invested in randomised trials are wasted because of limited evidence upon which to base many aspects of design, conduct, analysis, and reporting of clinical trials. Trial Forge will help to address this lack of evidence.

Quantifying consumer portion control practices. A cross-sectional study

The use of portion control practices has rarely been quantified. The present study aimed to: (1) explore which portion control practices are actually used by the general population and their association with cognitive restraint, demographic background and general health interest (GHI), and (2) examine how the usage of portion control practices predicts the estimated consumption of an energy dense food (i.e. pizza). Twenty-two portion control practices were rated in terms of their frequency of use from 'never' to 'very often' by a representative sample of 1012 consumers from the island of Ireland. Three factors were extracted and named: measurement-strategy scale, eating-strategy scale, and purchasing-strategy scale. The eating-strategy scale score was the highest, while the measurement-strategy scale carried the lowest frequency score. For each strategy scale score, the strongest predictor was GHI, followed by gender. Having higher GHI and being female were independently associated with more frequent portion control. Both the eating-strategy scale score and the purchasing-strategy scale score were negatively associated with pizza portion size consumption estimates. In conclusion, while this study demonstrates that the reported use of portion control practices is low, the findings provide preliminary evidence for their validity. Further studies are needed to explore how portion control practices are used in different kinds of portion size decisions and what their contribution is to the intake of food over an extended period of time.

Escola e diversidade: os desafios da diversidade cultural na gestão do currículo : alunos imigrantes nas escolas do 1º ciclo do ensino básico de Abrantes: um estudo de caso

Partindo do objeto de estudo: a gestão do currículo para a diversidade cultural é nossa intenção compreender a forma como o discurso do multiculturalismo se encontra presente nos principais documentos definidores de uma política de escola e na postura desta e dos professores, através das decisões e práticas adotadas perante uma realidade diversificada, na presença de culturas de imigrantes. A construção do saber e a análise que fazemos da forma como o currículo é gerido, seguiram um percurso assente num quadro teórico nos campos curricular e da educação intercultural, bem como nas opções metodológicas em que o estudo assenta, e às quais recorremos para a realização da componente empírica. Nesta, analisamos a forma como as escolas-alvo de estudo e os professores respondem à presença dos alunos imigrantes através das representações dos próprios alunos, seus professores e responsáveis pelas escolas; ou seja, analisamos a forma como é gerido o currículo para a diversidade cultural. /ABSTRACT - Taking the subject under study: curricular management for cultural diversity, as our starting point, our aim is to gain an understanding of the nature of multiculturalism as portrayed in the main documents that define school policy as well as in the position taken both by the school and the teachers, in the light of the decisions and practices adopted in the presence of a culturally diverse reality, immigrant cultures. The construction of a body of knowledge and the assessment we make of how the curriculum is managed, has been based on a theoretical framework in the areas of intercultural curricula and education, as well as on the choice of methodology for the study used in carrying out the empirical component In the latter, We have analysed the way in which the schools and the teachers under study responded to the presence of immigrant pupils, seen in the descriptions given by the pupils themselves, their teachers and those responsible for the schools, that is to say, we have analysed the way in which the curriculum for cultural diversity has been managed.

The economic effects of common agricultural policy on Mediterranean montado/dehesa ecosystem

The decoupling of CAP payments leads production decisions and resources allocation to be more dependent on market prices and competitive advantages. The objective of this paper is to assess the effects of CAP trends on the montado/dehesa traditional ecosystem of Mediterranean regions in terms of farm income, land, labour and capital. A positive mathematical supply model disaggregated by the montado agro-forestry production systems of the Alentejo region in southern Portugal is developed. The results show that decoupling payments of CAP have negative economic effects on agricultural activities and resource use. Agricultural income increases with single farm payments but the foreseen increases in prices do not compensate the loss of the Agenda 2000 area payments in terms of competitiveness. These results reinforce the need to promote alternative agricultural and non-agricultural activities and policies in Mediterranean rural European areas and regions. (C) 2011 Society for Policy Modeling. Published by Elsevier Inc. All rights reserved.

A definição de mercados relevantes no direito europeu e português da concorrência : teoria e prática

Tese de doutoramento, Direito (Ciências Jurídico-Económicas), Universidade de Lisboa, Faculdade de Direito, 2014

Autoridade e autonomia : conjugalidade e vidas femininas em Essaouira, Marrocos

Tese de doutoramento, Antropologia (Antropologia do Parentesco e do Género), Universidade de Lisboa, Instituto de Ciências Sociais, 2015

Que futuro nestas ruas cheias de memórias? : a identidade histórica do espaço urbano no crescimento europeu 2020 : o caso de estudo da vila de Sesimbra

Tese de doutoramento, História (Arte, Património e Restauro), Universidade de Lisboa, Faculdade de Letras, 2016

Responsabilidade ambiental: análise das divulgações ambientais das empresas do PSI-20 comparativamente com empresas não cotadas

Orientador: Mestre, António Pinto Marques