Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests

Patey, Andrea M.; Islam, Rafat; Francis, Jill J; Bryson, Gregory L.; Grimshaw, Jeremy

doi:10.1186/1748-5908-7-52

Cited by 192 publications

(209 citation statements)

References 36 publications

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“…This sample size is in line with previous studies that have used the TDF to explore barriers and facilitators to other behaviors (e.g., [20,21]) and consistent with conventions of sampling in qualitative methods. [22,23] The majority of nonusers were male (76.9%) while most adopters were female (69.2%), with respective mean ages of 49 and 53 years old.…”

Section: Participantssupporting

confidence: 70%

Exploring end user adoption and maintenance of a telephone-based physical activity counseling service for individuals with physical disabilities using the Theoretical Domains Framework

Tomasone

Arbour-Nicitopoulos

Pila

et al. 2016

Disability and Rehabilitation

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The findings provide strategies to improve recruitment, adoption, and retention of clients in counseling services and to enhance the experiences of targeted service users. Implications for Rehabiliation Peer support and education for equipment use should be built into physical activity programs to encourage participation among persons with physical disabilities. Programs that encourage physical activity among individuals with disabilities should be designed by practitioners to be responsive to a variety of needs, which are addressed in the program's advertisements and offerings. The Theoretical Domains Framework is a useful framework for providing valuable insight about clients' experiences of adoption and maintenance of a behavior change service, suggesting merit in other rehabilitation settings.

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Section: Participantssupporting

confidence: 70%

Exploring end user adoption and maintenance of a telephone-based physical activity counseling service for individuals with physical disabilities using the Theoretical Domains Framework

Tomasone

Arbour-Nicitopoulos

Pila

et al. 2016

Disability and Rehabilitation

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“…This may be related to the conflicting recommendations for antiviral use appearing in the literature after SBPS, especially in relation to severe cases 33–35. These uncertainties make recommendations less likely to be adopted 10. Relatively few studies have attempted to evaluate the impact of clinical trials on clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Impact of clinical trial findings on Bell's palsy management in general practice in the UK 2001–2012: interrupted time series regression analysis

et al. 2013

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ObjectivesTo measure the incidence of Bell's palsy and determine the impact of clinical trial findings on Bell's palsy management in the UK.DesignInterrupted time series regression analysis and incidence measures.SettingGeneral practices in the UK contributing to the Clinical Practice Research Datalink (CPRD).ParticipantsPatients ≥16 years with a diagnosis of Bell's palsy between 2001 and 2012.Interventions(1) Publication of the 2004 Cochrane reviews of clinical trials on corticosteroids and antivirals for Bell's palsy, which made no clear recommendation on their use and (2) publication of the 2007 Scottish Bell's Palsy Study (SBPS), which made a clear recommendation that treatment with prednisolone alone improves chances for complete recovery.Main outcome measuresIncidence of Bell's palsy per 100 000 person-years. Changes in the management of Bell's palsy with either prednisolone therapy, antiviral therapy, combination therapy (prednisolone with antiviral therapy) or untreated cases.ResultsDuring the 12-year period, 14 460 cases of Bell's palsy were identified with an overall incidence of 37.7/100 000 person-years. The 2004 Cochrane reviews were associated with immediate falls in prednisolone therapy (−6.3% (−11.0 to −1.6)), rising trends in combination therapy (1.1% per quarter (0.5 to 1.7)) and falling trends for untreated cases (−0.8% per quarter (−1.4 to −0.3)). SBPS was associated with immediate increases in prednisolone therapy (5.1% (0.9 to 9.3)) and rising trends in prednisolone therapy (0.7% per quarter (0.4 to 1.2)); falling trends in combination therapy (−1.7% per quarter (−2.2 to −1.3)); and rising trends for untreated cases (1.2% per quarter (0.8 to 1.6)). Despite improvements, 44% still remain untreated.ConclusionsSBPS was clearly associated with change in management, but a significant proportion of patients failed to receive effective treatment, which cannot be fully explained. Clarity and uncertainty in clinical trial recommendations may change clinical practice. However, better ways are needed to understand and circumvent barriers in implementing clinical trial findings.

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“…Both anaesthesiologists and surgeons are equally guilty when it comes to the ordering of "routine testing". Anaesthesiologists often, but not inevitably, will check the results of the tests that they order; however it is the experience of many that surgeons rarely check the results or respond to abnormal results of the tests that they order [16].…”

Section: Discussionmentioning

confidence: 99%

“…The preoperative history and physical examination should be the determinants of any testing applicable to each particular patient. Indeed, the ordering of non-demonstrablynecessary tests as a routine is not appropriate [16].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Laboratory Testing in Patients Undergoing Elective Surgery: An Analysis of Practice at Komofo Anokye Teaching Hospital

Antwi-Kusi¹

2017

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Abstract:Background: Perioperative laboratory investigations should be obtained for specific indications based on the patient history, physical examination, co morbidities and the type of surgery. A test is likely to be indicated only if it can correctly identify abnormalities and will change the diagnosis, the management plan, or the patient's outcome. Routine laboratory investigation before surgery is rampant. It seldom however changes the anaesthetic care plan or influence outcome. This research sought to find out the practice of preoperative laboratory testing at the Komfo Anokye Teaching Hospital (K. A. T. H). Methodology: This was a prospective, cross sectional study of patients undergoing elective surgery at K. A. T. H from 1 st to 31 st March 2014. A quantitative technique was used to effectively quantify laboratory results that were contained in a patient's folder before an elective surgical procedure. Close and open ended questionnaire was developed and answered by reviewing patient's folders during the pre-anaesthesia assessment. Data were analyzed using Statistical Package of Social Sciences (SSPS) version 22. Results: The average age of patients studied was 50 years. Complete blood count (CBC) is the most ordered laboratory investigation at KATH (98.8%). Every patient had at least four (4) laboratory investigations done. At the time of preoperative assessment by the anaesthetist, laboratory investigations had already been ordered by the surgical team in almost all the patients studied (98.8%). The anaesthetists ordered investigations in only 1.2% of the patients. When tests ordered were compared to the Canadian Anesthesiology Society (CAS) guidelines, it was found that 54.4% of renal function test ordered had no indication, as was the case with serum electrolytes 40.4%, coagulation studies 39.9% and complete blood count 23.9%. Conclusion: A lot of laboratory investigations requested for patients undergoing surgery at K. A. T. H have no clinical indication. Members of the surgical team are responsible for ordering the laboratory investigations. Complete blood count is the most frequently ordered investigation.

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Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests

Cited by 192 publications

References 36 publications

Exploring end user adoption and maintenance of a telephone-based physical activity counseling service for individuals with physical disabilities using the Theoretical Domains Framework

Exploring end user adoption and maintenance of a telephone-based physical activity counseling service for individuals with physical disabilities using the Theoretical Domains Framework

Impact of clinical trial findings on Bell's palsy management in general practice in the UK 2001–2012: interrupted time series regression analysis

Preoperative Laboratory Testing in Patients Undergoing Elective Surgery: An Analysis of Practice at Komofo Anokye Teaching Hospital

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