Episiotomy to prevent obstetric anal sphincter injuries during instrumental delivery in nulliparous women: a national prospective comparative cohort study.

Background: We are lacking data with a high level of evidence on the use of episiotomy during instrumental delivery to prevent anal sphincter injury, which nonetheless presents the highest risk.

Objective: Our main objective was to assess the protective effect of episiotomy against obstetric anal sphincter injury in nulliparous women during instrumental delivery according to type of instrument. We also investigated its impact on immediate maternal and neonatal morbidity.

The impact of integrated disease management in high-risk COPD patients in primary care.

Patients with chronic obstructive pulmonary disease (COPD) have a reduced quality of life (QoL) and exacerbations that drive health service utilization (HSU). A majority of patients with COPD are managed in primary care. Our objective was to evaluate an integrated disease management, self-management, and structured follow-up intervention (IDM) for high-risk patients with COPD in primary care.

Guideline uptake is influenced by six implementability domains for creating and communicating guidelines: a realist review.

Objectives: To identify factors associated with the implementability of clinical practice guidelines (CPGs) and to determine what characteristics improve their uptake.

Study Design And Setting: We conducted a realist review, which involved searching multiple sources (eg, databases, experts) to determine what about guideline implementability works, for whom, and under what circumstances. Two sets of reviewers independently screened abstracts and extracted data from 278 included studies.

Making sense of complex data: a mapping process for analyzing findings of a realist review on guideline implementability.

Background: Realist reviews offer a rigorous method to analyze heterogeneous data emerging from multiple disciplines as a means to develop new concepts, understand the relationships between them, and identify the evidentiary base underpinning them. However, emerging synthesis methods such as the Realist Review are not well operationalized and may be difficult for the novice researcher to grasp. The objective of this paper is to describe the development of an analytic process to organize and synthesize data from a realist review.

E-learning interventions are comparable to user's manual in a randomized trial of training strategies for the AGREE II.

Background: Practice guidelines (PGs) are systematically developed statements intended to assist in patient and practitioner decisions. The AGREE II is the revised tool for PG development, reporting, and evaluation, comprised of 23 items, two global rating scores, and a new User's Manual. In this study, we sought to develop, execute, and evaluate the impact of two internet interventions designed to accelerate the capacity of stakeholders to use the AGREE II.