Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 May 8:10:67.
doi: 10.1186/s13012-015-0258-5.

The effect of professional-led guideline workshops on clinical practice for the management of patent ductus arteriosus in preterm neonates in Japan: a controlled before-and-after study

Tetsuya Isayama  1   2 , Xiang Y Ye  3 , Hironobu Tokumasu  4 , Hiroo Chiba  5 , Hideko Mitsuhashi  6 , Sadequa Shahrook  7 , Satoshi Kusuda  8 , Masanori Fujimura  9 , Katsuaki Toyoshima  10 , Rintaro Mori  11 ; Neonatal Research Network of Japan
Affiliations

The effect of professional-led guideline workshops on clinical practice for the management of patent ductus arteriosus in preterm neonates in Japan: a controlled before-and-after study

Tetsuya Isayama et al. Implement Sci. .

Abstract

Background: Clinical guidelines assist physicians to make decisions about suitable healthcare. We conducted a controlled before-and-after study to investigate the impact of professional-led guideline workshops for patent ductus arteriosus (PDA) management on physicians' clinical practices, discharge mortality, and associated morbid conditions among preterm neonates.

Methods: We recruited physicians practicing at two neonatal intensive care units (NICUs) in Japan and used the data of all neonates weighing less than or equal to 1,500 g admitted to 90 NICUs (2 intervention NICUs and 88 control NICUs) in the Neonatal Research Network of Japan from April 2008 to March 2010. We held 1-day workshops for physicians on PDA clinical practice guidelines at the two intervention NICUs. Physicians' skills assessed by confidence rating (CR) scores and the Sheffield Peer Review Assessment Tool (SPRAT) were compared between pre- and post-workshop month at the intervention NICUs using Wilcoxon signed-rank tests. Neonatal discharge mortality and morbidity were compared between pre- and post-workshop year at both the intervention and control NICUs using multivariable regression analyses adjusting for potential confounders.

Results: Fifteen physicians were included in the study. Physicians' CR scores (2.14 vs. 2.47, p = 0.02) and SPRAT (4.14 vs. 4.50, p = 0.05) in PDA management improved after the workshops. The analyses of neonatal outcomes included 294 and 6,234 neonates in the intervention and control NICUs, respectively. Neonates' discharge mortality declined sharply at the intervention NICUs (from 15/146 to 5/148, relative risk reduction -0.67; adjusted odds ratio 0.30, 95% confidence interval 0.10 to 0.89) during the post-workshop period. The mortality reduction was much greater than that in the control NICUs (from 207/3,322 to 147/2,912, relative risk reduction -0.19; adjusted odds ratio 0.75, 95% confidence interval 0.59 to 0.95), although the difference between the intervention and control NICUs were not statistically significant.

Conclusions: Overall, physicians' confidence in PDA management improved after attending guideline workshops. Face-to-face workshops by guideline developers can be a useful strategy to improve physicians' PDA management skills and, thereby, might reduce PDA-associated mortality in preterm neonates.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of the study. Legend: WS: workshop.
Figure 2
Figure 2
Mortality in intervention NICUs and control NICUs before and after the workshop. Legend: VLBW: very low birth weight, WS: workshop, NICUs: neonatal intensive care units.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Clyman RI. Ibuprofen and patent ductus arteriosus. N Engl J Med. 2000;343:728–30. doi: 10.1056/NEJM200009073431009. - DOI - PubMed
    1. The Investigators of the Vermont-Oxford Trials Network Database Project The Vermont-Oxford Trials Network: very low birth weight outcomes for 1990. Investigators of the Vermont-Oxford Trials Network Database Project. Pediatrics. 1993;91:540–5. - PubMed
    1. Noori S, McCoy M, Friedlich P, Bright B, Gottipati V, Seri I, et al. Failure of ductus arteriosus closure is associated with increased mortality in preterm infants. Pediatrics. 2009;123:e138–144. doi: 10.1542/peds.2008-2418. - DOI - PubMed
    1. Brooks JM, Travadi JN, Patole SK, Doherty DA, Simmer K. Is surgical ligation of patent ductus arteriosus necessary? The Western Australian experience of conservative management. Arch Dis Child Fetal Neonatal Ed. 2005;90:F235–239. doi: 10.1136/adc.2004.057638. - DOI - PMC - PubMed
    1. Rojas MA, Gonzalez A, Bancalari E, Claure N, Poole C, Silva-Neto G. Changing trends in the epidemiology and pathogenesis of neonatal chronic lung disease. J Pediatr. 1995;126:605–10. doi: 10.1016/S0022-3476(95)70362-4. - DOI - PubMed

Publication types

MeSH terms

LinkOut - more resources