title: 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.
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.
authors.affiliation: Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. isayama@air.ocn.ne.jp.|Maternal-Infant Care Research Center, Mount Sinai Hospital, Toronto, ON, Canada. isayama@air.ocn.ne.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Isayama
authors.affiliation: Maternal-Infant Care Research Center, Mount Sinai Hospital, Toronto, ON, Canada. pye@mtsinai.on.ca.
authors.forename: Xiang Y
authors.initials: XY
authors.lastname: Ye
authors.affiliation: Department of Consultation, Kurashiki Clinical Research Institute, Kurashiki, Okayama, Japan. tokumasu.hironobu@kchnet.or.jp.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Tokumasu
authors.affiliation: Division of Pediatrics, Sendai City Hospital, Sendai, Miyagi, Japan. chiba-hir@hospital.city.sendai.jp.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Chiba
authors.affiliation: Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan. mitsuhashi.hideko@twmu.ac.jp.
authors.forename: Hideko
authors.initials: H
authors.lastname: Mitsuhashi
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan. s.shahrook@gmail.com.
authors.forename: Sadequa
authors.initials: S
authors.lastname: Shahrook
authors.affiliation: Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan. kusuda.satoshi@twmu.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kusuda
authors.affiliation: Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan. mfuji@pd.highway.ne.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Fujimura
authors.affiliation: Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan. nqf37179@nifty.com.
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Toyoshima
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan. rintaromori@gmail.com.
authors.forename: Rintaro
authors.initials: R
authors.lastname: Mori
mesh_terms: D004374:Ductus Arteriosus, Patent / Q000601:surgery / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007318:Inservice Training / Q000458:organization & administration*; D007363:Intensive Care Units, Neonatal / Q000592:standards; D007564:Japan; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*