Trial reportCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2013
Effectiveness of disseminating consensus management recommendations for ulcer bleeding: a cluster randomized trial.
Trial report in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 8 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Audit and feedback: effects on professional practice.The Cochrane database of systematic reviews · 2025Pooled it
- Exploring the content and delivery of feedback facilitation co-interventions: a systematic review.Implementation science : IS · 2024Pooled it
- Inappropriate use of clinical practices in Canada: a systematic review.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2022Pooled it
- Manually-generated reminders delivered on paper: effects on professional practice and patient outcomes.The Cochrane database of systematic reviews · 2019Pooled it
- Computer-generated reminders delivered on paper to healthcare professionals: effects on professional practice and healthcare outcomes.The Cochrane database of systematic reviews · 2017Pooled it
- Tailored interventions to address determinants of practice.The Cochrane database of systematic reviews · 2015Pooled it
- Timing of rebleeding in high-risk peptic ulcer bleeding after successful hemostasis: a systematic review.Canadian journal of gastroenterology & hepatology · 2014Pooled it
- The effects of on-screen, point of care computer reminders on processes and outcomes of care.The Cochrane database of systematic reviews · 2009Pooled it
- Expert of Experts Verification and Alignment (EVAL) Framework for Large Language Models Safety in Gastroenterology.NPJ digital medicine · 2025Article
- A Simple Admission Order-set Improves Adherence to Canadian Guidelines for Hospitalized Patients With Severe Ulcerative Colitis.Journal of the Canadian Association of Gastroenterology · 2023Article
- Implementation of effective practices in health facilities: a systematic review of cluster randomised trials.BMJ global health · 2017Article
- Stress-related mucosal disease in the critically ill patient.Nature reviews. Gastroenterology & hepatology · 2015Review
- Adherence to guidelines: a national audit of the management of acute upper gastrointestinal bleeding. The REASON registry.Canadian journal of gastroenterology & hepatology · 2014Article
- Can the presence of endoscopic high-risk stigmata be predicted before endoscopy? A multivariable analysis using the RUGBE database.Canadian journal of gastroenterology & hepatology · 2014Article
- Predictors of early rebleeding after endoscopic therapy in patients with nonvariceal upper gastrointestinal bleeding secondary to high-risk lesions.Canadian journal of gastroenterology = Journal canadien de gastroenterologie · 2013Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 1 institution in 1 country.
Funding
Abstract
backgroundInternational guidelines for the management of nonvariceal upper gastrointestinal bleeding have not been widely adopted in clinical practice. We sought to determine whether a national, multifaceted intervention could improve adherence to guidelines, especially for patients at high risk of nonvariceal upper gastrointestinal bleeding.
methodsIn this randomized trial, we stratified hospitals by region and size and allocated sites to either the control or experimental group. Health care workers in the experimental group were given published guidelines, generic algorithms, stratification scoring systems and written reminders and attended multidisciplinary guideline education groups and case-based workshops. These interventions were implemented over a 12-month period after randomization, with performance feedback and benchmarking. The primary outcome of adherence rates to key guidelines in endoscopic and pharmacologic management, determined by chart review, was adjusted according to site characteristics and possible within-site dependencies. We also report the rates of adherence to other recommendations.
resultsForty-three sites were randomized to the experimental (n=21) or control (n=22) groups. In our primary analysis, we compared patients before (experimental group: n=402 patients; control group: n=424 patients) and after (experimental group: n=361 patients; control group: n=389 patients) intervention. Patient-level analysis revealed no significant difference in adherence rates to the guidelines after the intervention (experimental group: 9.8%; control group: 4.8%; p=0.99) after adjustment for the rate of adherence before the intervention (experimental group: 13.2%; control group: 7.1%). The adherence rates to other guidelines were similar and decreased over time, varying between 5% and 93%.
interpretationThis national knowledge translation-based trial suggests poor adherence to guidelines on nonvariceal upper gastrointestinal bleeding. Adherence was not improved by an educational intervention, which highlights both the complexity and poor predictability of attempting to alter the behaviour of health care providers (Trial registration: ClinicalTrials.gov, no. MCT-88113).
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.